Gait Evaluation Checklist (circle findings)
Head Tilt (Straight, Lean Right, Lean Left)
Shoulder Drop
Asymmetrical Arm Swing
Dominance to One Side
Trunk Mobility (Limited, Normal, Excessive)
Hip Hike (Right or Left)
Belt Line (Higher Right or Left)
Hip Rotation (limited, normal, excessive)
Excessive Shock (Right or Left or Both)
Limited Knee Rotation (Right—straight vs external, Left—straight vs external)
Excessive Internal Knee Rotation (Right or Left or Both)
Heel Motion at Heel Contact (Right—eversion, none, inversion, Left—eversion, none, inversion)
Symmetry of Arch Collapse (Right more vs Left more)
Digital Clawing (Right or Left or Both)
Angle of Gait (Right—internal, straight, external, Left—internal, straight, external)
Other Structural Variations: Pes Cavus, Pes Planus, Tibial Varum, Genu Valgum, etc
Correlation to Symptoms: _____________________________________________________________________________________________________________________________________________________________________________________________
Other Observations: ______________________________________________________________________________________________________________________________________________
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