Do you know what your gait depends on? It turns out that with various diseases, not only a person’s appearance and facial expression changes, but also a person’s gait. An experienced doctor can often make a diagnosis just by looking at the patient. Many internal ailments are reflected in our appearance, and assessing how a person looks, moves, what kind of gait, posture, manner of sitting and standing they have, largely helps a specialist make the correct diagnosis, and then support it with various studies.
Doctors very often ask the patient to walk around the office, assessing gait.
What ailments can your gait tell about?
If, when walking, the shoulders are bent forward, as if protecting the chest and abdomen, the head is slightly retracted, there is a manner of clasping hands on the stomach - a sign of diseases of the gastrointestinal tract: chronic gastritis, stomach ulcers, duodenal ulcers.
If a person walks as if on prosthetics, trying to bend his knees as little as possible, takes small steps, he has to make an effort to sit down and especially stand up, there are problems with the joints: arthrosis, arthritis.
A person walks holding his head like a crystal vase, turning not his neck, but his entire body - cervical osteochondrosis. In combination with general pallor - severe headaches, migraines. If at the same time the head is tilted slightly to one side, we can talk about myositis - inflammation of the neck muscles.
A person who holds himself too straight, bends his whole body, without bending his back, is a sign of ankylosing spondylitis.
An unsteady gait, as if constantly searching for support, is characteristic of those who suffer from dizziness due to problems with blood pressure or vegetative-vascular dystonia.
“Gait can tell not only about illnesses, but also about a person’s psychological problems. Observe your movements and determine what your problem is.”
A shuffling gait coupled with drooping shoulders and head is a symptom of deep depression.
A nervous, hinge-like gait, excessive gesticulation even during a calm conversation are a sign of neuroses and psychopathy.
Retardation of movements, low mobility, stiffness of the hands are a sign of a serious mental disorder, including schizophrenia.
Even a barely noticeable shaking of the head indicates atherosclerosis of the cerebral vessels or neurological problems; in young people this is often post-traumatic parkinsonism. Trembling hands indicate vascular pathology.
If a person has suffered a mini-stroke, then while walking he falls to one side and makes a characteristic movement: the arm is pressed to the body, the leg is moved to the side.
A cautious gait, fear of touching something, arms pressed to the body - some kind of chronic pain syndrome.
A shaking gait, as if a person is stepping on hot coals, is a sign of gout or polyarthritis.
If a person walks with his legs apart, as if on stilts, and sits mostly sideways, then we may be talking about hemorrhoids.
Gait can tell not only about ailments, but also about a person’s psychological problems, since when problems arise, the brain receives a signal and transmits it to the muscles, and this is reflected, among other things, in the gait. Observe your movements and determine what your problem is.
General's gait- marches, taking a step. Thus, a person demonstrates strength and superiority, but is often overly self-confident and cruel.
Spy- walks as if sneaking, stands not on the heel, but on the entire foot, strongly straining the calf muscle. Such a person is cautious and afraid to take responsibility. This gait develops in those who have no one to rely on in life.
Jumping- walks, almost without touching the ground with his heel, springs on tiptoes, striving upward. Such a person has his head in the clouds, dreams of something, considers himself an unrecognized genius.
Senile- shuffles, walks slowly, dragging his feet behind him. This gait usually occurs in the elderly, as well as in people who lack ambition, are weak-willed, lazy, and slow.
Star- theatrical movements, chin raised very high, steps measured and precise. Pretense is revealed if the pace of walking is accelerated: with a majestic posture, a fussy step looks unnatural and absurd. So the gait speaks of inflated self-esteem, arrogance, snobbery.
Marine- walks with a sway, legs spread wide. Such a person has no confidence in the future. The official position is precarious, family relationships are bursting at the seams. It’s not for nothing that sailors who spend most of their lives away from home walk like this.
Elephant- stomps loudly, shaking surrounding objects. Moreover, the “loudness” of a person’s gait completely depends on a person’s weight. Such a person is timid and shy, trying to compensate for the lack of willpower and rigor with a heavy gait.
Walking dysbasia or gait disturbance - causes of unsteadiness in older people
Balance and gait disorders are relatively common phenomena, also called unsteadiness of gait.
Walking dysbasia occurs more often in older people with deteriorating vision.
This condition is caused by various diseases, alcoholic beverages, drugs, and sedatives.
The appearance of gait disturbances in some cases is associated with infections of the inner ear.
Symptoms of gait dysbasia
The name of the disease contains the Greek prefix dys, meaning “disturbance.” A typical manifestation of the disease is gait asymmetry.
For example, a person takes a normal step with his leading leg, and then slowly pulls up the second. Difficulties may arise at the very beginning of the movement.
The patient cannot lift his feet off the floor, he stomps in one place and takes small steps.
Common symptoms of dysbasia:
- inability to bend the leg joints normally;
- constant collisions with objects around;
- difficulties in performing turns;
- difficulty walking up stairs;
- feeling of stiff muscles;
- stumbling, falling;
- muscle weakness;
- trembling in the legs.
Similar symptoms can occur when blood vessels are damaged and connections between brain structures (BM) are disrupted. More bizarre gait changes are associated with hysteria.
This is walking in a zigzag, sliding movements, half-bent legs. Joint diseases are often manifested by a slow, unsteady gait and shortened stride.
Causes of the disease
Two main groups of factors that lead to gait dysbasia are anatomical and neurological.
Diseases of the musculoskeletal system, brain and spinal cord cause gait disturbances.
Thus, based on a disorder of vascular innervation, angioedema occurs.
Lesions of the intervertebral disc in the lower back also affect gait.
Anatomical reasons
Anatomical causes of gait dysbasia:
- excessively inwardly rotated femur;
- lower limbs of unequal length;
- congenital dislocations of the legs.
Most often, dysbasia appears in various diseases of the central nervous system.
Shaking paralysis, muscular dystrophy, sclerosis are serious lesions in which walking is often impaired.
The same effect occurs with the abuse of alcohol, sedatives, and drug use.
