Walking abnormalities

Gait abnormalities

The pattern of how a person walks is called the gait. Different types of walking problems occur without a person's control. Most, but not all, are due to a physical condition.

Some walking abnormalities have been given names:

• Propulsive gait -- a stooped, stiff posture with the head and neck bent forward
• Scissors gait -- legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
• Spastic gait -- a stiff, foot-dragging walk caused by a long muscle contraction on one side
• Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
• Waddling gait -- a duck-like walk that may appear in childhood or later in life

Abnormal gait may be caused by diseases in different areas of the body.

General causes of abnormal gait may include:

• Arthritis of the leg or foot joints
• Conversion disorder (a psychological disorder)
• Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin sore, swelling, or spasms)
• Fracture
• Injections into muscles that causes soreness in the leg or buttocks
• Infection
• Injury
• Legs that are of different lengths
• Myositis
• Shin splints
• Shoe problems
• Tendonitis
• Torsion of the testis

This list does not include all causes of abnormal gait.

CAUSES OF SPECIFIC GAITS

Propulsive gait:

• Carbon monoxide poisoning
• Manganese poisoning
• Parkinson's disease
• Use of certain drugs, including phenothiazines, haloperidol, thiothixene, loxapine, and metoclopramide (usually, drug effects are temporary)

Spastic (scissors) gait:

• Brain abscess
• Brain or head trauma
• Brain tumor
• Cerebrovascular accident (stroke)
• Cerebral palsy
• Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
• Liver failure
• Multiple sclerosis
• Pernicious anemia
• Spinal cord trauma
• Spinal cord tumor
• Syphilitic meningomyelitis
• Syringomyelia

Steppage gait:

• Guillain-Barre syndrome
• Herniated lumbar disk
• Multiple sclerosis
• Muscle weakness of the tibia
• Peroneal neuropathy
• Poliomyelitis
• Spinal cord injury

Waddling gait:

• Congenital hip dysplasia
• Muscular dystrophy
• Muscle disease (myopathy)
• Spinal muscle atrophy

Ataxic or broad-based gait:

• Acute cerebellar ataxia
• Alcohol intoxication
• Brain injury
• Damage to nerve cells in the cerebellum of the brain (cerebellar degeneration)
• Medications (phenytoin and other seizure medications)
• Polyneuropathy (damage to many nerves, as occurs with diabetes)
• Stroke

Treating the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.

Physical therapy almost always helps with short-term or long-term gait disorders. Therapy will reduce the risk of falls and other injuries.

For an abnormal gait that occurs with conversion disorder, counseling and support from family members are strongly recommended.

For a propulsive gait:

• Encourage the person to be as independent as possible.
• Allow plenty of time for daily activities, especially walking. People with this problem are likely to fall because they have poor balance and are always trying to catch up.
• Provide walking assistance for safety reasons, especially on uneven ground.
• See a physical therapist for exercise therapy and walking retraining.

For a scissors gait:

• People with a scissors gait often lose skin sensation. Skin care should be used to avoid skin sores.
• Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
• Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity.

For a spastic gait:

• Exercises are encouraged.
• Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
• A cane or a walker is recommended for those with poor balance.
• Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity.

For a steppage gait:

• Get enough rest. Fatigue can often cause a person to stub a toe and fall.
• Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.

For a waddling gait, follow the treatment your health care provider prescribed.

If there is any sign of uncontrollable and unexplained gait abnormalities, call your health care provider.

The provider will take a medical history and perform a physical examination.

Medical history questions may include:

• Time pattern, such as when the problem started, and if it came on suddenly or gradually
• Type of gait disturbance, such as any of those mentioned above
• Other symptoms, such as pain and its location, paralysis, whether there's been a recent infection
• What medicines are being taken
• Injury history, such as leg, head, or spinal injury
• Other illnesses such as polio, tumors, stroke or other blood vessel problems
• If there have been recent treatments such as vaccinations, surgery, chemotherapy or radiation therapy
• Self and family history, such as birth defects, diseases of the nervous system, growth problems, problems of the spine

The physical examination will include muscle, bone, and nervous system examination. The provider will decide which tests to do based on the results of the physical examination.