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Walking abnormalities

Definition

Walking abnormalities are unusual and uncontrollable walk patterns, usually caused by diseases or injuries to the legs, feet, brain, spine, or inner ear.

Alternative Names

Gait abnormalities

Considerations

The pattern of how a person walks is called their gait. Many different types of walking abnormalities are produced unconsciously. Most, but not all, are due to some physical condition.

Some walking abnormalities are so characteristic that they have been given descriptive names:

• Propulsive gait -- a stooped, rigid posture, with the head and neck bent forward
• Scissors gait -- legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement
• Spastic gait -- a stiff, foot-dragging walk caused by one-sided, long-term, muscle contraction
• Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking
• Waddling gait -- a distinctive duck-like walk that may appear in childhood or later in life

Common Causes

Abnormal gait may be caused by diseases in many different areas of the body. General causes of abnormal gait may include:

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

This list is not all-inclusive.

CAUSES OF SPECIFIC GAITS

• Propulsive gait:
  • Carbon monoxide poisoning
  • Manganese poisoning
  • Parkinson's disease
  • Use of certain drugs including phenothiazines, haloperidol, thiothixene, loxapine, metoclopramide, and metyrosine (usually drug effects are temporary)
• Spastic and scissors gait:
  • 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
  • Cerebral palsy
• Spastic gait:
  • Brain abscess
  • Brain tumor
  • Cerebrovascular accident (stroke)
  • Head trauma
  • Multiple sclerosis
• Steppage gait:
  • Guillain-Barre syndrome
  • Herniated lumbar disk
  • Multiple sclerosis
  • Peroneal muscle atrophy
  • Peroneal nerve trauma
  • Poliomyelitis
  • Polyneuropathy
  • Spinal cord trauma
• Waddling gait:
  • Congenital hip dysplasia
  • Muscular dystrophy
  • Spinal muscle atrophy
• Ataxic or broad-based gait
  • Alcohol intoxication
  • Long term brain injury due to alcoholism
  • Neuropathy (as with diabetes)
  • Stroke
  • Use of certain medicines such as Dilantin and other seizure medications

Home Care

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.

For an abnormal gait that occurs with conversion disorder, psychiatric counseling as well as support from family members is strongly recommended.

For a propulsive gait:

• Encourage the person to be as self-reliant and independent as possible.
• Allow plenty of time for daily activities, especially walking. People with this problem are susceptible to falls because of poor balance and an unconscious effort to always catch up.
• Provide walking assistance for safety reasons, especially on uneven ground.
• Consult a physical therapist about exercise therapy and walking retraining.

For a scissors gait:

• Loss of skin sensation is often associated with scissors gait, so skin care should be provided in order to avoid skin breakdown and ulcers.
• 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.

For a spastic gait:

• Both active and passive exercises are encouraged.
• 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.

For a steppage gait:

• Adequate rest is encouraged. Fatigue can often cause an affected person to stub his toe and fall.
• 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.

For a waddling gait, follow the prescribed therapy.

Call your health care provider if

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

What to expect at your health care provider's office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting the problems with walking in detail may include:

• Time pattern
  • When did this problem with walking begin?
  • Did it occur suddenly or gradually?
  • Has it become worse over time?
• Quality (type of gait disturbance)
  • Scissors gait (flexed hips and knees, legs cross each other)
  • Steppage gait (foot drop, toes scrape ground)
  • Spastic gait (stiff, foot-dragging walk)
  • Propulsive gait (stooped, rigid posture, with head, neck bent forward)
• Other symptoms
  • Is there pain?
  • If there is pain, is it in the muscles, joints, spine, or other location?
  • Is there a fever?
  • Is there testicular pain?
  • Does there appear to be muscle atrophy (wasting)?
  • Is there any paralysis?
  • Are there any muscle spasms?
  • Are there joint deformities?
  • Has there been a recent infection?
• Medications
  • What medications are being taken?
• Injury history
  • Have there been any recent or past leg injuries?
  • If there was a leg injury, what type? Was it a broken bone, dislocation, or burn?
  • Has the person had any head injuries, especially one that resulted in a coma?
  • Has the person had any spinal injuries or nerve injuries?
• Illness history
  • Are there any known blood vessel problems?
  • Are there any known illnesses such as polio, meningitis, myositis, tumors, or stroke?
  • Have there been any recent infections, including abscesses?
  • Does the person have hemophilia?
  • Has the person been exposed to carbon monoxide?
• Treatments
  • Have there been any recent immunizations?
  • Has there been a recent surgery?
  • Has there been any chemotherapy or radiation therapy?
• Self and family history
  • Are there any known birth defects, such as spina bifida, myelomeningocele, or hip dysplasia?
  • Is there a history of cerebral palsy or muscular dystrophy?
  • Has anyone in the family had multiple sclerosis?
  • Has the affected person had any growth abnormalities?
  • Are the legs different lengths?
  • Is there a known problem with scoliosis?

The physical examination will probably include neurological examination. Diagnostic tests will be determined by the results of the physical examination workup and observation of the gait abnormalities.

References

Griggs R, Jozefowicz R, Aminoff M. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 418.

Timmann D, Diener H. Coordination and ataxia. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 17.