Neurological causes of dysbasia
Neurological causes of dysbasia:
- damage to the sheaths of nerve fibers of the GM and SC (sclerosis);
- peroneal nerve palsy of the lower limb;
- shaking palsy or;
- circulatory disorders in the vessels of the brain;
- functional disorders in the cerebellum;
- pathologies of the frontal lobe of the brain;
- cerebral palsy.
A deficiency of vitamin B12 in the body leads to a feeling of numbness in the limbs.
As a result, a person cannot determine the position of his feet in relation to the floor surface.
Diabetes mellitus worsens balance problems due to decreased sensation in the lower extremities.
Types of dysbasia
A cautious, shuffling gait and difficulty maintaining balance are the most common symptoms of gait dysbasia.
There are other manifestations, on the basis of which experts distinguish several types of violations.
Ataxia is a violation of the coordination of muscle movements. The sick person staggers when walking and cannot move without assistance.
There are several causes of ataxia, one of the main ones is damage to the cerebellum. The coordination of muscle movements is disrupted in vestibular disorders.
Frontal dysbasia
The sick person partially or completely loses the ability to walk.
Such disorders appear with extensive damage to the frontal lobes of the brain. This type of dysbasia is often accompanied by,.
Hemiparetic gait (“squinting”)
The victim has difficulty lifting the affected leg from the surface and moving it forward, performing an outward circular movement with the limb.
The person tilts his body in the opposite direction. Hemiparetic gait occurs with injuries, tumors of the cerebral and spinal cord.
Hypokinetic gait (“shuffling”)
The patient stomps on the spot for a long time, then makes slow, stiff movements of his legs.
The body posture is tense, steps are short, turns are difficult. The causes can be many diseases and syndromes.
"Duck" gait
Muscle weakness, paresis, congenital hip dislocations are the main causes of difficulty in lifting the leg and moving forward.
The patient tries to carry out such actions by turning the pelvis and tilting the body.
The pathology usually occurs in both limbs, so a person’s gait resembles the movement of a duck - the body waddles to the left and then to the right.
The fact is that walking dysbasia is characterized by a variety of symptoms and causes.
This makes it difficult to choose which doctor the patient should see first.
You will need the help of a neurologist, traumatologist, or surgeon. Sometimes consultations with an endocrinologist, otolaryngologist or ophthalmologist are needed.
When a patient has dysbasia, a neurologist uses various diagnostic techniques.
The patient is prescribed a study of the cerebrospinal fluid, x-ray, CT, MRI, ultrasound. You need to take general and biochemical blood tests.
Treatment of walking disorders
Medications can help relieve pain.
Complex treatment will be required, long-term and requiring persistence on the part of the patient.
Piracetam - a remedy for dysbasia
The course of therapy often includes massage, therapeutic exercises, and physiotherapy.
Drug treatment of dysbasia:
- Piracetam is a nootropic drug. Improves microcirculation and metabolism in neurons. An analogue of the active substance is the drug Memotropil;
- Tolperisone is a muscle relaxant. Reduces pain in the area of peripheral nerve endings, eliminates increased muscle tone;
- Mydocalm - tolperisone in combination with lidocaine (local anesthetic);
- Tolpecaine is a muscle relaxant and local anesthetic;
- Ginkoum is an angioprotector of plant origin. Reduces permeability and normalizes metabolic processes in the vascular wall.
Conclusion
Walking dysbasia occurs in many dangerous diseases.
It is necessary to undergo an examination as early as possible so that specialists can establish the causes, type of walking impairment and prescribe adequate treatment.
The course of therapy is long and includes the use of nootropic drugs, muscle relaxants and angioprotectors.
Video: How to fix a duck walk
If a child walks on his toes, the reasons for the phenomenon are different. In one child this tendency indicates illness, while in another it is a common desire to become taller. Is this a harmless symptom, what to do in this or that case? Let's figure it out together!
The main reasons for walking on toes
When a child walks on his toes, the reasons may lie in both pathology and behavior. It is considered within the normal range when a child under one year of age moves by swaying from side to side, turning his feet, or lifting himself up using his toes.
If a child walks on his toes, the reasons may be play, fear and apprehension. In order not to give away his location with loud steps, he moves on tiptoe.
Reasons for walking on toes may include:
- Cold floor in the house.
- The presence of a splinter or the memory of it.
- Attracting parents' attention.
- Copying the gait of women in heels.
Parents also have reasons for concern; we are talking about five diseases:
cerebral palsy
A disease that develops in young children. The reason for its appearance is the incorrect course of pregnancy or the birth process. Walking on tiptoes is the main symptom.
Birth injury or premature birth
It is possible to find out about such a deviation long before parents see the first steps of their child.
Pyramidal insufficiency
It manifests itself in disorders of the nervous system. According to doctors, this is a common diagnosis.
Incorrect placement of two feet or feet
This phenomenon appears in children who were put into walkers from an early age.
Muscular dystonia
With muscular dystonia, there is a disturbance in the child’s activity and increased muscle tone.
Causes of improper walking at different ages
Reasons for a two-year-old child
A small child may simply like to walk on his toes. If a child is 2 years old and walks on his toes, the reasons are often harmless. For prevention and to calm your child, you can sign up for a foot massage.
Speaking about the development of diseases, they are detected by the end of the first year of life and manifest themselves with more terrible symptoms.
When a child walks on his toes, Komarovsky sees this as the reason that his calf muscles are developed. The doctor doesn’t find anything wrong with this pattern.
To the reasons for walking on toes the doctor attributes the habit that is developed after a long stay in a walker. In an incorrectly selected walker, the baby is unable to rest his entire foot on the surface.
Reasons for a five-year-old child
If a child is 5 years old and walks on his toes, are there any good reasons? Firstly, if you have any concerns, it is recommended to consult a doctor - pediatrician, orthopedist, neurologist.
As many doctors say, if a child walks on his toes at 3-4 years old, the reasons are not serious, provided there are no other symptoms. This phenomenon goes away over time without special treatment. By the age of five, it disappears and children begin to step on their full feet.
Parents should be concerned if they notice:
- Loss of appetite.
