Walking disorders and their causes

are described as any deviation from normal walking. Numerous etiologies can cause these disorders. Due to the different clinical presentations, a high level of suspicion is necessary. The etiology can be determined by the clinical presentation, laboratory analyzes and diagnostic tests. Article content\n \n \n . ro or from the SfatulMedicului mobile application (iOS, Android)\n .

Continuous or chronic gait disorders are those that the patient has adapted due to the chronicity of the neurological dysfunction. Episodic disorders include those that appear suddenly and the patient has not adapted to them and are a frequent cause of complications such as unexpected falls. Most other gait disorders belong to the chronic category. Neurological causes are more common than non-neurological causes. Sensory ataxia caused by polyneuropathy, parkinsonism, subcortical vascular encephalopathy and dementia is among the most common neurological causes.

and knees that cause pain and limit movement are common non-neurological causes of gait disorders. Neurological disease\r\n. Due to the complexity of the communications between these two systems, even subtle changes can lead to gait disturbances. Electrolytic imbalance\r\n. Hyponatremia, being one of the most common, can lead to severe neurological symptoms that affect walking.

Electrolyte balance is essential for maintaining proper musculoskeletal function, which directly contributes to normal walking. Vitamin deficiency\r\n. It has been shown that the deficiency of these vitamins causes neurological dysfunctions, which prevent proper walking. Vitamin B12 deficiency, which causes subacute combined degeneration of the spinal cord, can lead to numbness and paresthesias, which ultimately affect walking. .

Other\r\n. psychiatry\r\n. The typical presentation of gait disorders can be evident during the clinical examination. However, it may be subclinical. Therefore, the entire clinical picture must be taken into account.

An extensive patient history is required. The social history, as well as the medical history, is critical in the evaluation. Understanding how long the symptoms have been present is essential, as well as determining whether the onset was sudden or insidious. Simply knowing the history of the patient's symptoms can help narrow down the etiology of gait disorders. Understanding various aspects of a patient's social history is important, especially their diet, ability to perform daily activities and physical limitations.

The objective examination can separate walking disorders into two categories: musculoskeletal and neuromuscular (lower motor neuron and upper motor neuron). Musculoskeletal\r\n. Causes: any condition in the lower limb that causes pain. Walking on tiptoes: occurs when there is a discrepancy in the length of the limbs; . Causes: short calcaneal tendon, true differences in the length of his legs.

Neuromuscular\r\n. Causes: weakness of the middle and small gluteal muscles, poliomyelitis, muscular dystrophy. Walking in extension: the trunk tilted back with the hip hyperextended during the stance phase of the affected limb. Causes: weakness of the hip extensor muscles (gluteus major)\r\n. Causes: extensors of the knee (quadriceps) in the aftermath of fractures of the femoral condyles, capsulo-ligamentary hyperlaxation, neuropathies, etc.

. Stepped gait: the knee is raised abnormally from above so as not to be hindered by the toes, the ground is initially touched with the tip of the toes and then with the rest of the sole, the steps are regular. Causes: dorsiflexion weakness of the ankle due to peroneal nerve damage, sciatic nerve palsy, L5 radiculitis, pyramidal lesions, tibial or peroneal muscle paralysis. Calcaneal gait (flat foot): limited plantar flexion of the ankle, prevents propulsive action by hyperextension of the toes. Causes: weakness of the plantar flexor of the ankle (gastrecnomian and soleus muscles)\r\n.

Causes: pelvic girdle muscle weakness - pregnancy, congenital hip dysplasia, muscular dystrophies, spinal muscular atrophy. Leaping gait: the weakness of the quadriceps or causes a strained gait with the avoidance of support on them, patients avoid flexion of the thigh on the abdomen. Causes: inflammation of the iliopsoas, damage to the knee joint. Scissors walk (crouching/paraspastic): small but regular steps, the limbs are mobilized with difficulty and slowly from the knee or hip; . Causes: prolonged neonatal cerebral hypoxia or brain injuries during birth, cerebral palsy, multiple sclerosis, spinal cord compression, bilateral stroke.

Cerebellar ataxic gait: the gait is unstable, uncoordinated and irregular, the patient usually deviates towards the affected side. Causes: cerebellar syndrome (alcohol, phenytoin, stroke, tumor, degenerative or inflammatory disease, multiple sclerosis). Sensory ataxic gait: patients use visual control to compensate for the loss of proprioception, thus constantly paying attention to the ground, the gait is disordered, with wide movements of the limbs, the foot is allowed to fall with a noise. Causes: lesions of the posterior cords, deep sensitivity disorders in peripheral neuropathies, bilateral damage to the parietal lobes (rare), vitamin B12 deficiency. Hemiparetic gait (hemispastic): the gait is slow, the knee and hip are extended, unable to flex the leg due to spasticity, the paretic leg performs a lateral circumduction movement and touches the ground with the tip of the fingers, also called \.

Cause: stroke, tumor, trauma, degenerative, inflammatory disease, vasculitis\r\n\n\n \n \n \n \n \n \n \n\n \n\n \n \n \n . Cause: Parkinson's disease, atherosclerotics. Apraxic (magnetic) frontal gait: insufficient initiation of walking, walks with hesitation in small and uncertain steps, inability to lift the feet from the floor \. Myelopathic gait: stiff (spastic) gait, with small steps and a wide base of implantation, with balance or coordination disorders. Causes: cervical myelopathy (cervical spondylosis, degenerative disc disease, ossification of the posterior longitudinal or yellow ligament, congenital stenosis of the cervical spinal canal).

Propulsive gait: center of gravity located in front of the body, stooped, rigid posture, with the head and neck bent forward, with a tendency to accelerate (\. Causes: Toxins (carbon monoxide), Parkinson's disease or certain drugs (such as haloperidol). The prognosis of gait disorders depends on the etiology. Metabolic etiologies of gait disorders have a relatively good prognosis. If the metabolic disorder is addressed, the patients mostly recover without the persistence of symptoms.

Some neurological diseases often have no treatment and must be treated symptomatically. Often, neurological disorders worsen over time, and medications become inadequate for managing symptoms. Patient education and counseling, depending on the patient's needs, is a multidisciplinary team effort for better management and results:\r\n. Walking and posture are extremely important for a patient's quality of life. A normal gait leads the patient to functional independence.

Patient education is a vital part of identifying gait disorders; . Corrective rehabilitation, gait training, use of assistive devices and fall prevention measures should be implemented. Bibliography:\r\n\r\n\r\n\n\n \n \n\n \n \n \n\n \n \n . Eugenia Anca\n . Dan belt\n .

Delia Cinteza\n . Mariana Racu\n . .