Unsteady Gait

Gait is a style of ambulation or walking. Gait is described as normal or abnormal. The manner in which a person walks is medically termed as gait. A normal gait is one in which an individual walks in a coordinated fashion with equal stride length and arm swing. Unsteady Gait or Abnormal Gait results following joint or leg pain caused by disease or trauma in lower extremity. Diseases, which causes unsteady gait or abnormal gait are arthritis, muscle diseases, gout and diabetic neuropathy.1 The abnormal gait of an individual is associated with atypical muscle coordination resulting in deviant joint movements.

Unsteady Gait

What is Unsteady Gait or Abnormal Gait?

  • Lack of Coordination- A gait is said to be unsteady or abnormal when there is lack of coordination when walking.
  • Abnormal Posture During Ambulation- Ambulatory or walking abnormalities are caused by difficulties in balancing the body movements. The posture as well as movement of the arms and legs are established to prevent falls or swaying of the upper body resulting in abnormal gait. Abnormal gait is caused usually by injuries, trauma, or an underlying medical condition with regard to the lower extremities, brain, spine, or the inner ear.
  • Gait Influenced By Pain- Abnormal gait or deviation from normal walking style results from chronic pain. Chronic pain intensity increases with activities or movement of lower extremities.
  • Muscle Abnormalities- Abnormal gait is also seen when patient is suffering with muscle weakness, lack of normal muscle tone, strength and joint abnormality.
  • Nervous System- Unsteady gait also follows abnormalities of nervous system. Nervous system diseases causing unsteady gait is associated with symptoms like pain, tingling, numbness, joint stiffness and muscle weakness.

What Can Cause Unsteady Gait or Abnormal Gait in Person?

What Can Cause Unsteady Gait or Abnormal Gait in Person?

Some of the causes of an unsteady gait or abnormal gait

  1. Inflammatory Joint Diseases Causing Unsteady Gait or Abnormal Gait

  2. Joint And Bone Infection Causing Unsteady Gait or Abnormal Gait -

    • Joint infection and joint abscess
    • Osteomyelitis
    • Fracture- Femur, tibia, fibula, patella, tarsal bones, metatarsal bone and phalanges.
    • Dislocation- Hip, knee, ankle, metacarpal and phalangeal joint dislocation.
    • Bone Tumor- Primary or metastatic bone tumor.
    • Ingrown toenail
  3. Muscle Diseases Causing Unsteady Gait or Abnormal Gait

    • Muscle spasm or cramps
    • Muscle injury or tear
  4. Tendon Diseases Causing Unsteady Gait or Abnormal Gait

    • Tendonitis- Tendon inflammation,
    • Tendon rupture or tear
  5. Unsteady Gait or Abnormal Gait Due To Trauma

    Causes of severe trauma resulting in fracture or dislocation are as follows-

    • Auto injury
    • Work injury
    • Domestic Injury
  6. Congenital Diseases Causing Unsteady Gait or Abnormal Gait

    • Abnormal Leg Length- One leg shorter than other
    • Frederick's Ataxia
    • Syringomyelia
  7. Footwear Causing Unsteady Gait or Abnormal Gait

    • Loose or tight fitting shoes

Classification Of Unsteady Gait or Abnormal Gait

There are various classifications of an unsteady gait or an abnormal gait. Some of the classifications of gait abnormalities are:

  1. Propulsive Gait:

    This is a type of gait in which patient takes time to move and posture is bent and rigid. The head and neck are bent forwards while middle spine is curved forward. Patient maintains the position while walking. Observer often feels patient is trying to prevent from falling on the ground during forward movement.

    Propulsive Gait Is Caused By Following Abnormalities:-

    • Poisoning- Manganese and carbon monoxide
    • Side Effects of Medications- Phenothiazine, haloperidol and metoclopramide
  2. Spastic Gait:

    Also known as dragging walk. This is a type of gait in which the individual drags the foot when walking. The posture is stiff often associated with rigid body movements and tight muscle contraction in extremity and upper body.