- Sleep disturbance.
- Incorrect coordination.
- Complaints of headaches.
- Decreased activity.
If these symptoms are present, you should contact a neurologist, who, after examination, will prescribe additional examination.
Causes in older children
A clawed foot is a possible reason for a child walking on his toes. The development of deformity can be affected by injuries and pathologies of the neuromuscular system. If a child is 8 years old and walks on his toes, the reasons lie in the development of the musculoskeletal system and neurology.
It’s one thing if he stands on his toes because of his mood or necessity. And it’s completely different if he regularly moves like this.
Parents should monitor their child's behavior for other symptoms.
Especially if the child has previously been diagnosed with or.
It is rare to encounter a child suddenly starting to stand on tiptoes. More often, the deviation appears from the moment the baby begins to take his first steps.
When a 10-year-old child walks on his toes, the reasons may be the same as in younger children. Perhaps the child wants to relieve emotional stress in this way. This symptom can occur in a child with hyperactivity, increased excitability, or in a shy child prone to anxiety.
Medical treatment of toe walking
Drug treatment may involve taking certain medications. Their choice largely depends on the reason for the child walking on his toes. These can be either vitamin complexes or serious drugs that affect the nervous system.
The doctor may prescribe:
- A course of physiotherapy, UHF or electrophoresis.
- Taking baths with herbs.
- Massage.
- Daily gymnastics.
- Swimming.
These treatments are effective, efficient and proven. Thanks to their implementation, you can get rid of the disease in less than a month. Provided you consult a doctor in a timely manner.
Don't remain indifferent to the fact that your child often walks on his toes! It is better to consult a doctor and find out the true cause as early as possible. The health of the child and his happy life depend only on you.
Giving the child a massage
If your child regularly walks on his toes, massage may be required. It is advisable that the massage be performed by an experienced specialist.
Effective massage techniques can be performed at home:
Flexion and straightening of the foot
The movement is performed reflexively. To do this, you need to gently press on the area that is under the fingers, moving from the little finger towards the heel.
Stroking movements on the foot
Massage movements should be clear and painless To perform this, place the index and middle finger of one hand on the instep of the foot, and hold the child’s foot with the other. Use your thumb to draw a figure eight along the foot.
Stepping
A small child should be placed on a hard, flat surface and forced to walk on it. The child must be held in weight, under the arms, making sure that he fully rests on all feet.
Squats
It will take 15 sessions to restore normal walking. For prevention purposes, it is recommended to repeat the course after a month.
If a child walks on his toes, and the parents don’t know what to do, It is recommended to listen to the following 5 tips:
- Take a thorough approach to the choice of shoes, giving preference to orthopedic models. The most important thing is that the instep of the foot is secured with lacing or Velcro fasteners. It is recommended to buy shoes that fit and are made from quality material. Ideally genuine leather.
- Try to get him to walk barefoot at home. It’s good if a child walks barefoot outside in the summer - on sand, shells, stones and grass. Walking on such surfaces will be a kind of massage that promotes the correct formation of the foot.
- For schoolchildren, the doctor recommends active exercises: jumping, walking on an inclined surface, bear walk, walking on heels, goose step.
- Do therapeutic exercises and perform simple exercises at home. Your baby should start every morning with exercise. For the purpose of treatment and prevention, it is recommended to exercise.
Using these tips, you will be able to teach your child to walk on a full foot and avoid further deviations.
What will happen if left untreated?
Constantly walking on the tiptoes of a child can negatively affect his posture. If a child walks on his toes over the age of 7 years, finding out the reasons should be entrusted to a competent doctor. Most often they are associated with pathological processes.
The sad consequences that tiptoeing leads to:
- Clubfoot.
- Flat feet.
- Incorrect posture.
- Curvature of the legs.
- Pain in the back and legs.
- Developmental delay.
- Torticollis.
If a child constantly stands on his toes, his heel will stop developing and its growth will slow down. The part of the foot on which he walks will begin to grow, making it disproportionate.
No matter how harmless the symptom of tiptoeing may seem, the child must be shown to a doctor for examination and to identify the causes of such deviation.
Gait is the physiognomy of the body, according to Balzac. By a person’s gait you can determine not only his gender and age, but also his mood, character, and social affiliation. How to determine the meaning of gait?
Let's start with the simplest thing - with the gait of a confident person. If a person walks smoothly, straight, swiftly, the pace of his steps is fast, this indicates the confidence of the owner of such a gait.
If a person shuffles his feet, his arms dangle out of step, and his head is lowered, it feels like he is going to execution or carrying a heavy burden, this indicates a disorder of feelings, deep depression. Perhaps the person is in a state of crisis or is facing a not very pleasant meeting. Therefore, if you notice that a person is walking towards a meeting with you, shuffling his feet, this may indicate his reluctance to see you, he does this out of necessity.
A bouncing gait (a person seems to be springing on his feet) can have a double meaning. First. The direct meaning of such a gait is a happy, unclouded mood, joyful events occur in a person’s life, he is happy and cheerful, cheerful, and positive. The second meaning, more hidden: a person deliberately tries to be cheerful and carefree, although in fact he is oppressed by something. It is very easy to calculate imaginary joy; just pay attention to facial expressions and gestures.
If a person does not straighten his knees and walks on half-bent legs, this may be evidence of his advanced age and pain in the joints, but if the owner of such a gait is young, then this feature indicates that he is unsure of himself, withdrawn, and suspicious.
If a person throws his legs strongly to the sides, his hands can rest in his pockets or prop up his sides, his posture resembles the letter “F”. This is either a sign of excessive self-confidence or carelessness, lack of employment, or constant idleness. He paces this way because he simply has nowhere to rush, he is not burdened with any responsibilities.
A careful person very often, when walking, first steps on his heels and rolls lightly onto his toes; you will never see him resting on his entire foot. He is careful in everything, including his gait.
If a person knocks his feet very hard while walking, this means that he wants to attract as much attention as possible from others. He feels like a very important person, wanting to loudly announce his appearance.
