GAIT ABNORMALITY
Gait abnormalities are changes to a normal walking pattern caused by injuries or pathologies of the spinal cord, brain, legs, or feet.
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Gait Abnormality
The term gait refers to the movement your child makes when walking or running. Walking, which is a complex series of movements, requires the cooperation of the brain, bones, and muscles, as well as the assistance of your child’s heart and lungs. If any of those systems malfunction, it may impair the ability to walk. This is referred to as a gait abnormality.
Gait Abnormalities Defined
Gait abnormalities are changes in one’s walking pattern caused by injuries or pathologies of the spinal cord, brain, legs, or feet. For instance, they can affect your child’s walking speed and cause issues with consistency, symmetry, or unsynchronized movements. Also, a gait occurs as a result of a repetitive cycle in which various structures of the central and peripheral nervous systems are involved. In addition, neurological diseases or musculoskeletal factors that affect gait and balance can disrupt this cycle.
Causes
A person may have difficulty walking due to an acute problem, such as a bruise, cut, or fracture. These may cause them to limp or walk differently, but they are not considered abnormal gait causes. However, there are several diseases that can attack the nervous system and cause abnormal gait. The following are some of the most common causes of abnormal gait:
- Amputation of the legs or feet.
- Soft tissue infections in the legs.
- Fractured bones in the feet and legs.
- Birth defects.
- Infections of the middle ear.
- CP (cerebral palsy).
- Conversion disorder or other mental illnesses.
- Shin splints.
QUESTIONS AND ANSWERS
What constitutes a gait abnormality in children, and when should a parent take their child to the doctor?
A gait abnormality refers to an unusual walking pattern or way of moving that deviates from the typical, normal gait seen in children. It may involve limping, toe-walking, excessive tripping or falling, walking with an uneven stride, or other noticeable irregularities. Some gait abnormalities appear as normal during early childhood when a child learns to walk. However, persistent or worsening gait abnormalities beyond the typical age range of development, or those causing pain, discomfort, or difficulty with everyday activities, should cause parents to seek an evaluation by a healthcare professional.
What causes gait abnormalities in children?
The cause of gait abnormalities in children can point to various factors, including congenital conditions, orthopedic issues, neurological disorders, muscle weakness, bone deformities, joint problems, injury, or developmental delays. Some common causes include flat feet, tibia vara (Blount’s disease), cerebral palsy, muscular dystrophy, scoliosis, and hip dysplasia. It’s important for a healthcare professional to conduct a thorough evaluation to determine the specific cause of the gait abnormality and guide appropriate treatment.
How do doctors diagnose and treat gait abnormalities in children?
Diagnosis involves a comprehensive evaluation, including a medical history, physical examination, and often imaging studies such as X-rays, MRI, or CT scans to assess bone structure and alignment. Doctors can perform a gait analysis to analyze the child’s walking pattern in detail.
Treatment varies based on the underlying cause of the gait abnormality. It may include physical therapy to improve muscle strength, balance, and coordination, orthotics (custom shoe inserts) to correct foot posture, braces or splints to support the legs, or surgical interventions for more severe conditions. Early intervention and appropriate treatment tailored to the child’s specific needs are key to managing gait abnormalities effectively and optimizing the child’s gait and overall mobility.
Many young children may have an abnormal gait for a period of time as they grow and learn to walk. Parents should make an appointment with us to have their child examined if they believe something is wrong.
What are the Eight Basic Gaits Associated with Neurological Conditions?
When it comes to understanding how different neurological disorders affect movement, there are eight primary types of gaits to consider:
- Sensory Gait: Resulting from sensory nerve problems, this gait displays a stomping action with the feet as individuals rely on proprioception to compensate for the loss of sensation.
- Parkinsonian Gait: Notably linked to Parkinson’s disease, this gait is marked by a stooped posture, shuffling steps, and a reduced arm swing.
- Ataxic (Cerebellar) Gait: Caused by cerebellar dysfunction, it is recognized by unsteady, staggering steps akin to those seen when intoxicated.
