Difficulty walking / gait disorders – causes, symptoms, therapies

Difficulty walking and gait disorders occur primarily in older people. It is believed that general age-related deposits in the vessels and especially in the brain lead to reduced blood flow and reduced function during movement and thus limit the ability to coordinate. There are also numerous diseases and symptoms that can cause problems when walking. Therefore, it must first be examined whether the walking difficulties are of neurological, internal, psychogenic or orthopedic origin. In principle, walking difficulties are perceived by those affected as severely restricting and reducing the quality of life. It is therefore particularly important to track down the cause and initiate promising therapy.

(Image: lassedesignen / fotolia.com)

Table of Contents

  • Trouble walking
  • Gait disorders – a brief overview
  • definition
  • What does a normal gait look like?
    • Walking problems can have a variety of causes
  • Neurological causes of walking difficulties
    • Subcortical arteriosclerotic encephalopathy
    • Trendelenburg gang and Parkinson’s disease
    • Stroke and spastic hemiplegia
    • Other neurological causes
  • Gait disorders with orthopedic causes
    • Relief limp
    • Waddling gait pattern (Trendelenburg gait)
    • Slight difficulty walking
    • Tarsal tunnel syndrome
    • Lumbar problems
  • Difficulty walking due to internal causes
    • Peripheral Arterial Disease (PAD)
    • Arterial calcification
  • Difficulty walking with psychogenic causes
  • Risk factors that can lead to difficulty walking
    • Footwear as a risk factor
  • diagnosis
    • More walking tests
    • Determine previous illnesses
  • Treatment options for walking difficulties
    • Treatments for circulatory disorders
    • Obesity and obesity
    • Therapies for neurological causes
  • Treatments for psychological causes
  • Naturopathic treatment
  • Own measures against walking disorders
    • A healthy lifestyle relieves gait problems
  • Fall prevention

Gait disorders – a brief overview

Here is a brief overview of the symptoms of a walking disorder with the possible causes. The individual points are discussed in more detail below:

  • Definition: If the gait pattern or walking speed deviate from the typical movement patterns for age and height, one speaks of a gait disorder. This can range from a slight limp to the loss of independent walking.
  • Symptoms: reduced gait speed, inconsistencies, deviations or abnormalities in the gait pattern such as waddling, limping, tripping or limping.
  • Causes: There are numerous different diseases and symptoms that can cause problems when walking. The causes can be neurological, internal medicine, psychological or orthopedic.
  • Neurological causes: Parkinson’s disease, multiple sclerosis, damage to the peripheral nerves ( polyneuropathy ), inner ear complaints, B12 vitamin deficiency , stroke , brain tumor, inflammation ( e.g. due to Lyme disease ), brain damage due to alcoholism .
  • Internal causes: changes in the blood vessels in the legs, peripheral arterial occlusive disease ( PAD ), hardening of the arteries (arteriosclerosis).
  • Psychogenic causes: Psychogenic tremor, psychogenic dystonia (movement disorder ), psychogenic myoclonus ( muscle twitching ), psychogenic parkinsonism, psychogenic gait disorder, post-traumatic stress disorder (PTSD).
  • Orthopedic causes: joint wear (arthrosis), spinal stenosis, rheumatic diseases, muscle weakness, herniated disc , injuries such as a broken femur or other broken bones in the leg and foot area.

Many people experience difficulty walking during their lives. (Image: lassedesignen / fotolia.com)

definition

Difficulty walking and gait disorders are movement disorders that are particularly noticeable when walking. The cause can be due to neurological, orthopedic, internal or psychogenic problems and disorders. In addition to the problems with walking, other complaints often occur, for example in diseases such as Parkinson’s disease or multiple sclerosis. In many cases , if walking difficulties occur, therapies can only alleviate the symptoms , but not remedy the cause.

What does a normal gait look like?

A healthy gait is characterized on the one hand by the walking speed and on the other hand by a harmonious gait pattern. In a healthy gait, adults travel an average of around 2.5 meters per second. In old age, this value can drop to around 1.5 meters. This is not a concern and is part of the normal aging process. If regular discrepancies, deviations or abnormalities are noticed in the speed or gait pattern, there may be difficulty walking. A harmonious gait pattern is characterized by the following aspects:

  • Smooth and symmetrical movement,
  • Swinging arms,
  • Foot distance is normal (neither too wide-legged nor too close together),
  • stride length is normal and constant (people between 1.5 and 1.7 meters tall have an average stride length of 60 cm; people between 1.7 and 1.9 meters average 70 cm),
  • the feet are neither raised too high nor too little when walking.

Walking problems can have a variety of causes

Difficulty walking can vary greatly among those affected. The problems range from a slight limp or an insecure gait to very striking gait patterns, in which those affected are hardly able to walk. Accordingly, many causes come into question as triggers of walking difficulties, which the doctor must first clarify.

The causes of gait difficulties can be varied. Neurological, orthopedic, internistic or mental illnesses are among the possible bases of the complaints. (Image: zinkevych / fotolia.com)

Neurological causes of walking difficulties

When walking difficulties that are due to a neurological problem, dizziness and general walking insecurities often occur. The balance can be so disturbed that those affected temporarily lose consciousness.

