Walking abnormalities
Gait abnormalities
Walking abnormalities are unusual and uncontrollable walking patterns. They are usually due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear.
Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from wear and tear on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.
Head injuries can range from a minor bump on the head to a devastating brain injury. Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someones life. Common causes of head injury include traffic accidents, falls, physical assault, and accidents at home, work, outdoors, or while playing sports.
Herniated lumbar disk is a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (the nucleus pulposus) is forced through a weakened part of the disk, resulting in back pain and nerve root irritation.
A stroke involves loss of brain functions caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within the vasculature of the brain.
Considerations
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
- Ataxic, or broad-based, gait -- feet wide apart with irregular, jerky, and weaving or slapping when trying to walk
- Magnetic gait -- shuffling with feet feeling as if they stick to the ground
Causes
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 mental disorder)
- Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin sore, swelling, or spasms)
- Broken bone
- Injections into muscles that causes soreness in the leg or buttocks
- Infection
- Injury
- Legs that are of different lengths
- Inflammation or swelling of the muscles (myositis)
- Shin splints
- Shoe problems
- Inflammation or swelling of the tendons (tendinitis)
- Torsion of the testis
- Brain, spinal cord, and peripheral nerves diseases
- Vision problems
This list does not include all causes of abnormal gait.
CAUSES OF SPECIFIC GAITS
Propulsive gait:
- Carbon monoxide poisoning
- Manganese poisoning
- Parkinson disease
- Use of certain drugs, including phenothiazines, haloperidol, thiothixene, loxapine, and metoclopramide (usually, drug effects are temporary)
Spastic or scissors gait:
- Brain abscess
- Brain or head trauma
- Brain tumor
- Stroke
- Cerebral palsy
- Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
- Liver failure
- Multiple sclerosis (MS)
- Pernicious anemia (condition in which there aren't enough healthy red blood cells to provide oxygen to body tissues)
- Spinal cord trauma
- Spinal cord tumor
- Neurosyphilis (bacterial infection of the brain or spinal cord due to syphilis)
- Syringomyelia (collection of cerebrospinal fluid that forms in the spinal cord)
Steppage gait:
- Guillain-Barré syndrome
- Herniated lumbar disk
- Multiple sclerosis
- Muscle weakness of the tibia
- Peroneal neuropathy
- Polio
- Spinal cord injury
Waddling gait:
- Congenital hip dysplasia
- Muscular dystrophy (group of inherited disorders that cause muscle weakness and loss of muscle tissue)
- Muscle disease (myopathy)
- Spinal muscle atrophy
Ataxic, or broad-based, gait:
- Acute cerebellar ataxia (uncoordinated muscle movement due to disease or injury to the cerebellum in the brain)
- Chiari malformation
- Alcohol intoxication
- Brain injury
- Damage to nerve cells in the cerebellum of the brain (cerebellar degeneration)
- Medicines (phenytoin and other seizure medicines)
- Polyneuropathy (damage to many nerves, as occurs with diabetes)
- Stroke
Magnetic gait:
- Disorders that affect the front part of the brain
- Hydrocephalus (swelling of the brain)
Home Care
Treating the underlying 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 for 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.
- Medicines (muscle relaxers, anti-spasticity medicines) 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.
- Medicines (muscle relaxers, anti-spasticity medicines) 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.
For a magnetic gait due to hydrocephalus, walking may improve after the brain swelling is treated.
When to Contact a Medical Professional
If there is any sign of uncontrollable and unexplained gait abnormalities, call your provider.
What to Expect at Your Office Visit
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.
References
Magee DJ, Manske RC. Assessment of gait. In: Magee DJ, Manske RC, eds. Orthopedic Physical Assessment. 7th ed. St Louis, MO: Elsevier; 2021:chap 14.
Thompson PD, Nutt JG. Gait disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 25.
Version Info
Last reviewed on: 1/28/2021
Reviewed by: Evelyn O. Berman, MD, Assistant Professor of Neurology and Pediatrics at University of Rochester, Rochester, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