- Steppage Gait: Common in peripheral nerve diseases, it features a high stepping motion to compensate for foot drop, ensuring the toes do not drag.
- Choreiform Gait: Related to disorders like Huntington’s disease, this gait involves irregular, dance-like, involuntary movements.
- Myopathic Gait: Associated with muscular diseases, this gait exhibits a waddle as a result of weakened pelvic girdle muscles.
- Diplegic Gait: Often seen in conditions like cerebral palsy, this gait involves stiff movements with legs crossing in a scissor-like fashion.
- Hemiplegic Gait: Typically results from a stroke; this gait is characterized by one leg dragging due to weakness or paralysis on one side of the body.
Recognizing these gait patterns can significantly aid in identifying the specific neurological or musculoskeletal condition affecting the patient. By carefully studying these movements, clinicians can make more informed decisions, potentially reducing the need for extensive testing or consultations.
Understanding Sensory Gait Presentation and Its Causes
Sensory Gait presents uniquely due to the loss of proprioceptive input, which is crucial for spatial awareness of the feet. Without this feedback, individuals often resort to slamming their feet onto the ground to detect their position upon landing. This phenomenon results in a distinctive walking pattern, sometimes described as a “stomping gait.”
Characteristics of Sensory Gait
- High Stepping: Patients tend to lift their legs higher than normal to ensure forceful contact with the ground.
- Increased Auditory Feedback: The impact of the foot hitting the ground helps compensate for the lack of sensory feedback.
- Visual Reliance: Difficulties are exacerbated in low-visibility conditions, such as darkness, when visual cues are unavailable.
Conditions Leading to Sensory Gait Development
Several conditions can lead to the development of this gait pattern:
Dorsal Column Disorders:
- Vitamin B12 Deficiency: A lack of this essential nutrient affects nerve health, impairing proprioception.
- Tabes Dorsalis: Associated with untreated syphilis, this condition affects the spinal cord’s ability to transmit the necessary sensory signals.
Peripheral Nerve Damage:
- Uncontrolled Diabetes: Long-term damage to peripheral nerves can compromise proprioceptive feedback, contributing to gait abnormalities.
Severe Manifestations
In advanced cases, this gait can mimic cerebellar ataxia, presenting a significant challenge for mobility. With its reliance on visual cues, managing sensory gait frequently involves addressing underlying conditions and incorporating compensatory strategies to enhance balance and coordination.
Understanding the nuances of sensory gait is vital in diagnosing and formulating treatment plans that address both the physiological and sensory aspects of affected individuals.
Understanding the Gait in Parkinson’s Disease
The Parkinson Gait is associated with Parkinson’s disease, and is characterized by several distinctive features that set it apart from typical walking patterns. A primary aspect is rigidity and bradykinesia—a slowness in movement which marks the condition. Patients often exhibit a stooped posture, leaning forward with their head and neck, while their knees remain slightly bent.
Key Features of the Parkinsonian Gait
- Posture and Movement: The entire upper body maintains a flexed position, though the fingers might extend outward, creating a stark contrast.
- Step Pattern: Individuals typically take slow, short steps, a pattern described as marche à petits pas, or “walk of little steps.”
- Initiation Challenges: Starting to walk appears difficult, as the disease often hampers the ability to initiate movement effectively.
- Festination: Patients may experience an involuntary urge to speed up, resulting in a series of quick, accelerating steps.
This particular gait is not exclusively seen in Parkinson’s disease; it might also arise from Parkinsonism induced by certain medications or other medical conditions.
Understanding Ataxic Gait
An Ataxic Gait is characterized by uncoordinated, clumsy, and staggering movements, often with a wide base. This instability affects a person’s ability to walk smoothly and is typically associated with cerebellar dysfunction.
Key Characteristics
- Staggering Movements: Walking can appear erratic, resembling a zig-zag pattern, making it difficult for individuals to maintain a straight line.
- Wide-Based Stance: To compensate for instability, those affected often adopt a broader stance.
