Physical examination maneuver

Physical Exam

Tandem Gait

also known as Heel-to-toe walking
🎬
Video coming September 2026

How to Perform

Ask the patient to walk heel-to-toe in a straight line for several steps, placing the heel of each foot directly in front of the toes of the other. Watch for stepping off the line, side-stepping, or loss of balance.

How to Interpret

Showing 4 of 8 findings

Atypical Parkinsonism

Inability to complete 10 consecutive tandem steps without a sidestep (ten-steps test)
Rule in
HelpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Limited
Unable to tandem walk in a patient with parkinsonism
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited

Parkinson Disease

Able to tandem walk in a patient with parkinsonism
Rule in
Somewhat helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Limited

Vestibular Dysfunction

Tandem gait abnormal
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited

References

  • Stolze H, Klebe S, Petersen G, Raethjen J, Wenzelburger R, Witt K, Deuschl G. Typical features of cerebellar ataxic gait. J Neurol Neurosurg Psychiatry. 2002;73(3):310-312. doi:10.1136/jnnp.73.3.310. PMID: 12185166.
  • Yoo D, Kang KC, Lee JH, Lee KY, Hwang IU. Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy. Sci Rep. 2021;11(1):17212. doi:10.1038/s41598-021-96725-6. PMID: 34446786.
  • Stuster J. Validation of the standardized field sobriety test battery at 0.08% blood alcohol concentration. Hum Factors. 2006;48(3):608-614. doi:10.1518/001872006778606895.
  • Cohen HS, Stitz J, Sangi-Haghpeykar H, Williams SP, Mulavara AP, Peters BT, Bloomberg JJ. Tandem walking as a quick screening test for vestibular disorders. Laryngoscope. 2018;128(7):1687-1691. doi:10.1002/lary.27022. PMID: 29226324.
  • Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-M94. PMID: 8126356.
  • Borm CDJM, Krismer F, Wenning GK, et al. Axial motor clues to identify atypical parkinsonism: a multicentre European cohort study. Parkinsonism Relat Disord. 2018;56:33-40. doi:10.1016/j.parkreldis.2018.06.015. PMID: 29910157.
  • Abdo WF, Borm GF, Munneke M, Verbeek MM, Esselink RAJ, Bloem BR. Ten steps to identify atypical parkinsonism. J Neurol Neurosurg Psychiatry. 2006;77(12):1367-1369. PMID: 16847047. PMCID: PMC2077404.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.

Related Systems / Regions

Neurological

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