Women's gait should be discussed separately. By the way a woman moves, you can determine her goal, her life attitude. If a woman walks slowly, taking small steps, smoothly swaying her hips, then she is currently in the mood to find a companion, her goal is to attract surrounding men.
If a woman walks confidently, kicking her heels, her hips move from side to side very sharply, this indicates her mood for business communication. This is a firm, business woman who is unlikely to easily give up her principles.
A woman shifts from one leg to another, which means she has not learned to use the most important female tool - gait. Such a woman is used to doing housework. Her destiny is home, life, family. Perhaps she is a mother of many children.
- Atactic gait:
- cerebellar;
- stamping (“tabetic”);
- with vestibular symptom complex.
- “Hemiparetic” (“mowing” or “triple shortening” type).
- Paraspastic.
- Spastic-atactic.
- Hypokinetic.
- Apraxia of walking.
- Idiopathic senile dysbasia.
- Idiopathic progressive freezing dysbasia.
- Gait in the “skater position” in idiopathic orthostatic hypotension.
- “Peroneal” gait - unilateral or bilateral stepping.
- Walking with hyperextension of the knee joint.
- "Duck" gait.
- Walking with pronounced lordosis in the lumbar region.
- Gait in diseases of the musculoskeletal system (ankylosis, arthrosis, tendon retraction, etc.).
- Hyperkinetic gait.
- Dysbasia in mental retardation.
- Gait (and other psychomotor skills) in advanced dementia.
- Psychogenic gait disorders of various types.
- Dysbasia of mixed origin: complex dysbasia in the form of gait disturbances against the background of certain combinations of neurological syndromes: ataxia, pyramidal syndrome, apraxia, dementia, etc.
- Iatrogenic dysbasia (unsteady or “drunk” gait) due to drug intoxication.
- Dysbasia caused by pain (antalgic).
- Paroxysmal gait disturbances in epilepsy and paroxysmal dyskinesias.
Atactic gait
Movements in cerebellar ataxia are poorly commensurate with the characteristics of the surface on which the patient walks. Balance is disturbed to a greater or lesser extent, which leads to corrective movements that give the gait a chaotic character. Characteristic, especially for lesions of the cerebellar vermis, is walking on a wide base as a result of instability and staggering.
The patient often staggers not only when walking, but also when standing or sitting. Sometimes titubation is detected - a characteristic cerebellar tremor of the upper half of the body and head. Dysmetria, adiadochokinesis, intention tremor, and postural instability are identified as accompanying signs. Other characteristic signs may also be detected (scanned speech, nystagmus, muscle hypotonia, etc.).
Main reasons: cerebellar ataxia accompanies a large number of hereditary and acquired diseases that occur with damage to the cerebellum and its connections (spinocerebellar degenerations, malabsorption syndrome, alcoholic cerebellar degeneration, multiple system atrophy, late cerebellar atrophy, hereditary ataxias, OPCA, tumors, paraneoplastic cerebellar degeneration and many other diseases).
When the conductors of deep muscular sense are damaged (most often at the level of the posterior columns), sensitive ataxia develops. It is especially pronounced when walking and is manifested by characteristic movements of the legs, which are often defined as a “stamping” gait (the leg is forcefully lowered with the entire sole to the floor); in extreme cases, walking is generally impossible due to loss of deep sensitivity, which is easily revealed by examining the muscle-articular sense. A characteristic feature of sensitive ataxia is its correction by vision. The Romberg test is based on this: when the eyes are closed, sensory ataxia increases sharply. Sometimes, with the eyes closed, pseudoathetosis is detected in the arms extended forward.
Main reasons: Sensitive ataxia is characteristic not only of damage to the posterior columns, but also of other levels of deep sensitivity (peripheral nerve, dorsal root, brain stem, etc.). Therefore, sensitive ataxia is observed in the picture of such diseases as polyneuropathy (“peripheral pseudotabes”), funicular myelosis, tabes dorsalis, complications of treatment with vincristine; paraproteinemia; paranesplastic syndrome, etc.)
With vestibular disorders, ataxia is less pronounced and manifests itself more in the legs (staggering when walking and standing), especially at dusk. Severe damage to the vestibular system is accompanied by a detailed picture of the vestibular symptom complex (systemic dizziness, spontaneous nystagmus, vestibular ataxia, autonomic disorders). Mild vestibular disorders (vestibulopathy) are manifested only by vestibular stress intolerance, which often accompanies neurotic disorders. With vestibular ataxia there are no cerebellar signs and impairment of muscle-articular sense.
Main reasons: vestibular symptom complex is characteristic of damage to the vestibular conductors at any level (cerumen plugs in the external auditory canal, labyrinthitis, Meniere's disease, acoustic neuroma, multiple sclerosis, degenerative lesions of the brain stem, syringobulbia, vascular diseases, intoxications, including drugs, cranial brain injury, epilepsy, etc.). A kind of vestibulopathy usually accompanies psychogenic chronic neurotic conditions. For diagnosis, analysis of complaints of dizziness and accompanying neurological manifestations is important.
"Hemiparetic" gait
Hemiparetic gait is manifested by extension and circumduction of the leg (the arm is bent at the elbow joint) in the form of a “squinting” gait. When walking, a paretic leg is exposed to body weight for a shorter period than a healthy leg. Circumduction (circular movement of the leg) is observed: the leg extends at the knee joint with slight plantar flexion of the foot and performs a circular movement outward, while the body deviates slightly in the opposite direction; the homolateral arm loses some of its functions: it is bent at all joints and pressed against the body. If a stick is used when walking, it is used on the healthy side of the body (for which the patient bends over and transfers his weight to it). With each step, the patient raises the pelvis to lift the straightened leg off the floor and has difficulty moving it forward. Less commonly, the gait is upset by the “triple shortening” type (flexion in three joints of the leg) with a characteristic rise and fall of the pelvis on the side of paralysis with each step. Associated symptoms: weakness in the affected limbs, hyperreflexia, pathological foot signs.