- Titubation: While standing still, individuals may exhibit swaying movements, both back and forth and side to side.
Associated Conditions
Ataxic Gait is most commonly linked to cerebellar disease, affecting the region of the brain responsible for balance and coordination. Some specific conditions include:
- Cerebellar Disease: Midline cerebellar disease, particularly affecting the vermis, is often indicated by increased trunk instability.
- Acute Alcohol Intoxication: The unsteady walk characteristic of intoxication closely resembles ataxic gait, highlighting the cerebellum’s role in coordination.
Understanding these aspects can aid in recognizing ataxic gait and its potential underlying causes.
Understanding Steppage Gait
Steppage Gait, often referred to as Neuropathic gait or equine gait, is primarily associated with a condition known as foot drop. This results from weakened foot dorsiflexion, compelling individuals to lift their legs higher than usual to prevent the foot from dragging along the ground during walking.
Key Characteristics
- Foot Drop: The most recognizable feature is where patients have difficulty lifting the front part of the foot.
- High Leg Lifting: To compensate for foot drop, individuals raise their legs notably high with each step.
Potential Causes
Unilateral Causes
- Peroneal Nerve Palsy: A condition that impacts the ability to control the foot and leg muscles, often leading to foot drop on one side.
- L5 Radiculopathy: A spinal nerve root issue, commonly resulting from herniated discs, which may affect leg sensation and strength.
Bilateral Causes
- Amyotrophic Lateral Sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord.
- Charcot-Marie-Tooth Disease: A hereditary disorder that damages peripheral nerves, influencing muscle control.
- Peripheral Neuropathies: Conditions often linked to diseases like uncontrolled diabetes, causing nerve damage and functional impairments.
In summary, neuropathic gait is marked by distinct walking adaptations due to foot drop, with causes ranging from nerve-related issues on one side to broader neurological conditions affecting both sides.
Understanding Choreiform Gait
Defining Choreiform Gait
Choreiform Gait, also known as hyperkinetic gait, is a distinctive walking pattern characterized by erratic and involuntary movements throughout the body. This type of gait is notably marked by sudden, unpredictable jerks and twists, which are most apparent in the arms and legs.
Key Features of Choreiform Gait
- Irregular Movements: The gait is dominated by abrupt, involuntary motions that can affect balance and coordination.
- Jerky Motions: Unlike smooth, controlled walking, choreiform gait involves spasmodic and unpredictable steps.
- Involuntary Movements: These are not intentional or controlled by the person, often leading to an unusual walking pattern.
- Full-body Involvement: While walking, the irregular movements may involve one or more extremities, sometimes making the underlying movement disorder more noticeable.
Associated Disorders
Choreiform gait is commonly observed in several neurological conditions, particularly those affecting the basal ganglia, which is a group of structures in the brain that regulate movement:
- Huntington’s Disease: A genetic disorder that leads to motor dysfunction, cognitive decline, and psychiatric issues.
- Sydenham’s Chorea: Often a complication of rheumatic fever, this condition primarily affects children and results in temporary but severe movement problems.
- Other Forms of Chorea: These include various other disorders characterized by similar movement disruptions.
- Athetosis and Dystonia: Conditions featuring slow, writhing movements and sustained muscle contractions that may also contribute to a choreiform gait pattern.
Understanding choreiform gait and its association with these disorders is crucial in diagnosing and managing conditions that impact motor function.
Understanding Myopathic Gait and the Trendelenburg Sign
A Myopathic Gait, often referred to as a “waddle,” is usually a result of muscle weakness in the hip girdle. This type of gait becomes evident when the muscles responsible for stabilizing the pelvis, essential for smooth walking, cannot perform their function effectively. This weakness may occur on one or both sides of the body.
Causes of Myopathic Gait
- Muscle Weakness: The primary cause is weakened hip muscles, often observed in medical conditions like muscular dystrophy. These muscles are crucial for maintaining a balanced pelvis while walking.
