Abnormal Gait

Abnormal gait affects many people, causing changes in their walking patterns. It can lead to balance difficulties, increased risk of falls, and reduced mobility, impacting daily activities and overall quality of life. This article explores different abnormal gait types, their symptoms, and what causes them. We'll also look at risk factors, possible complications, and how doctors diagnose and treat these conditions. Additionally, we'll discuss when to see a doctor and ways to prevent gait abnormalities. 

What is an Abnormal Gait?

An abnormal gait is a change in a person's walking pattern. The ability to stand and walk normally depends on input from several systems, including visual, vestibular, cerebellar, motor, proprioceptive, and sensory. Any disruption to these systems can result in gait abnormalities. Common examples include Parkinsonian gait, characterised by rigidity and small steps, and hemiplegic gait, often caused by brain injury or stroke.

Types of Abnormal Gait

Abnormal gait patterns can be classified into various types, each with distinct characteristics: 

• Hemiplegic Gait: It is seen in individuals who have experienced a stroke and circumduction of the foot on the affected side, with the arm typically held in a flexed position.
• Parkinsonian Gait: It is associated with Parkinson's disease and is characterised by universal flexion of joints, small steps (festination), and a possible tremor. 
• Cerebellar Ataxic Gait: This type of abnormal gait presents as broad-based and unsteady, with the person potentially falling towards the affected side.
• Spastic Diplegic Gait: It is commonly observed in cerebral palsy and involves bilateral leg extension and adduction, sometimes leading to a 'scissors gait' pattern. 
• Neuropathic Gait, or Steppage Gait: This abnormal gait requires the individual to lift their leg higher than usual due to foot drop.
• Myopathic Gait or Waddling Gait: It results from weakness in the pelvic girdle muscles, causing side-to-side motion while walking. 
• Sensory Ataxic Gait: This abnormal gait occurs when proprioception is disturbed, leading to an insecure, broad-based walking pattern.
• Other types include antalgic gait due to pain, Trendelenburg gait from weak gluteus medius muscles, and hyperkinetic gait seen in basal ganglia disorders.

Symptoms of Gait Abnormalities

Abnormal gait presents with various symptoms, depending on the underlying cause. Common signs of abnormal gait include: 

• Dragging or shuffling feet, which can be observed in conditions like Parkinson's disease
• The feeling of imbalance while walking 
• Stiffness in the muscles or joints of the hips and legs 
• Side-to-side swaying motion, known as a waddling gait 
• Walking with the head and neck bent towards the ground 
• Taking higher than normal steps and dropping the feet with each step
• Taking small steps, also known as festination
• Pain while walking 
• Irregular, jerky movements, foot drop, and difficulty maintaining a straight path while walking

Causes of Abnormal Gait 

Abnormal gait can stem from various factors, ranging from physical injuries to underlying health conditions. These are:

• Joint pain, particularly in the spine, hip, leg, or foot
• Injuries such as broken bones or sprains
• Foot problems, including calluses, corns, ingrown toenails, or warts
• Diseases affecting the brain, spinal cord, or peripheral nerves 
  • Parkinson's disease
  • Multiple sclerosis 
  • Stroke 
• Musculoskeletal conditions like arthritis
• Cerebral palsy
• Inner ear problems can affect balance
• Vision problems 

Risk Factors for Gait Abnormalities

Several factors increase the likelihood of developing abnormal gait patterns. These include:

• Age: Gait disturbances become more common as individuals grow older. 
• Cognitive Impairment: Early cognitive decline has been associated with reduced gait smoothness and changes in speed and stride length. 
• Depression: It has also been identified as a risk factor for gait disorders, particularly neurological ones.
• Medications: Multiple psychoactive medications can lead to unpredictable or highly variable gait patterns.
• Other Risk Factors: These include neurological conditions affecting motor control, sensory or motor neuropathies, and musculoskeletal disorders such as spinal stenosis.

Complications of Gait Abnormalities

Abnormal gait patterns can lead to various complications that significantly impact an individual's quality of life and overall health, such as: 

• Increased risk of falls, particularly in older adults, which can cause severe injuries, such as traumatic brain injuries or hip fractures
• Individuals with low gait speed are more likely to experience elevated depressive symptoms, cognitive decline and anxiety. 
• In some cases, an abnormal gait may be a symptom of more serious conditions, such as septic arthritis or severe vascular disease, which can be life or limb-threatening if left undiagnosed and untreated.