The legs are usually extended at the knee and ankle joints. The gait is slow, the legs “shuffle” along the floor (the soles of the shoes wear out accordingly), sometimes they move like scissors with their crossing (due to increased tone of the adductor muscles of the thigh), on the toes and with a slight curling of the toes (“pigeon” toes). This type of gait disturbance is usually caused by more or less symmetrical bilateral damage to the pyramidal tracts at any level.
Main reasons: Paraspastic gait is most often observed under the following circumstances:
- Multiple sclerosis (characteristic spastic-atactic gait)
- Lacunar state (in elderly patients with arterial hypertension or other risk factors for vascular diseases; often preceded by episodes of minor ischemic vascular strokes, accompanied by pseudobulbar symptoms with speech impairment and bright reflexes of oral automaticity, gait with small steps, pyramidal signs).
- After a spinal cord injury (history, level of sensory disorders, urinary disorders). Little's disease (a special form of cerebral palsy; symptoms of the disease are present from birth, there is a delay in motor development, but normal intellectual development; often only selective involvement of the extremities, especially the lower ones, with scissor-like movements with crossing the legs while walking). Familial spastic spinal palsy (hereditary slowly progressive disease, symptoms often appear in the third decade of life). In cervical myelopathy in the elderly, mechanical compression and vascular insufficiency of the cervical spinal cord often cause a paraspastic (or spastic-atactic) gait.
As a result of rare, partially reversible conditions, such as hyperthyroidism, portocaval anastomosis, lathyrism, damage to the posterior columns (with vitamin B12 deficiency or as paraneoplastic syndrome), adrenoleukodystrophy.
An intermittent paraspastic gait is rarely observed in the picture of “intermittent spinal claudication.”
Paraspastic gait is sometimes imitated by dystonia of the lower extremities (especially with the so-called dopa-responsive dystonia), which requires a syndromic differential diagnosis.
Spastic-atactic gait
With this gait disorder, a clear ataxic component is added to the characteristic paraspastic gait: unbalanced body movements, slight hyperextension in the knee joint, instability. This picture is characteristic, almost pathognomonic, of multiple sclerosis.
Main reasons: it can also be observed in subacute combined degeneration of the spinal cord (funicular myelosis), Friedreich's disease and other diseases involving the cerebellar and pyramidal tracts.
Hypokinetic gait
This type of gait is characterized by slow, stiff leg movements with decreased or absent cooperative arm movements and a tense posture; difficulty initiating walking, shortening the step, “shuffling”, difficult turns, marking time before starting to move, and sometimes “pulsion” phenomena.
Most Frequent etiological factors This type of gait includes:
- Hypokinetic-hypertensive extrapyramidal syndromes, especially parkinsonism syndrome (in which there is a slight flexor posture; there are no friendly movements of the arms while walking; rigidity, a mask-like face, quiet monotonous speech and other manifestations of hypokinesia, rest tremor, cogwheel phenomenon are also noted; slow gait, “shuffling”, rigid, with a shortened step; “pulsating” phenomena are possible when walking).
- Other hypokinetic extrapyramidal and mixed syndromes, including progressive supranuclear palsy, olivo-ponto-cerebellar atrophy, Shy-Drager syndrome, strio-nigral degeneration ("parkinsonism-plus" syndromes), Binswanger's disease, vascular "parkinsonism of the lower half of the body." In the lacunar state, there may also be a gait of the “marche a petits pas” type (small short irregular shuffling steps) against the background of pseudobulbar palsy with swallowing disorders, speech disorders and Parkinson-like motor skills. “Marche a petits pas” can also be observed in the picture of normal pressure hydrocephalus.
- Akinetic-rigid syndrome and a corresponding gait are possible with Pick's disease, corticobasal degeneration, Creutzfeldt-Jakob disease, hydrocephalus, frontal lobe tumor, juvenile Huntington's disease, Wilson-Konovalov disease, post-hypoxic encephalopathy, neurosyphilis and some other rarer diseases.
In young patients, torsion dystonia can sometimes begin with an unusual, tense, stiff gait due to dystonic hypertonicity in the legs.
Constantly active muscle fiber syndrome (Isaacs syndrome) is most often observed in young patients. Unusual tension of all muscles (mainly distal), including antagonists, blocks gait, as well as all other movements (armadillo gait)
Depression and catatonia may be accompanied by a hypokinetic gait.
Apraxia of walking
Apraxia of gait is characterized by the loss or decrease in the ability to properly use the legs in the act of walking in the absence of sensory, cerebellar and paretic manifestations. This type of gait occurs in patients with extensive cerebral damage, especially to the frontal lobes. The patient cannot imitate some movements with his legs, although certain automatic movements are preserved. The ability for a consistent composition of movements during “bipedal” walking decreases. This type of gait is often accompanied by perseveration, hypokinesia, rigidity and, sometimes, gegenhalten, as well as dementia or urinary incontinence.
A variant of walking apraxia is the so-called axial apraxia in Parkinson's disease and vascular parkinsonism; dysbasia in normal pressure hydrocephalus and other diseases involving frontal-subcortical connections. Isolated gait apraxia syndrome has also been described.
Idiopathic senile dysbasia
This form of dysbasia (“gait of the elderly,” “senile gait”) is manifested by a slightly shortened slow step, mild postural instability, and a decrease in cooperative arm movements in the absence of any other neurological disorders in elderly and old people. This dysbasia is based on a complex of factors: multiple sensory deficits, age-related changes in the joints and spine, deterioration of vestibular and postural functions, etc.
Idiopathic progressive freezing dysbasia
“Freezing dysbasia” is commonly seen in the presentation of Parkinson's disease; It is less common in multi-infarction (lacunar) conditions, multisystem atrophy and normal pressure hydrocephalus. But elderly patients have been described in whom “freezing dysbasia” is the only neurological manifestation. The degree of freezing varies from sudden motor blocks when walking to a complete inability to start walking. Biochemical tests of blood, cerebrospinal fluid, as well as CT and MRI show a normal picture, with the exception of mild cortical atrophy in some cases.