- Pelvic Instability: When there’s weakness on one side, the pelvis tends to drop on the opposite side. This phenomenon is known as the Trendelenburg sign. If both sides are weak, the pelvis will drop alternately on either side, resulting in a waddling motion.
Connection to the Trendelenburg Sign
The Trendelenburg sign is an indicator of what’s happening with the pelvic muscles. When a person stands on one leg, the opposite side of the pelvis should remain level; if it drops, this indicates weakness of the hip abductor muscles on the standing leg. In bilateral cases, where both sides are affected, the result is the characteristic side-to-side swaying.
Impact on Daily Life
Individuals with a myopathic gait may experience challenges in balance and movement. It can affect their ability to perform everyday activities and increase the risk of falls.
Understanding the relationship between a myopathic gait and the Trendelenburg sign highlights the importance of muscle strength around the hips for stable and efficient movement. Addressing muscle weakness through rehabilitation and strengthening exercises can help manage or improve the condition.
Understanding Diplegic Gait in Cerebral Palsy
In individuals with cerebral palsy, a Diplegic Gait is characterized by movement challenges affecting both sides of the body, though the lower extremities are more significantly impacted than the upper ones. This type of gait is marked by a distinct narrow base of support, causing individuals to walk with legs dragging and toes scraping the ground.
Key Features of Diplegic Gait
- Spasticity: Increased muscle to, predominantly in the legs, contributes to difficulty in coordination and movement.
- Gait Pattern: The legs tend to cross over each other while walking, creating what is known as a “scissors gait.”
- Hip Adductors: The tightness in the hip adductor muscles is so pronounced that it can cause crossing of the legs beyond the midline.
- Bilateral Lesions: Commonly, this gait is associated with bilateral periventricular lesions, a hallmark affecting motor control and coordination.
Intervention Possibilities
Surgical interventions like hip adductor release may be available in regions with access to comprehensive medical care. This procedure aims to alleviate the scissoring effect, improving mobility and comfort for patients with cerebral palsy.
Understanding these features helps healthcare providers in assessing and creating tailored treatment plans to support individuals with cerebral palsy and improve their quality of life.
Characteristics of a Hemiplegic Gait
A Hemiplegic Gait is a distinctive walking pattern observed in individuals with unilateral weakness, commonly resulting from a stroke.
Key Characteristics:
- Arm Position:
- The patient typically holds the affected arm close to the body.
- The arm is often flexed, adducted, and internally rotated.
- Leg Position:
- The leg on the affected side remains extended, with the foot and toes in a plantar flexed position.
- Walking Pattern:
- As the person walks, they tend to drag the affected leg in a semicircular motion, a movement known as circumduction.
- This occurs due to weakness in the distal muscles, often referred to as foot drop.
- Hypertonia:
- There is notable extensor hypertonia in the lower limb, contributing to the leg’s stiffness.
- Arm Swing Loss:
- Even with mild hemiparesis, patients exhibit a reduction or complete loss of the normal arm swing on the affected side.
This gait pattern is most frequently seen in stroke survivors, and its severity can vary. In cases of mild hemiparesis, subtle changes such as slight circumduction and reduced arm swing might appear as the only noticeable signs.
Understanding the Cerebellar Gait
Cerebellar gait is a distinctive walking pattern often associated with issues in the cerebellum, a region in the brain responsible for motor control. This gait is commonly recognized for its telltale signs, such as a broad stance and a noticeable, wide-based staggering. Individuals with cerebellar issues may find themselves veering toward the side affected by the impairment. For instance, if the left cerebellar hemisphere has a problem, a person might fall toward the left side.
While stationary, individuals might exhibit a swaying motion of the trunk, known as titubation. This instability is further apparent when performing various cerebellar function tests, highlighting their struggle to maintain balance.
How Cerebellar Gait Differs from Other Gaits
One common misconception involves the Romberg test, which many mistakenly associate with cerebellar disease. In reality, this test evaluates proprioception, or the body’s ability to sense its position in space. When standing with eyes open, proprioception relies on joint signals to orient us. However, those with proprioceptive deficiencies—often due to peripheral nerve or spinal column issues—depend on visual cues. When asked to close their eyes, they begin to sway, resulting in a positive Romberg test, unrelated to cerebellar function.
