What Can Cause Antalgic Gait and What Are Its Treatment?
Antalgic Gait- An individual is said to have antalgic or a painful gait when the individual starts to avoid putting pressure on one of the two leg or both. The leg pain significantly affects the walking abilities of the individual. There can be numerous causes resulting in antalgic gait. Difficulties in ambulation or walking results in restriction of activities and patient is often considered disabled.
What Is Antalgic Gait?
Individual is said to have an Antalgic Gait or a painful gait when he or she experiences pain in lower leg while walking. Most often pain is localized in foot, knee or hip joint. Body weight is transmitted through the leg to the ground. Individual suffering with leg pain avoids putting pressure on the affected leg and usually shifts weight abruptly to the normal leg while walking. This act of abrupt interruption of transfer of weight from the affected leg to the normal leg is termed as an abnormal gait. In an Antalgic or painful gait, the individual tries to put as little body weight on the affected leg as possible. The abnormal gait is associated with substantial shortening of stride length. Antalgic Gait can be sudden or gradual in onset depending on the cause of pain in the legs. The gait abnormality is temporary or permanent. Anyone can have an Antalgic Gait but usually it is noticed in the elderly populations who normally have underlying conditions like arthritis resulting in pain. Similarly young population and young athletes suffer with antalgic gait subsequent to leg injury.
What Are The Causes Of Antalgic Gait?
Some Of The Common Causes Of An Antalgic Gait Are:
a. Injury Causing Antalgic Gait-
Leg trauma causing hip, knee, ankle and foot injury results in antalgic gait. The leg injury is caused by following trauma-
b. Antalgic Gait Due To Joint Arthritis-
c. Antalgic Gait Caused By Joint and Leg Deformity-
- Rickets- Vitamin D deficiency
- Joint Subluxation
- Joint malalignment after fracture healing
- Bone malalignment following fracture healing.
d. Stress Fracture Causing Antalgic Gait-
- Metatarsal bone fracture
- Metacarpal bone fracture
e. Antalgic Gait Due To Inflammation of Soft Tissue-
f. Antalgic Gait Caused By Infection in the Bones-
- Osteomyelitis of femur, tibia, fibula, humerus, radius and ulna.
- Joint infection and abscess.
g. Antalgic Gait Caused By Primary and Metastatic Tumor of Bone-
- Bone tumor causing pain, fracture and deformity.
h. Antalgic Gait Caused By Muscle or Tendon Rupture or Tear-
- Muscles tear of upper and lower extremity following weight lifting or injury causes severe pain during walking and change of position.
- Tendon or ligament rupture is often observed following car accident, work injury or sports injury. The partial or total rupture is associated with inflammation and severe pain, which results in severe intractable pain.
i. Joint Sprain Causing Antalgic Gait-
- Ankle sprain is associated with abnormal twist and turn of the ankle joint.
- Knee sprain is often caused by fall and sports injury resulting in partial tear of ligament.
- Hip joint injury is rare but often seen in older patient suffering with severe arthritis.
What Are The Symptoms Of Antalgic Gait?
Some Of The Symptoms Of Antalgic Gait Are:
- Unusual walking style
- Alteration in gait pattern so as to decrease pain
- Increased pain when trying to walk normally
- Shortened stride length and stance phase
How Is Antalgic Gait Diagnosed?
Physical Examination (PT) To Diagnose The Cause of Antalgic Gait-
- Pain- Patient complaints of severe pain in one of the joint arm or leg. Pain is increased during walking, standing and jogging.
- Muscle Weakness- Patient suffers with weakness of one or several muscles of the extremities. Motor test to evaluate power, tone and coordination indicates the abnormal findings.
- Tenderness- Examination of the extremity bones and joint suggests severe pain over the joint and extremity bones.
- Change in gait or walking style.
- Abnormal gait associated with limited use of painful leg,
- Alteration in gait during the course of the day. Pain is severe in the morning and thus deformity is more predominant in the morning.
- Painful Movement- Increased pain when trying to walk normally.
- Shortened stride length and stance phase
- Joint swelling
- Joint stiffness
- Muscle cramps
Antalgic Gait is a deformity, which is quite visible and is noticed by the treating physician with the naked eye. The goal of the treating physician is to identify as to what is causing the Antalgic Gait. For this, the treating physician takes a detailed history and compares finding of the examination with radiological studies.
Blood Examination To Diagnose the Cause of Antalgic Gait-
- White Blood Cell Count- Increases when antalgic gait is caused by joint infection.
- Rheumatoid Factors (RF)- Test is positive in patients suffering with rheumatoid arthritis.
- Citrulline Modified Proteins (Anti-CCP) - Anti-CCP predicts severity of rheumatoid disease (RD) and also subclinical RD.
- Serum Cytokines- Cytokines and related protein factors are elevated in early stages of rheumatoid disease.
- ESR- ESR is increased in Rheumatoid Disease and osteoarthritis.
Image or Radiological Study to Diagnose the Cause of Antalgic Gait -
- X-ray- the image study of hip, knee, ankle and foot is performed to find the cause of leg pain. Fracture, dislocation, subluxation and joint inflammation is diagnosed by examination of X-Ray films.
- CT Scan and MRI- The detailed joint and bone study is possible with MRI or CT scan. The soft tissue injury like partial or completer tear of muscle, tendon and ligament is diagnosed by using MRI and CT Scan examination.
Ultrasound Examination to Diagnose the Cause of Antalgic Gait-
Useful In Diagnosis Of Following Diseases:
- Joint Deformity
- Joint Fluid Collection
- Joint Infection
Joint Fluid Analysis (Arthrocentesis) to Diagnose the Cause of Antalgic Gait -
- Rule-out Gout: Uric acid crystals are observed in gout
- Septic Arthritis- Bacterial cells, red blood cells and pus cells are observed in septic arthritis.
What Are The Treatments For Antalgic Gait?
The treatment of Antalgic Gait usually begins by identifying the cause of pain, and once identified, then treating the cause of pain leading to antalgic gait. In majority of the cases, once the underlying cause is treated like in cases of trauma or an injury then the gait normalizes quickly. Additionally, the physician may prescribe the following to help with pain and normalize gait as much as possible:
a. Conservative Treatment For Antalgic Gait-
- Use of a cane or a crutch or other types of devices especially in cases of a stress fracture or other forms of trauma or injury
b. Medication Prescribed For Antalgic Gait-
- NSAIDs- Prescribed to treat inflammation
- Opioids- Prescribed to treat chronic intractable pain.
- Muscle Relaxant- Prescribed for muscle pain and muscle spasm.
c. Exercises For Antalgic Gait-
- Swimming and biking for gait and balance training
d. Physical Therapy (PT) For Antalgic Gait-
- Helps to improve joint mobility
- Helps to improve muscle tone and co-ordination
e. Specific Treatment For Antalgic Gait -
- For Antalgic Gait Caused Due To Rickets- Calcium and Vitamin D
- For Osteoporosis - Calcium, vitamin D and estrogen hormone
- Osteoarthritis- NSAIDs
- Rheumatoid Arthritis-
- Methotrexate (Trexall)
- Leflunomide (Arava)
- Hdroxychloroquine (Plaquenil)
- Sulfasalazine (Azulfidine)
f. Surgery To Treat Antalgic Gait-
- Joint Surgery- Dislocation, subluxation and arthritis
- Bone Repair- For fracture
- Excision of Tumor
- Tendon Repair
- Muscle Tear Repair
Recovery Time For Antalgic Gait
The recovery time after these procedures is usually three to four months during which time the individual will have an Antalgic Gait and will need ambulatory devices, but once healed from the procedure, normal gait returns.
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