Skater's gait in idiopathic orthostatic hypotension
This gait is also observed in Shy-Drager syndrome, in which peripheral autonomic failure (mainly orthostatic hypotension) becomes one of the leading clinical manifestations. The combination of parkinsonian symptoms, pyramidal and cerebellar signs influences the gait characteristics of these patients. In the absence of cerebellar ataxia and severe parkinsonism, patients try to adapt gait and body posture to orthostatic changes in hemodynamics. They move with wide, slightly sideways, quick steps on their legs slightly bent at the knees, their torso bent low forward and their head down (“skater’s pose”).
"Peroneal" gait
Peroneal gait - unilateral (more often) or bilateral stepping. Steppage-type gait develops with the so-called foot drop and is caused by weakness or paralysis of dorsoflexion (dorsial flexion) of the foot and (or) toes. The patient either “drags” the foot when walking, or, trying to compensate for the drooping of the foot, raises it as high as possible in order to lift it off the floor. Thus, increased flexion in the hip and knee joints is observed; the foot is thrown forward and falls down onto the heel or the entire foot with a characteristic slapping sound. The support phase of walking is shortened. The patient is unable to stand on his heels, but can stand and walk on his toes.
The most common reason unilateral paresis of the foot extensors is a dysfunction of the peroneal nerve (compressive neuropathy), lumbar plexopathy, rarely damage to the roots of L4 and, especially, L5, as with a herniated intervertebral disc (“vertebral peroneal palsy”). Bilateral paresis of the extensors of the foot with bilateral “stepping” is often observed with polyneuropathy (paresthesia, sensory disturbances like stockings, absence or decrease in Achilles reflexes are noted), with Charcot-Marie-Tooth peroneal muscular atrophy - a hereditary disease of three types (high arches of the foot, atrophy of the lower leg muscles (stork legs), absence of Achilles reflexes, sensory disturbances are minor or absent), with spinal muscular atrophy - (in which paresis is accompanied by atrophy of other muscles, slow progression, fasciculations, absence of sensory disturbances) and with some distal myopathies ( scapulo-peroneal syndromes), especially in Steinert-strong atten-Gibb dystrophic myotonia.
A similar picture of gait disturbance develops when both distal branches of the sciatic nerve are affected (“foot drop”).
Walking with hyperextension of the knee joint
Walking with unilateral or bilateral hyperextension of the knee joint is observed with knee extensor paralysis. Paralysis of the knee extensors (quadriceps femoris) leads to hyperextension when supporting the leg. When the weakness is bilateral, both legs are hyperextended at the knee joints while walking; otherwise, transferring weight from foot to foot can cause changes in the knee joints. The descent down the stairs begins with a paretic leg.
Causes unilateral paresis include damage to the femoral nerve (loss of the knee reflex, impaired sensitivity in the area of innervation of n. saphenous) and damage to the lumbar plexus (symptoms similar to those with damage to the femoral nerve, but the abductor and iliopsoas muscles are also involved). The most common cause of bilateral paresis is myopathy, especially progressive Duchenne muscular dystrophy in boys, as well as polymyositis.
"Duck" gait
Paresis (or mechanical failure) of the abductor muscles of the thigh, that is, the hip abductors (mm. gluteus medius, gluteus minimus, tensor fasciae latae) leads to the inability to hold the pelvis horizontally in relation to the load-bearing leg. If the deficiency is only partial, then hyperextension of the trunk towards the supporting leg may be sufficient to shift the center of gravity and prevent pelvic distortion. This is the so-called Duchenne lameness, when there are bilateral disorders, this leads to an unusual “waddling” gait (the patient seems to waddle from one foot to the other, a “duck” gait). With complete paralysis of the hip abductors, the transfer of the center of gravity described above is no longer sufficient, which leads to a skew of the pelvis with each step in the direction of movement of the leg - the so-called Trendelenburg lameness.
Unilateral hip abductor palsy or insufficiency can be caused by damage to the superior gluteal nerve, sometimes as a result of intramuscular injection. Even in an inclined position, there is insufficient strength for external abduction of the affected leg, but there are no sensory disturbances. A similar deficiency is found in unilateral congenital or post-traumatic hip dislocation or postoperative (prosthetic) damage to the hip abductors. Bilateral paresis (or insufficiency) is usually a consequence myopathies, especially progressive muscular dystrophy, or bilateral congenital hip dislocation.
Walking with pronounced lordosis in the lumbar region
If the hip extensors are involved, especially the m. gluteus maximus, then climbing the stairs becomes possible only when the movement starts with the healthy leg, but when going down the stairs, the affected leg goes first. Walking on a flat surface is impaired, as a rule, only with bilateral weakness of m. gluteus maximus; such patients walk with a ventrally inclined pelvis and increased lumbar lordosis. With unilateral paresis of m. gluteus maximus, it is impossible to move the affected leg backward, even in a pronated position.
Reason There is always (rare) damage to the inferior gluteal nerve, for example due to intramuscular injection. Bilateral paresis m. gluteus maximus is found most often in the progressive form of pelvic girdle muscular dystrophy and Duchenne form.
Occasionally, the literature mentions the so-called lumbar-femoral extension rigidity syndrome, which manifests itself as reflex disorders of muscle tone in the extensors of the back and legs. In an upright position, the patient has a fixed, mildly expressed lordosis, sometimes with a lateral curvature. The main symptom is the “board” or “shield”: in a supine position with passive lifting of outstretched legs by both feet, the patient has no flexion in the hip joints. Walking of a jerky nature is accompanied by compensatory thoracic kyphosis and forward tilt of the head in the presence of rigidity of the cervical extensor muscles. The pain syndrome is not the leading one in the clinical picture and is often of a vague, abortive nature. A common cause of the syndrome: fixation of the dural sac and filum terminale by a cicatricial adhesive process in combination with osteochondrosis due to dysplasia of the lumbar spine or with a spinal tumor at the cervical, thoracic or lumbar level. Regression of symptoms occurs after surgical mobilization of the dural sac.