In contrast, the cerebellar gait does not rely on visual input to manifest imbalance. The individual’s instability is already present, distinguishing it from other gait abnormalities primarily influenced by deficits in proprioception.
Understanding these differences is crucial for accurately diagnosing and addressing the root causes of various balance and coordination issues.
Gait Abnormality Treatment
Doctors will prescribe medications and physical therapy as treatments. If your child has any of the following conditions, your doctor may prescribe medication to help your child with an unsteady gait:
- Orthostatic Hypertension (OH).
- Parkinson’s disease (PD).
- Rhythmic Issues
- Lack of vitamin B-12.
Some conditions may necessitate surgery to correct the underlying cause of unsteady gait. These included spinal disorders, including lumbar spinal stenosis and cervical stenosis. Additionally, hearing aids for hearing problems, canes or walkers to help with walking, and vision correction with glasses or a new prescription for glasses are all possible treatments. If an underlying condition is causing an abnormal gait, the person’s walking should improve once the condition is treated. Furthermore, this is usually the case with broken bones, which can be treated with a cast. Other injuries may necessitate surgery or physical therapy to restore normal gait. Doctors will treat Long-term cases of abnormal gait with assistive devices. These could include:
- Knee braces
- Leg braces
- orthotics
- Walking canes
While treatment cannot completely cure an abnormal gait, it can reduce the severity of symptoms in a large number of cases. Only a medical professional can officially treat abnormal gait. A doctor will most likely ask about a person’s medical history and symptoms, as well as observe how they walk. A doctor may also order additional testing to rule out neurological conditions and nerve damage.
Gait Abnormality Physical Therapy
Physical therapists play an important role in assisting children to improve their gait. A physical therapist will collaborate with you to create a treatment plan that addresses your child’s unique needs and goals. Your physical therapist will assist you in retraining your child’s walking style. Variations in physical therapy methods occur because of the different underlying conditions — vestibular, neurological, or muscular. Your physical therapist may recommend balance exercises to help you stabilize your child’s walking pattern.
Treatment options may include
Without taking a single step, your physical therapist may begin your child’s treatment by having your child perform activities and exercises that will help parents understand how to improve your child’s gait. These exercises can range from simple activities like standing and lifting a leg in place to more complex strategies like stepping in place and contacting your child’s heel to the ground first, followed by other parts of the foot.
Neuromuscular Reeducation
Physical Therapists may use Neuromuscular reeducation techniques to activate any inactive muscle groups that affect Gait Abnormality.
Splinting or bracing
If your child’s gait dysfunction is caused by significant ligament weakness or paralysis, your physical therapist may teach you how to use adaptive equipment, such as a brace or splint, to help your child move.
If an underlying condition causes an abnormal gait, the person’s walk should improve once a doctor treats the condition. For example, broken bones can usually be treated with a cast. Other injuries may necessitate surgery or physical therapy to help restore normal gait. While treatment cannot always completely correct an abnormal gait, it can usually reduce the severity of symptoms.
Gait Abnormality Prevention
Finally, in some cases, a person can do nothing to prevent an abnormal gait caused by genetics or a medical condition. However, people can take precautions to avoid injuries that result in an abnormal gait. Preventative measures include:
- Refraining from participating in contact sports.
- Wearing protective gear
- During physical activity, wear well-fitting footwear.
- If necessary, wear leg braces
Why Choose Medical City Children’s Orthopedics and Spine Specialists
Finally, our doctors at Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX, understand the importance of maintaining your child’s health. In addition, our experts and specialists have the training, knowledge, and experience required to treat children with an abnormal gait. If you believe your child may have an abnormal gait or any other kind of condition, don’t hesitate to call our office to schedule an appointment to get a proper diagnosis at one of our four locations.
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Footnote:
Medical News Today: What is an Abnormal Gait
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