Gait is a fundamental aspect of human locomotion, influenced by the central and peripheral nervous systems. A normal gait relies on the coordinated interaction between the spinal intraneuronal network, brainstem, motor and premotor cortex, and cerebellum. Disruptions in this system can lead to gait abnormalities.
Types of Gait Problems
Gait abnormalities are classified as either episodic or chronic. Episodic disturbances, such as freezing gait and festinating gait, occur suddenly and can lead to falls. Chronic disturbances develop over time, allowing the patient to adapt. These are often due to long-term neurological dysfunction, which is more common than non-neurological causes.
How Does Your Normal Gait Cycle Function?
Gait, balance, and sensorimotor function can be affected by diseases or the aging process. Abnormalities are seen in 8–19% of older adults, with 14% of those over 65 and 50% of those over 85 experiencing such issues.
NICE Guidelines for Identifying and Referring Individuals with Suspected Neurological Disorders:
A sudden onset of unsteady gait should prompt an evaluation for stroke or TIA.
Rapidly progressive gait ataxia over days to weeks requires urgent referral to a neurologist.
Gradually progressive gait ataxia should also be referred to a neurologist. The GP should consider screening for alcohol consumption, vitamin B12 deficiency, folate deficiency, thyroid dysfunction, and celiac disease.
Gait apraxia, characterized by difficulty initiating or coordinating walking, should be referred to neurology or geriatric care to rule out normal pressure hydrocephalus.
Individuals at high risk of falls due to gait abnormalities should undergo a falls assessment and may require referral to a falls service.
Types of Gait Abnormalities
Musculoskeletal Issues:
Antalgic gait: A limping pattern caused by pain, where the stance phase is shorter than the swing phase.
Vaulting gait: A compensatory mechanism, often seen in children with limb length discrepancy, causing pelvic drooping.
Neurological Issues:
Trendelenburg gait: The pelvis drops to the unaffected side due to weakness in the hip abductors.
Steppage gait: The inability to perform a heel strike, leading to initial toe contact, and foot drop.
Waddling gait: Toe-walking with bilateral Trendelenburg gait, often caused by proximal muscle weakness.
Scissor gait: A gait abnormality commonly seen in individuals with cerebral palsy.
Ataxic gait: A broad-based, unsteady gait, usually seen in cerebellar syndromes.
Hemiparetic gait: Characterized by slow movement, a broad stance, and lateral circumduction of the paretic leg during the swing phase.
Festinating gait: A short-stepped, hurried gait with weak arm swings, often seen in Parkinson’s disease. Some patients may also experience freezing and difficulty turning.
Propulsive gait: A walking pattern where the center of gravity is shifted forward.
In conclusion, gait abnormalities are common and tend to increase with age. Some are caused by underlying health conditions that may improve with treatment, while others require lifelong care. A gait abnormality increases the risk of injury and falls, so taking precautions and consulting a healthcare provider for guidance is essential.
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