Marche à petits pas
Formal Definition
Marche à petits pas (French for "gait with small steps") — a clinical gait abnormality characterized by short, shuffling, hesitant steps taken at a markedly reduced stride length, with decreased arm swing, often accompanied by a stooped posture, hesitant start (start hesitation), and possibly festination (involuntary acceleration); most classically associated with normal-pressure hydrocephalus (NPH) but also seen in frontal gait disorders, Parkinson's disease (in a milder form), vascular dementia, and other frontal-subcortical pathologies.
How It's Used on the Ward
"Marche à petits pas" or "magnetic gait" — when a patient walks as if their feet are stuck to the floor, taking tiny shuffling steps, often with difficulty initiating gait but then improving slightly with repetition; the classic triad of NPH (wet, wacky, wobbly) is gait disturbance (often marche à petits pas first), urinary incontinence, and dementia.
Example
""78-year-old retired engineer presenting with 18 months of progressive gait difficulty and 6 months of new urinary incontinence. Family reports recent short-term memory decline. Exam: short shuffling steps, hesitant gait initiation, no arm swing, mild stooped posture, slow turn. After repeated practice, gait marginally improves (no festination). MMSE 24/30 (normal-pressure hydrocephalus cognitive pattern). MRI brain: ventriculomegaly out of proportion to cortical atrophy. Large-volume LP (Miller-Fisher / Tap test): gait and cognition improved markedly for 24 hours. Diagnosis: normal-pressure hydrocephalus (NPH) with classic marche à petits pas. Referred to neurosurgery for ventriculoperitoneal shunt evaluation.""
Clinical Context
Normal-pressure hydrocephalus (NPH) classic triad ("wet, wacky, wobbly"): gait disturbance (often the first symptom, classically marche à petits pas), urinary incontinence, and cognitive impairment (often subcortical/frontal pattern). Gait improvement after large-volume LP (tap test) predicts shunt responsiveness. Pathophysiology: communicating hydrocephalus with normal opening pressure; ventricular enlargement compresses periventricular white matter tracts, particularly affecting frontal gait control circuits. Differential: Parkinson's disease (gait is festinating rather than short-stepped, with more rigidity and tremor; responds to levodopa), vascular dementia with frontal involvement, frontal lobe tumor (mass effect), cervical myelopathy (leg spasticity, not shuffling), peripheral neuropathy. Workup: brain imaging (MRI preferred for vascular assessment), formal gait assessment, cognitive testing (MMSE, MoCA), urologic evaluation if incontinence present. Treatment: ventriculoperitoneal shunt (VP shunt) — gait improves most reliably, cognition less so. Counter-concept: "wide-based ataxic gait" (cerebellar), "steppage gait" (foot drop), "antalgic gait" (limp from pain) — distinct pattern, distinct localization.