Walking Abnormalities

Definition

Walking abnormalities are unusual and uncontrollable walking patterns that are usually due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear.

Alternative Names

Gait abnormalities

Considerations

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

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
• 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 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

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.

Thompson PD. Gait disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 24.

Alternative Names

Gait abnormalities

Home Care

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.

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 health care provider will take a medical history and perform a physical examination.

Medical history questions 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 drops, toes scrape ground)
  • Spastic gait (stiff, foot-dragging walk)
  • Propulsive gait (stooped, rigid posture, with head and 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 pain in the testicles?
  • Does there appear to be muscle wasting (atrophy)?
  • 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 led to 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 vaccinations?
  • 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 problems?
  • Are the legs different lengths?
  • Is there a known problem with scoliosis?

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

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.

Thompson PD. Gait disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 24.