Hyperkinetic gait
Hyperkinetic gait is observed with various types of hyperkinesis. These include diseases such as Sydenham's chorea, Huntington's chorea, generalized torsion dystonia (camel gait), axial dystonic syndromes, pseudo-expressive dystonia and foot dystonia. More rare causes of walking impairment are myoclonus, trunk tremor, orthostatic tremor, Tourette's syndrome, and tardive dyskinesia. In these conditions, the movements necessary for normal walking are suddenly interrupted by involuntary, erratic movements. A strange or “dancing” gait develops. (This gait in Huntington's chorea sometimes looks so strange that it may resemble psychogenic dysbasia). Patients must constantly combat these disturbances in order to move purposefully.
Gait disturbances in mental retardation
This type of dysbasia is a problem that has not yet been sufficiently studied. Awkward standing with the head too bent or straightened, pretentious position of the arms or legs, awkward or strange movements - all this is often found in children with mental retardation. In this case, there are no disturbances in proprioception, as well as cerebellar, pyramidal and extrapyramidal symptoms. Many motor skills developed in childhood are age dependent. Apparently, unusual motor skills, including gait, in mentally retarded children are associated with delayed maturation of the psychomotor sphere. It is necessary to exclude conditions comorbid with mental retardation: cerebral palsy, autism, epilepsy, etc.
Gait (and other psychomotor behavior) in advanced dementia
Dysbasia in dementia reflects the total breakdown of the ability to organize, purposeful and adequate action. Such patients begin to attract attention with their disorganized motor skills: the patient stands in an awkward position, marks time, spins, being unable to purposefully walk, sit down and adequately gesture (disintegration of “body language”). Fussy, chaotic movements come to the fore; the patient looks helpless and confused.
Gait can change significantly in psychosis, in particular in schizophrenia (“shuttle” motor skills, movements in a circle, stamping and other stereotypies in the legs and arms while walking) and obsessive-compulsive disorders (rituals while walking).
Psychogenic gait disorders of various types
There are gait disturbances, often similar to those described above, but developing (most often) in the absence of ongoing organic damage to the nervous system. Psychogenic gait disorders often begin acutely and are provoked by an emotional situation. They are variable in their manifestations. They may be accompanied by agoraphobia. The predominance of women is typical.
This gait often looks strange and is difficult to describe. However, careful analysis does not allow us to classify it as a known example of the above-mentioned types of dysbasia. Often the gait is very picturesque, expressive or extremely unusual. Sometimes it is dominated by the image of falling (astasia-abasia). The patient's entire body reflects a dramatic call for help. During these grotesque, uncoordinated movements, patients appear to periodically lose their balance. However, they are always able to hold themselves up and avoid falling from any awkward position. When the patient is in public, his gait may even acquire acrobatic features. There are also quite characteristic elements of psychogenic dysbasia. A patient, for example, demonstrating ataxia, often walks, “plaiting” his legs, or, showing paresis, “drags” his leg, “dragging” it along the floor (sometimes touching the floor with the dorsum of the big toe and foot). But a psychogenic gait can sometimes outwardly resemble the gait of hemiparesis, paraparesis, cerebellar diseases, and even parkinsonism.
As a rule, there are other conversion manifestations, which are extremely important for diagnosis, and false neurological signs (hyperreflexia, Babinski pseudosymptom, pseudoataxia, etc.). Clinical symptoms must be assessed comprehensively, and it is very important in each such case to discuss in detail the likelihood of true dystonic, cerebellar or vestibular gait disorders. All of them can sometimes cause erratic changes in gait without sufficiently clear signs of organic disease. Dystonic gait disorders more often than others may resemble psychogenic disorders. Many types of psychogenic dysbasia are known and their classifications have even been proposed. Diagnosis of psychogenic movement disorders should always be subject to the rule of their positive diagnosis and the exclusion of organic disease. It is useful to use special tests (Hoover test, weakness of the sternocleidomastoid muscle, and others). The diagnosis is confirmed by the effect of placebo or psychotherapy. Clinical diagnosis of this type of dysbasia often requires specialized clinical experience.
Psychogenic gait disorders are rarely observed in children and the elderly
Dysbasia of mixed origin
Often there are cases of complex dysbasia against the background of certain combinations of neurological syndromes (ataxia, pyramidal syndrome, apraxia, dementia, etc.). Such diseases include cerebral palsy, multiple system atrophy, Wilson-Konovalov disease, progressive supranuclear palsy, toxic encephalopathies, some spinocerebellar degenerations and others. In such patients, the gait bears the features of several neurological syndromes at the same time, and its careful clinical analysis is needed in each individual case in order to assess the contribution of each of them to the manifestations of dysbasia.
Dysbasia iatrogenic
Iatrogenic dysbasia is observed during drug intoxication and is often ataxic (“drunk”) in nature, mainly due to vestibular or (less often) cerebellar disorders.
Sometimes such dysbasia is accompanied by dizziness and nystagmus. Most often (but not exclusively) dysbasia is caused by psychotropic and anticonvulsant (especially difenin) drugs.
Dysbasia caused by pain (antalgic)
When there is pain while walking, the patient tries to avoid it by changing or shortening the most painful phase of walking. When the pain is unilateral, the affected leg bears weight for a shorter period. The pain may occur at a certain point in each step, but may be present throughout the entire act of walking or gradually decrease with continuous walking. Gait disturbances caused by pain in the legs most often manifest themselves externally as “lameness.”
Intermittent claudication is a term used to describe pain that occurs only when walking a certain distance. In this case, the pain is due to arterial insufficiency. This pain regularly appears when walking after a certain distance, gradually increases in intensity, and over time occurs at shorter distances; it will appear more quickly if the patient climbs up or walks quickly. The pain causes the patient to stop, but disappears after a short period of rest if the patient remains standing. The pain is most often localized in the lower leg area. The typical cause is stenosis or occlusion of blood vessels in the upper thigh (typical history, vascular risk factors, absence of foot pulses, murmur over proximal blood vessels, no other cause of pain, sometimes stocking-type sensory disturbances). In such circumstances, there may be additional pain in the perineum or thigh caused by occlusion of the pelvic arteries, such pain must be differentiated from sciatica or a process affecting the cauda equina.
