Table of Contents
- 1 Overview
- 2 Types of Gait Abnormalities
- 3 Final Thoughts
Have you ever keenly observed people walking? Do you believe that everyone walks with a straight and upright posture? You might not. People may have a normal, stooped, limping, or uneven walk or gait pattern when they walk. These abnormalities of gait can be caused by muscular, skeletal, or nervous system disorders.
Is the abnormal gait a serious issue? Yes, of course. Your walking pattern or gait reveals more about your mental, emotional, and physical health. Any abnormality of gait can be a symptom of an underlying problem that must be thoroughly analyzed. This article delves into the various types of gaits, and what causes gait disturbances.
Types of Gait Abnormalities
Propulsive Gait (Parkinsonian Gait)
The person’s body will be stiff in a propulsive gait, with the head and neck slouched forward. This hunched posture will make it difficult for the person to find balance. This type of gait is caused primarily by carbon monoxide poisoning and manganese toxicity. Since people with Parkinson’s disease exhibit the same symptoms, it is also referred to as Parkinsonian gait. Parkinson’s disease patients will have shorter steps and tremors. They cannot fully control their movements because they have difficulty moving their muscles while walking.
Dopamine is a hormone produced by our bodies that acts as a neurotransmitter or chemical messenger. It is produced by the brain’s substantia nigra, ventral tegmental area, and hypothalamus. When the cells in the substantia nigra begin to die in Parkinson’s disease, the dopamine hormone production decreases. This lack of production will have an impact on the transmission of signals between nerves. As a result, Parkinson’s disease patients would be unable to coordinate their movements while walking.
Scissors Gait (Diplegic)
The internal hip rotation occurs when the hip adductor muscles are not flexible. Because of the spasticity in the hip muscles, the affected person is unable to separate the thighs while moving around. During a walk, the thighs will be pressed together, or the knees will cross each other. This crisscross movement of the legs is known as scissors gait.
Scissors gait is one of the abnormalities of gait patterns seen in cerebral palsy patients. Motor impairments in the legs cause this diplegic gait. As you may be aware, if a particular body part does not receive the adequate movement, the muscles will eventually wean. Scissoring gait can cause developmental deformities and curtail muscle growth.
The scissors gait disturbance symptoms are that the affected person is prone to losing balance and falling often. The constant rubbing of the thighs and knees can lead to pressure ulcers. Every movement will be painful due to joint and muscle tightness.
As the proverb goes, “We can’t teach an old dog new tricks,” so management of this gait abnormality should begin early or when the children are young. It would be easy to reduce spasticity and relax the joints and muscles in the early stages with appropriate physical therapy and medications.
Botox injections and orthotic devices such as braces and splints can help prevent muscles and joints from tightening further. The length of the thigh muscles will be increased in adductor lengthening surgery. The nerves causing spasticity will be surgically removed during selective dorsal rhizotomy to reduce spasticity. In addition to all of this, physical therapy for walking normally and walkers with belts to keep the legs in place will be beneficial in correcting the scissors gait.
When one side of the body stiffens, as in post-stroke patients, they are unable to move their affected side leg smoothly while walking. This one-sided (hemiplegic) gait could be caused by spasticity in the arm, wrist, hip, and knee. The affected leg will be moved in a semi-circular motion, and so it is also referred to as circumduction gait. The body’s natural swing will be hindered, as on the affected side, the pelvis is tilted upward. When both sides lack spasticity, both legs move in a semi-circular motion.
Weakness in the gluteus maximus in the hip, quadriceps in the knee, and plantar flexors would result in extensive hip and knee flexion. This could be due to the affected side’s multiple sclerosis (stiffening of connective tissues). This hemiplegic spastic gait would decrease speed, stride length, swing phase, and cadence.
Botulinum toxin injections, electrical stimulations, kinesiotherapy, and exercises such as treadmill walking, sitting and standing up, lifting the legs, and standing over objects can all help to improve this gait abnormality.
