Problems with gait or difficulty in walking are among the most common mobility limitations associated with multiple sclerosis. Likewise, gait and/or balance problems are classic signs of Parkinson’s disease, which is why an estimated 38% of Parkinson’s sufferers experience falls routinely.
In addition to neurologic or neuromuscular disorders, gait disturbances may be associated with orthopedic conditions, inflammatory conditions of the joints (i.e., arthritic changes), or other abnormalities. Most often they are the result of some physical malfunction and may be a consequence of one or more of the following diseases or conditions:
- Vestibular (balance) disorders.
- Central nervous system disorders such as multiple sclerosis and cerebral palsy.
- Spinal cord abnormalities, including disease, trauma, and degeneration.
- Peripheral nerve diseases.
- Degenerative muscle diseases such as muscular dystrophy, myotonic dystrophy and myositis.
- Neurodegenerative disorders such as Parkinson’s disease.
- Skeletal abnormalities and disease.
- Foot conditions such as plantar warts, bunions, ingrown toenails, and pressure ulcers.
- Toxic reactions to alcohol, drugs, or allergens.
Gait Disorders: Symptoms
Gait abnormalities have very distinctive features and are often named to reflect the prominent characteristics of the walk:
- Propulsive: the posture is hunched over and rigid with the head and neck bent forward.
- Scissors: the legs flex slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissor-like movement.
- Spastic: the legs are stiff and the feet drag.
- Steppage: the toes scrape the ground while walking.
- Waddling: the gait is duck-like.
Gait Disorders: Diagnosis
A person’s manner of walking or gait can reveal disturbances involving motor, sensory, visual, vestibular, cerebellar, cognitive, psychological and musculoskeletal systems. For example, people in the later stages of Alzheimer’s often have “reduced gait,” meaning their ability to lift their feet as they walk has diminished.
Your doctor will review your medical history and perform a complete physical and neurological examination that will include an evaluation of your gait. He or she may ask you to walk in a corridor or climb stairs to observe specific features of your walk including:
- Stance, posture, and base (wide or narrow).
- Gait initiation (including start hesitation or freezing).
- Walking speed, stride length, step height, foot clearance.
- Continuity, symmetry, trunk sway, path deviation, arm swing.
- Involuntary movements (e.g., tremor, chorea, dystonia).
- Ability to turn.
- Ability to walk on heels and toes and squat.
- Ability to rise from a chair (without using the arms).
Some doctors will time their patient’s walking pace and even videotape their gait so that they can monitor changes over time.
The need for diagnostic tests will be determined by the results of the physical examination and your doctor’s observation of any gait abnormalities.
Gait Disorders: Treatment
Treatment of the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.
Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate. A cane or a walker is recommended for those with poor balance. Some Parkinson’s patients are advised to wear bowling shoes with upturned toes to reduce scuffing and stumbling. Physical therapy can be a very effective treatment to improve gait and balance in Parkinson’s Disease.
Gait Disorders: Resources
American Neurological Association
5841 Cedar Lake Road
Minneapolis, MN 55416