Subcortical arteriosclerotic encephalopathy

Older people often suffer from subcortical arteriosclerotic encephalopathy, a disease of the brain caused by vascular changes, in which the gait of affected people usually appears wide-legged, insecure and clumsy. Other complaints of this clinical picture are bladder disorders such as bladder weakness to incontinence and subcortical dementia.

Trendelenburg gang and Parkinson’s disease

Another neurological gait disorder is the so-called Trendelenburg gait, in which sufferers waddle due to paralysis of the middle gluteus muscle. This is often caused by damage to the supplying nerves. A small, tipping gait pattern, on the other hand, can be an indication of Parkinson’s , a neurological, degenerative disease that primarily affects the motor skills of those affected. A typical symptom of Parkinson’s is tremor, which is why people used to talk about shaking sickness in the past.

Stroke and spastic hemiplegia

Stroke patients often suffer from spastic hemiparesis and develop the so-called Wernicke-Mann gait pattern, in which the upper body is typically moved to the opposite side in order to more easily detach the spastic leg from the floor.

Other neurological causes

Stumbling “like drunk” characterizes a cerebellar gait with disorders of the cerebellum function, for example with ataxia, a disturbance of the coordination of movements. Another neurologically related walking disorder is the so-called “stepper walk”, which is also colloquially referred to as the stork walk. This gait disorder is caused by paralysis of the foot lifters.

Gait disorders with orthopedic causes

Most problems with walking are due to an orthopedic cause. Damage to the bones, muscles and joints of the feet, legs, pelvis and spine can cause difficulty walking. These can be caused, for example, by injuries such as broken bones or joint wear (arthrosis).

Injuries from accidents can be the basis for walking difficulties. (Image: britta60 / fotolia.com)
Model-Released

Relief limp

One of the orthopedic symptoms of walking disorders is the Duchenne limp (relief limp), in which those affected tend to have their torso stand. The cause can be a malposition in the hip joint, hip dysplasia or a hip dislocation. Weakened gluteal muscles can also trigger limping.

Waddling gait pattern (Trendelenburg gait)

The waddling gait pattern in the Trendelenburg gait can not only be neurological but also orthopedic, for example in a child’s hip dysplasia or a dislocation of the joint. Those affected also often limp in the event of joint stiffness or pain.

Slight difficulty walking

With mild gait difficulties, those affected often complain of numbness in the calves down to the feet. This is usually a nerve compression, whereby the neurological examination, the measurement of the nerve conduction speed, sometimes does not provide any findings.

Tarsal tunnel syndrome

If numbness occurs in the feet, it may be tarsal tunnel syndrome , which is a compression of the tibial nerve that runs along the inner ankle. Possible causes include broken bones, tendinitis in the affected area and disorders in the arterial supply to the lower leg and thus also the nerve.

Lumbar problems

The nerves that supply legs and feet can also severely restrict walking ability through compression. They originate from the lumbar spine and should be included in diagnosis and treatment if you have difficulty walking. In osteopathy, therefore, not only the back and the general statics of the body are considered, but also previous illnesses such as vertebral sliding, back pain , lower back pain or buttock pain . If nerve compression is suspected, polyneuropathy (certain disorders of the peripheral nervous system) and venous disorders should be excluded.

Orthopedic gait problems can come from the lumbar spine. Adequate and back-friendly training can reduce such complaints and have a preventive effect. (Image: lassedesignen / fotolia.com)

Difficulty walking due to internal causes

Problems with walking can also occur with changes in the blood vessels, which can lead to bleeding or circulatory disorders in the legs, for example.

Peripheral Arterial Disease (PAD)

Peripheral arterial occlusive disease (PAD) is a special type of circulatory disorder, which is also known as “shop window disease”, because sufferers have to stop at certain intervals, for example in front of a shop window, because they have leg pain. The arms are less often affected. Peripheral arterial disease is one of the chronic vascular diseases of the arteries. It arises from stenosis (narrowing) or occlusion (occlusion) of the arteries, which are responsible for the supply of the extremities.

Arterial calcification

In rare cases, the main artery is also affected. Atherosclerosis (hardening of the arteries) is one of the main causes of the disease, the clinical picture of which ranges from freedom from complaints and slight difficulty walking to gangrene, a tissue necrosis requiring amputation. There is a high risk of heart attack .

Difficulty walking with psychogenic causes

Psychogenic gait difficulties are problems with the counter that are caused by the psyche of those affected. They belong to dissociative disorders in psychiatry and occur much more frequently than is generally assumed. The causes include psychogenic tremor, psychogenic dystonia (movement disorder), psychogenic myoclonus (muscle twitching), psychogenic parkinsonism and psychogenic gait disorder. Concomitant diseases such as anxiety disorders and depression often occur .