Waddling Gait (Myopathic)
Weakness in the bilateral gluteal muscles in the pelvic girdle makes it impossible for the person to balance his body while walking. The walk’s instability is reminiscent of a waddling duck. Walking causes the hip to swing to one side.
The most common abnormalities of gait found in this are during pregnancy. Pregnant women in their third trimester are more likely to walk with a waddling gait. Their bodies will produce a hormone called relaxin during the third trimester to loosen the pelvic joints and make the delivery easier. This hormone leads to a waddling gait. Furthermore, walking with a full-bloomed belly in the later stages of pregnancy causes them to lean backward. This, however, is only temporary and can be reversed after childbirth.
Waddling gait is seen in children with Muscular Atrophy, Cerebral Palsy, Lumbar Lordosis, Hip Dysplasia, Pseudoachondroplasia, and Rhizomelia. Waddling gait is also referred to as myopathic gait.
Walkers and canes can be used to assist children in walking. Medication and physical therapy for joint flexibility, balance, and strength will help manage the myopathic waddling gait. Leg braces or splints may be useful in managing leg and foot alignment.
Steppage Gait (Neuropathic)
Due to dorsiflexion at the ankle, people with a steppage gait will find it difficult to lift the foot. As a result, they will lift their knee higher than usual and drop their foot harder when it falls. Therefore, it is also known as foot drop gait. Because of the weakness in the leg and peroneal muscles, they are unable to move the foot as freely as they would like.
This neuropathic gait is manifested in people with Multiple Sclerosis, Amyotrophic Lateral Sclerosis (ALS), Parkinson’s disease, Sciatica, spinal fracture, herniated disc, and post-surgical complications after joint replacement surgeries.
Physical therapy to the anterior tibialis muscles in the ankle and stretches to improve the range of motion of the ankle joint will aid in the management of the high steppage gait. The tibialis muscles will be relieved by neuromuscular electrical stimulation to the ankle.
People with these abnormalities of gait can benefit from a walking cane with a rectangular base (quad cane) or wheeled walkers to help them move around. Braces that connect your ankle and foot, or elastic bands that connect your leg and foot, may be used temporarily to avoid this abnormal gait.
Cerebellar Ataxic Gait
The ataxic cerebellar gait is caused by a malfunction of the cerebellum, which controls movement coordination. This will resemble people walking under the influence of alcohol. They will find it very difficult to walk in a straight line. They also have a lack of balance, inconsistent body movements, and a tendency to veer sideways while walking.
Some of the causes of ataxic gait include extreme intoxication, toxic reactions to certain medications, stroke, infections, head trauma, tumor, cerebral palsy, autoimmune diseases, multiple sclerosis, hypo or hypoparathyroidism, and brain tissue degeneration. People who have Wilson’s disease, in which copper accumulates in various organs, may also have this. Some people are born with mutated genes and suffer from ataxia.
The most appropriate way to treat ataxic gait is treating the diseases causing these abnormalities of gait, like reducing alcohol consumption, discontinuing the medication causing the intoxication, treating head trauma, or treating other conditions. Physical therapy to help with balance and coordination will be beneficial as well.
Choreiform (Hyperkinetic Gait)
Choreiform gait, also known as Chorea, is caused by a type of neurological dysfunction known as dyskinesias. The hyperkinetic or involuntary movements of the entire body and the acceleration or deceleration of the speed while walking are the obvious symptoms of this gait. The trunk would be tilted anteriorly.
These abnormalities of gait manifest themselves in the early stages of Huntington’s disease (HD). HD is an autosomal neurodegenerative disease that is inherited. HD symptoms include reduced walking speed, difficulty initiating steps, and differences in each step of the stride.
Since HD cannot be completely cured, doctors may prescribe Deutetrabenazine and Tetrabenazine to treat the symptoms. However, these medications have serious side effects such as anxiety, depression, and suicidal tendencies. These medications are not suitable for people who have a psychiatric history. Corticosteroids will aid in the control of involuntary movements.
