The Elephant is Walking Differently: Where Should the Investigation Begin?

When an elephant begins walking differently, the first challenge is not necessarily to identify the disease. 

It is to localise the problem. 

An altered gait may reflect pathology involving the foot, joints, bones, soft tissues or the wider musculoskeletal system. In a species where subtle locomotor changes can be difficult to quantify, a structured examination becomes particularly important. 

Start with the gait—not the presumed lesion 

The first assessment should establish what has actually changed. 

Look for: 

• Altered stride; 
• Reduced weight-bearing; 
• Changes in stance duration; 
• Reluctance to turn; 
• Asymmetry between limbs; 
• Changes in walking speed; 
• Progression over time. 

A newly published 2026 study used inertial measurement units (IMUs) to characterise gait in clinically sound Asian elephants and descriptively compare them with four elephants showing clinically abnormal gait. The study identified case-specific changes in stance allocation and bilateral vertical movement similarity^[1]. Importantly, the authors did not establish diagnostic thresholds and concluded that larger datasets are required before these parameters can be used as validated clinical cut-offs^[1]. 

For now, objective gait technology is therefore best viewed as a complement to clinical examination, not a substitute for it. 

Do not assume the foot is the whole problem 

External foot examination is essential, but it may not explain the entire clinical picture. 

CT evaluation of 52 elephant feet identified bone remodelling, enthesopathy, osteoarthritis, cyst-like lesions and other skeletal abnormalities^[2]. However, the same study also identified anatomical variations in phalanges and sesamoid bones that could potentially be mistaken for pathological lesions^[2]. 

This creates an important radiological principle: 

An imaging abnormality is not automatically the cause of the gait abnormality. 

The finding must be assessed against its location, severity, laterality and clinical relevance. 

Review the environment as part of the investigation 

A chronic gait abnormality also warrants review of the elephant’s management environment. 

Research in zoo elephants found associations between housing factors, including time spent on hard substrates, and foot and musculoskeletal conditions^[3]. Because this was an observational study in North American zoos, it cannot establish that hard substrate alone caused disease. However, it supports including substrate, space and activity in the history of an elephant with chronic locomotor problems^[3]. 

Use serial assessment 

A subtle gait abnormality can be easier to interpret when documented repeatedly. 

Consistent observations of walking, turning, standing and weight-bearing can help establish whether a finding is: 

• Transient; 
• Persistent; 
• Progressive; 
• Associated with a particular activity. 

If clinical findings and external foot examination do not adequately explain the gait abnormality, imaging can then be selected according to the suspected anatomical location. 

Clinical takeaway 

The investigation of altered gait should move from observation to localisation, then to targeted examination and imaging. 

New technologies such as IMUs may improve objective monitoring, but current evidence supports their complementary use rather than treating them as stand-alone diagnostic tools.

Reference:

1. Khammesri S, Wantanajittikul K, Namwongprom K, Kittisirikul N, Thitaram C, Thitaram N, Brown JL and Kongsawasdi S (2026) Inertial measurement unit–based characterization of gait patterns in Asian elephants: clinically sound elephants and elephants with gait abnormalities. Front. Vet. Sci. 13:1888434. https://doi.org/10.3389/fvets.2026.1888434
2. Regnault S, Dixon JJ, Warren-Smith C, Hutchinson JR, Weller R. Skeletal pathology and variable anatomy in elephant feet assessed using computed tomography. PeerJ. 2017;5:e2877. Published 2017 Jan 18. https://doi.org/10.7717/peerj.2877
3. Miller MA, Hogan JN, Meehan CL. Housing and demographic risk factors impacting foot and musculoskeletal health in African elephants [Loxodonta africana] and Asian elephants [Elephas maximus] in North American zoos. PLoS One. 2016 Jul 14;11(7):e0155223. https://doi.org/10.1371/journal.pone.0155223
4. Weisbrod TC, Isaza R, Cray C, Adler L, Stacy NI. The importance of manual white blood cell differential counts and platelet estimates in elephant hematology: blood film review is essential. Vet Q. 2021;41(1):30-35. https://doi.org/10.1080/01652176.2020.1867329