Gait Deviations

Original Editor - Lucinda hampton

Top Contributors - DeVonya Brown, Tony Varela, Nupur Smit Shah, Lucinda hampton, Kim Jackson, Mei Toone, Olajumoke Ogunleye, Lilian Ashraf, Cindy John-Chu, Jose Alvarado, Rucha Gadgil, Aminat Abolade and Alexander Dettmers  

Introduction

Gait disturbances are described as any deviations from normal walking or gait. These disturbances stem from numerous etiologies. Due to their different clinical presentations, a high index of suspicion is required. The etiology can be determined through lab work, clinical presentation, and diagnostic testing. Furthermore, this entity can be subdivided into episodic and chronic disturbances. Gait disturbances have a tremendous impact on patients, especially on the quality of life, morbidity, and mortality.

Causes of walking/gait disorders can range from arthritis to a neurological condition to something as simple as ill-fitting footwear. The variety of gait disorders call for different treatments.

Etiology:

The causes of gait disorders include neurological conditions (e.g. sensory or motor impairments), orthopedic problems (e.g. osteoarthritis and skeletal deformities) and medical conditions (e.g. heart failure, respiratory insufficiency, peripheral arterial occlusive disease and obesity).

• In older age, gait disorders typically have several causes, which may include impaired proprioceptive function in polyneuropathy, poor vision, frontal gait disorder associated with vascular encephalopathy and osteoarthritis of the hips or knees.
• If a gait disorder has an acute onset, cerebrovascular, spinal and neuromuscular causes should be considered, as should adverse drug effects and psychiatric disorders.

Some common causes are:

• A degenerative disease (such as arthritis)
• An inner ear disorder
• Stroke
• Foot conditions
• A neurologic condition
• Something as simple as ill-fitting shoes

What are some types of gait disorders?

The following gait disorders are so distinctive as to earn names:

• Propulsive gait. This type of gait is seen in patients with parkinsonism. It is characterized by a stooping, rigid posture, and the head and neck are bent forward. Steps tend to become faster and shorter.
• Scissors gait. This type of gait gets its name because the knees and thighs hit or cross in a scissors-like pattern when walking. The legs, hips, and pelvis become flexed, making the person appear as though he or she is crouching. The steps are slow and small. This type of gait occurs often in patients with spastic cerebral palsy.
• Spastic gait. Common to patients with cerebral palsy or multiple sclerosis, spastic gait is a way of walking in which one leg is stiff and drags in a semicircular motion on the side most affected by long-term muscle contraction.
• Steppage gait. A “high stepping” type of gait in which the leg is lifted high, the foot drops (appearing floppy), and the toes points downward, scraping the ground, when walking. Peroneal muscle atrophy or peroneal nerve injury, as with a spinal problem (such as spinal stenosis or herniated disc), can cause this type of gait.
• Waddling gait. Movement of the trunk is exaggerated to produce a waddling, duck-like walk. Progressive muscular dystrophy or hip dislocation present from birth can produce a waddling gait.

Epidemiology

Studies have demonstrated that gait disturbances occur as an individual age; these disturbances stemming from neurological and non-neurological causes. Studies have shown that while 85% of individuals 60-year-old have a normal gait, by the time they reach the age of 85, only 20% maintains normal gait. Gait disturbances are not commonly seen in the younger population unless they stem from a developmental or musculoskeletal etiology.

Treatment

It depends on the cause. Assistive devices such as canes and walkers may help in some cases in which balance is a problem.

• Physical therapy: may be appropriate in other cases to improve balance, strength and flexibility. You should also receive instruction in fall prevention.
• Maintaining proper foot alignment may require in-shoe splints or leg braces. A shoe lift may help in cases of an unequal leg length.
• Medicines are available to treat arthritis, Parkinson’s disease and multiple sclerosis.
• Surgery or prostheses may be recommended, such as hip and knee replacement for persons with osteoarthritis

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