Risk factors that can lead to difficulty walking

Since walking difficulties are due, among other things, to circulatory disorders, which are often associated with smoking, diabetes mellitus (diabetes), high blood pressure and lipid metabolism disorders such as hyperlipidemia and hypercholaesterinemia – the main risk factors for peripheral arterial disease – a healthy lifestyle is advisable. This also includes a low-fat, balanced diet and not using nicotine (help: quit smoking ).

Anyone who minimizes risk factors and often goes for walks can remain mobile into old age despite certain restrictions. (Image: oneinchpunch / fotolia.com)

Footwear as a risk factor

Wearing shoes that do not fit too tightly can also cause nerve compression on the feet, causing those affected to feel insecure due to numbness in the legs .

diagnosis

When diagnosing walking difficulties, it must first be determined whether the cause is neurological, orthopedic, internal or psychogenic. First, the doctor will review the patient’s gait by observing speed, stride, starting and stopping, contact with the ground, rolling, and movement in the large joints, feet, and toes when walking. Another test is to check the number of steps necessary to make a 180 degree turn. In addition, it can be tested whether the patient is able to walk in the tightrope walk, with one foot in front of the other on an imaginary line. To determine possible paralysis, the patient can be asked to walk on the toes or the verses.

More walking tests

Doctors also use the so-called Romberg standing test to check the balance. The patients must stand with their feet tightly together for a few minutes. The first part is done with eyes open, the second half with eyes closed. Another option to check the gait is the so-called Unterberger pedal test, in which those affected have to step about 60 times with their eyes closed and their arms outstretched.

Determine previous illnesses

Previous illnesses such as injuries, heart attacks, strokes or herniated discs must also be taken into account in order to find the cause of the walking difficulties. The doctor usually has a detailed discussion with the patient in order to better narrow the symptoms. This also includes questions about feeling and balance disorders. It may also be necessary to carry out further tests such as:

  • Eye tests,
  • Hearing tests,
  • a blood test ,
  • a cerebrospinal fluid puncture (brain water examination),
  • Computed tomography (CT),
  • Magnetic resonance imaging (MRI),
  • Electroencephalography (EEG),
  • Electromyography (EMG).

Difficulty walking can reduce quality of life, but it doesn’t always have to be that way. With orthopedic causes in particular, good results can often be achieved through manual therapy and physiotherapy. (Photo: Ljupco Smokovski / fotolia.com)

Treatment options for walking difficulties

The type of treatment for walking difficulties depends on the cause of the complaint. In the case of orthopedic problems, physiotherapy, manual therapy or physiotherapy can often achieve good results. In more severe cases, immobilization or surgery may be necessary. Movement therapy usually follows.

Treatments for circulatory disorders

If circulatory disorders are the cause of the walking difficulties, medication is often given, although depending on the diagnosis, surgery may also be necessary. Adequate exercise is also beneficial.

Obesity and obesity

If gait symptoms occur together with severe overweight or obesity , it is necessary to lose weight in order to improve the gait pattern.

Therapies for neurological causes

In the case of a neurological disease such as Parkinson’s or multiple sclerosis as the cause of the walking disorders, only symptomatic therapy is possible, since the course of the disease progresses and based on the currently available therapies, no cure is to be expected. Those affected can experience relief from their complaints through targeted exercise therapy (physiotherapy, physiotherapy) and physical treatments such as massages or electrical treatments.

Treatments for psychological causes

If the walking disorder is based on a psychogenic cause, psychotherapy can help, which may be accompanied by medication.

Naturopathic treatment

In naturopathy, osteopathy is a particularly promising method due to the holistic view of the patient’s complaints. Many statutory health insurance companies are now covering the costs of osteopathic treatments. Also acupuncture can be successfully applied. In addition, massages and heat therapies have positive effects on some gait problems.

Back-friendly training, a healthy lifestyle with lots of exercise and little alcohol can help to alleviate gait disorders or prevent them from occurring in the first place. (Image: metamorworks / fotolia.com / heilpraxis.de)

Own measures against walking disorders

In order to prevent walking difficulties caused by back pain, for example in the case of herniated discs, appropriate, back-friendly training is suitable, such as special strength or fitness training. Tai Chi is also a movement concept in which the upright posture plays an important role. Scientific studies also show that regular tai chi works better than strength training in Parkinson’s patients and reduces the risk of falls.

A healthy lifestyle relieves gait problems

A healthy lifestyle with enough exercise can alleviate a lot of walking problems. Regular training of the muscles and the sense of balance can have a positive effect on the gait pattern. For example, gymnastics, walks, Nordic Walking and Thai Chi are suitable. In addition, care should be taken to drink as little alcohol as possible.

Fall prevention

If there is an acute risk of falling or if those affected have already fallen, it is essential to ensure good fall prophylaxis, because falls often require care . As gait becomes increasingly insecure and people lose confidence in their gait skills, many tend to exercise less and less and isolate themselves. This exacerbates the course of the disease and the symptoms of the gait disorder. Appropriate fall prophylaxis can counteract this. For this, all potential fall triggers such as carpets or rugs should be removed from the apartment. Special pants with hip protectors also protect patients in the event of a fall. In addition, walking aids such as walking sticks or walkers can be used. (no, vb, updated on July 22, 2018)

 

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