Cauda equina claudication (caudogenic) is a term used to describe pain due to root compression, observed after walking various distances, especially when descending. Pain is a consequence of compression of the roots of the cauda equina in the narrow spinal canal at the lumbar level, when the addition of spondylous changes causes an even greater narrowing of the canal (canal stenosis). Therefore, this type of pain is most often found in older patients, especially men, but can also occur in young adults. Based on the pathogenesis of this type of pain, the observed disorders are usually bilateral, radicular in nature, mainly in the posterior perineum, upper thigh and lower leg. Patients also complain of back pain and pain when sneezing (Naffziger's sign). Pain during walking causes the patient to stop, but usually does not completely disappear if the patient stands. Relief occurs when the position of the spine changes, for example, when sitting, bending sharply forward, or even squatting. The radicular nature of the disorders becomes especially obvious if there is a shooting nature of the pain. There are no vascular diseases; radiography reveals a decrease in the sagittal size of the spinal canal in the lumbar region; myelography shows a violation of the passage of contrast at several levels. Differential diagnosis is usually possible, taking into account the characteristic location of pain and other features.
Pain in the lumbar region when walking may be a manifestation of spondylosis or damage to the intervertebral discs (history of acute back pain radiating along the sciatic nerve, sometimes the absence of Achilles reflexes and paresis of the muscles innervated by this nerve). Pain may be a consequence of spondylolisthesis (partial dislocation and “slippage” of the lumbosacral segments). It can be caused by ankylosing spondylitis (Bechterew's disease), etc. X-rays of the lumbar spine or MRI often clarify the diagnosis. Pain due to spondylosis and intervertebral disc pathology often increases with prolonged sitting or uncomfortable posture, but may decrease or even disappear with walking.
Pain in the hip and groin area is usually the result of arthrosis of the hip joint. The first few steps cause a sharp increase in pain, which gradually decreases as you continue to walk. Rarely, pseudoradicular irradiation of pain along the leg, impaired internal rotation of the hip, causing pain and a feeling of deep pressure in the femoral triangle, are observed. When a cane is used when walking, it is placed on the side opposite the pain to transfer body weight to the healthy side.
Sometimes, while walking or after standing for a long time, pain in the groin area may occur due to damage to the ilioinguinal nerve. The latter is rarely spontaneous and is more often associated with surgical interventions (lumbotomy, appendectomy), in which the nerve trunk is damaged or irritated by compression. This reason is confirmed by the history of surgical manipulations, improvement in hip flexion, the most severe pain in the area two fingers medial to the anterior superior iliac spine, sensory disturbances in the iliac region and the scrotum or labia majora.
Burning pain along the outer thigh is characteristic of meralgia paresthetica, which rarely leads to a change in gait.
Local pain in the area of long tubular bones that occurs when walking should raise suspicion of the presence of a local tumor, osteoporosis, Paget's disease, pathological fractures, etc. Most of these conditions, which can be detected by palpation (pain on palpation) or x-rays, are also characterized by back pain. Pain along the anterior surface of the lower leg may appear during or after long walking, or other excessive tension of the lower leg muscles, as well as after acute occlusion of the vessels of the leg, after surgery on the lower limb. Pain is a manifestation of arterial insufficiency of the muscles of the anterior region of the leg, known as anterior tibial arteriopathic syndrome (severe increasing painful swelling; pain from compression of the anterior parts of the leg; disappearance of pulsation in the dorsal artery of the foot; lack of sensitivity on the dorsum of the foot in the area of innervation of the deep branch of the peroneal nerve; paresis of the extensor digitorum and extensor pollicis brevis muscles), which is a variant of muscle compartment syndrome.
Pain in the foot and toes is especially common. Most cases are caused by foot deformities such as flat feet or wide feet. This pain usually appears after walking, after standing in shoes with hard soles, or after carrying heavy objects. Even after a short walk, a heel spur can cause pain in the heel and increased sensitivity to pressure on the plantar surface of the heel. Chronic Achilles tendonitis manifests itself, in addition to local pain, as palpable thickening of the tendon. Pain in the forefoot is observed in Morton's metatarsalgia. The cause is pseudoneuroma of the interdigital nerve. At the beginning, pain appears only after long walking, but later it can appear after short episodes of walking and even at rest (pain is localized distally between the heads of the III-IV or IV-V metatarsal bones; it also occurs when the heads of the metatarsal bones are compressed or displaced relative to each other; lack of sensitivity on the contacting surfaces of the toes; disappearance of pain after local anesthesia in the proximal intertarsal space).
Sufficiently intense pain on the plantar surface of the foot, which forces one to stop walking, can be observed with tarsal tunnel syndrome (usually with a dislocation or fracture of the ankle, pain occurs behind the medial malleolus, paresthesia or loss of sensation on the plantar surface of the foot, dry and thinning of the skin, lack of sweating on sole, inability to abduct the toes compared to the other foot). Sudden onset of visceral pain (angina pectoris, pain due to urolithiasis, etc.) can affect gait, significantly change it and even cause walking to stop.
Paroxysmal gait disturbances
Periodic dysbasia can be observed with epilepsy, paroxysmal dyskinesias, periodic ataxia, as well as with pseudoseizures, hyperekplexia, and psychogenic hyperventilation.
Some epileptic automatisms include not only gesticulation and certain actions, but also walking. Moreover, there are known forms of epileptic seizures that are provoked only by walking. These seizures sometimes resemble paroxysmal dyskinesias or apraxia of gait.
Paroxysmal dyskinesias that begin while walking can cause dysbasia, stopping, falling of the patient, or additional (forced and compensatory) movements while walking continues.
Periodic ataxia causes periodic cerebellar dysbasia.
Psychogenic hyperventilation often not only causes lipothymic states and fainting, but also provokes tetanic convulsions or demonstrative motor disorders, including periodic psychogenic dysbasia.
Hyperekplexia can cause gait disturbances and, in severe cases, falls.
Myasthenia gravis sometimes causes periodic leg weakness and dysbasia.