Sensory gait, also known as sensory ataxia gait, occurs when the vestibular, visual, and proprioceptive systems are compromised. Coordination is provided by all three systems in order to maintain balance. Defects in any of these systems will have an impact on the body’s balance. A person suffering from any of these will have difficulty walking with their eyes closed or in the dark. Walking in familiar places and on familiar surfaces with open eyes may not be difficult for them.
These abnormalities of gait can be identified in Romberg’s test. The affected people will raise their legs higher than normal in the darkness as if climbing the steps. This is because they are unsure of what is in front of them. When their eyes are open, they will examine each of their steps as they walk. People exhibit standing instability even while standing with closed eyes.
Sensory gait, like cerebellar ataxia, has no specific treatment. Treating the underlying causes can help with sensory gait management. To some extent, medications to reduce trembling and muscle disorders affecting the sensory systems will be helpful in treating this.
Trendelenburg gait is caused by pelvic instability in the contralateral gluteal muscles as a result of weakness in the gluteus medius and gluteus minimus on the opposite side in the buttock. When we walk normally, our hips will rise on the non-weight-bearing extremity. However, in a person with the Trendelenburg gait, the hip on the affected side drops while walking. The person will raise the hip on the opposite side to balance the body. In reverse Trendelenburg gait, the person raises his chest and head 30 degrees higher than his abdomen instead of his hip.
These gait abnormalities may be caused by diseases such as Legg-Calve-Perthes disease, developmental dysplasia or osteonecrosis of the hip, chronic hip dislocation due to trauma, tuberculosis of the hip, a labral tear in the hip, osteoarthritis, or muscular dystrophy. Poliomyelitis, L5 radiculopathy, superior gluteal nerve damage, tendinitis or abscess of the Gluteus medius and minimus muscles, and trochanteric avulsion are some of the other health conditions that can cause these gait disorders.
As previously stated, weakness in the hip adductor muscles can be caused by any of the aforementioned disorders or diseases. As a result, treating the underlying condition will be the most practical way to reduce these gait abnormalities. Children with hip dysplasia will benefit from the open reduction and Salter innominate osteotomy (SIO). People suffering from somatic dysfunctions can benefit from Osteopathic Manipulative Therapy (OMT). Pelvic support osteotomies will help individuals who have congenital dysplasia.
Whatever we’ve seen so far are non-antalgic gaits. Antalgic gait is not like them at all. It is the most common gait abnormality seen in people who are in pain. Many patients in casualties and clinics walk with a limp due to pain, which is referred to as a painful gait. When we have pain in our lower extremities, lower back, or hip, we tend to adjust our walk to avoid aggravating the pain.
Antalgic gait is distinguished by a faster step on the unaffected side and a slower step on the affected side. The toes, foot, ankle, lower leg, knee thigh, hip, or lumbar region may experience localized pain. People can use a cane, walker, or crutches to ease their walking until the pain goes away.
Injuries from auto accidents, pedestrian accidents, bicycle accidents, motorcycle accidents, slip and falls, or workplace accidents can cause trauma-related antalgic gait. Non-traumatic antalgic gait can be caused by pain in the lower extremities caused by sciatica, osteoarthritis, infections, cramps, sprains, inflammations, blisters, tumors, joint deformities, or stress-related musculoskeletal disorders.
Adults can explain the source of the gait disorder, but younger children cannot. As a result, imaging studies, such as CT or MRIs, will be useful in determining the source of the discomfort that is causing these abnormalities of gait. Physical therapies, anti-inflammatory medications, corticosteroid injections, and even surgery to treat the underlying cause will help alleviate pain.
In the same way that “the face is the index of the mind,” your walking style is an index of your health. If you notice any abnormalities of gait, seek medical attention right away. Ignoring your body’s warning signs may aggravate the situation, resulting in serious consequences. If proper treatment is received on time, the antalgic gait will resolve in a short period of time. Other abnormalities of gait, on the other hand, may necessitate serious intervention. Inadequate management can result in permanent disabilities in both children and adults.