Diagnosis

The diagnostic process includes:

• Physical Examination: Doctors assess muscle strength, tone, and coordination and check leg length, vision, and blood pressure. During the examination, doctors look for central or peripheral motor problems affecting the legs and feet, balance disorders, pain, and changes in step size. They may ask patients to walk in different settings to observe their gait characteristics more closely.
• Investigations: These may include CT scans, X-rays, MRI scans, and nerve conduction studies, providing valuable information about joint loading, pathological movement patterns, and potential neurological or musculoskeletal issues.

Treatment

The treatment of abnormal gait involves diagnosing the underlying cause and developing tailored treatment plans that may include a combination of approaches. 

• Supplements and dietary changes to address nutritional imbalances. 
• Medications to provide symptomatic relief and improve gait by increasing neurotransmitter levels 
• In cases of neurological causes, deep brain stimulation and allied healthcare techniques (external cueing physiotherapy, treadmill walking, and cognitive training) for Parkinson’s disease
• Intensive coordinative training on posture and gait, such as backward walking or side-stepping
• Exercise interventions, such as muscle strength, power, and resistance training
• Surgery, including hip or knee replacements. 

When to See a Doctor

If you experience difficulty walking or notice changes in your gait, it's crucial to consult a doctor promptly. Abnormal gait can significantly impact your quality of life and may indicate underlying health issues.

Prevention

Preventing abnormal gait involves addressing modifiable risk factors and maintaining overall health, including:

• Regular Physical Activity: 
  • A daily 30-minute walking programme is highly recommended to maintain mobility and gait function. Including inclines in the walking route can help maintain leg strength.
  • Strength and Balance Exercises: These activities help maintain muscle strength and coordination and decrease the risk of falls, particularly in older adults. 
• Resistance Training: They can be especially beneficial for improving gait speed and overall mobility.
• Managing Underlying Health Conditions: Management of conditions like diabetes, peripheral neuropathy, and osteoarthritis through proper treatment and certain essential lifestyle changes can significantly reduce their impact on gait function. 
• Regular Vision and Hearing Screenings: They are also important, as sensory impairments can affect balance and walking patterns.
• Environmental Modifications: Removing hazards and installing handrails can enhance safety and reduce fall-related injuries. Using walking sticks or canes can provide confidence and safety for older adults.

Conclusion

Maintaining a healthy gait is crucial for overall well-being and quality of life. By staying aware of the signs of abnormal gait and seeking medical advice when needed, you can take several proactive steps to prevent complications and improve mobility. Regular exercise, proper nutrition, and managing underlying health conditions all play a part in keeping our gait healthy and reducing the risk of falls and other related issues.

FAQs

1. Do I need surgery for a gait disorder?

The need for surgery generally depends on the underlying cause and severity of the gait disorder. Sometimes, non-surgical treatments like physical therapy, medication, or assistive devices may be sufficient. However, surgery might be recommended for conditions such as joint problems or severe injuries that affect walking. 

2. What are the causes of abnormal gait?

Abnormal gait can have various causes, including neurological conditions, musculoskeletal issues, or injuries. Common causes include stroke, Parkinson's disease, arthritis, and foot problems. Other factors, such as inner ear issues, nerve damage, or vision problems, can also lead to gait abnormalities. 

3. How do I improve my gait?

Improving your gait often involves a combination of approaches. Physical therapy exercises can help strengthen weak muscles, improve balance, and enhance coordination. Gait training exercises, such as backward walking or side-stepping, can be beneficial. Additionally, using proper footwear or orthotics, maintaining a healthy weight, and addressing any underlying medical conditions can improve gait. 

4. Is gait curable?

The curability of abnormal gait depends on its underlying cause. Some gait abnormalities, especially those resulting from temporary injuries or conditions, may be fully curable with appropriate treatment. However, a complete cure may not be possible for chronic neurological or musculoskeletal disorders. 

5. What age is normal gait developed?

Normal gait development is a gradual process that begins with the onset of walking, usually around 12 to 18 months. By age 3, most children have developed a near-mature gait pattern. A mature, adult-like gait typically develops around 7 to 8 years of age. 

6. How can I identify if I have an abnormal gait?

Signs of abnormal gait include limping, dragging feet, shuffling, taking unusually small or large steps, or experiencing pain while walking. You might notice changes in your walking speed, balance, or coordination. 

7. Are there side effects of the treatment?

Treatment side effects for abnormal gait vary based on the specific intervention. Medications may cause numerous side effects, such as drowsiness or gastrointestinal issues. Physical therapy is generally safe but might cause temporary muscle soreness. Surgical interventions carry risks like infection or complications from anaesthesia. 

Dr. Koteshwara Prasad Veeragandham

MBBS, MS, M.Ch (Ortho) UK Royal College of Surgeons, England
CARE Multispeciality Clinic, Srinagar Colony, Hyderabad, CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

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