    Spastic Gait Is Caused By Following Abnormalities-

    • Brain Diseases That Can Cause Spastic Gait
      • Brain Abscess
      • Head Injury
      • Cerebral Palsy
      • Meningomyelitis
      • BrainTumor
    • Vascular Disease That Can Cause Spastic Gait-
      • Ischemic brain disease
    • Spinal Cord Diseases That Can Cause Spastic Gait
    • Muscle Diseases Can Cause Spastic Gait
  3. Steppage Gait:

    Patient suffers with sensory nerve deficit. The numbness of the feet often causes difficulties in stepping forward and inconsistent forward stepping results in feeling of falling down. Patient often tries to balance the feeling of falling down by changing the gait, which often is abnormal in nature. The sensory and motor deficit causes foot drop. The toes are pointed downward thus making the toes touch the ground first followed by careful slow weight transfer to ground and forward movement.

    Steppage Gait Is Caused By Following Abnormalities:-

    • Peripheral Nerve Abnormalities That Can Cause Steppage Gait-
      • Guillan Barre Syndrome
      • Peripheral Neuropathy
      • Peroneal Neuropathy
    • Spinal Cord Diseases That Can Cause Steppage Gait-
      • Multiple Myelitis
      • Multiple Sclerosis
      • Spinal Cord Injury
      • Poliomyelitis
    • Vertebral Column Abnormalities That Can Cause Steppage Gait-
      • Disc Herniation
      • Spinal and Foraminal Stenosis
    • Muscle Diseases That Can Cause Steppage Gait-
      • Myopathy
      • Muscle injury in foot and leg
  4. Waddling Gait:

    In this type of gait, the affected individual has a duck like walk. The abnormal gait is caused by weakness in proximal muscles of the pelvic girdle resulting in gluteal weakness. Patient overcomes the weakness of gluteal muscle by waddling upper body forward by circumduction movement of pelvis and dragging lower leg forward.

    Waddling Gait Is Caused By Following Abnormalities-

    • Waddling Gait Due To Muscle Disease-
      • Myopathy
      • Muscular dystrophy
      • Paravertebral and gluteal muscle atrophy
    • Waddling Gait Deue To Skeletal Abnormality
      • Congenital hip dysplasia
      • Pelvic fracture
  5. Ataxic or Broad-Based Gait

    Ataxic or broad based gait is observed in patients suffering with cerebellar disease. Patient walks with legs widely separated to prevent fall, asymmetrical forward movement and erratic balancing of upper body. Patient is unable to walk in straight line or turn the body.

    Ataxic or Broad-Based Gait Is Caused By Following Abnormalities:-

    • Brain Diseases That Can Cause Ataxic or Broad-Based Gait-
      • Brain Injury
      • Brain Hemorrhage
      • Cerebellar Ataxia
      • Cerebellar Degeneration
    • Peripheral Nerve Diseases That Can Cause Ataxic or Broad-Based Gait
      • Peripheral Neuropathy
      • Polyneuropathy
      • Diabetic Neuropathy
    • Drug Intoxication That Can Cause Ataxic or Broad-Based Gait-
      • Alcohol Intoxication
      • Mercury Poisoning
    • Medications Side Effects That Can Cause Ataxic or Broad-Based Gait
      • Phenytoin
      • Tigerton
      • Depakote
  6. Scissoring Gait:

    This is a type of gait in which the leg is in slight flexed position at the knee and hip joint. The posture is presented as if the person is crouching and the knees crossing each other in a scissor like manner. The abnormal gait is observed in patients suffering with cerebellar palsy.

    Scissoring Gait Is Caused By Following Abnormalities:

    • Brain Diseases That Can Cause Scissoring Gait-
      • Stroke
      • Cerebellar Palsy
      • Syringomyelia
      • Cerebro-vascular Accident
    • Spinal Cord Abnormalities That Can Cause Scissoring Gait
      • Injury
      • Tumor
      • Multiple sclerosis That Can Cause Scissoring Gait
    • Liver That Can Cause Scissoring Gait
      • Liver failure
      • Jaundice
    • Blood That Can Cause Scissoring Gait
      • Pernicious anemia

Clinical Evaluation Of Unsteady Gait or Abnormal Gait

In order to start treatment for an unsteady gait, the treating physician will first take a detailed history and conduct a physical examination in order to identify the cause of the gait abnormality and then formulate a treatment plan, as treatments will be different for different causes for Unsteady Gait or Abnormal Gait.

History of Unsteady Gait or Abnormal Gait

  • Is the disease congenital (from birth) or followed by a certain disease affecting brain and spinal cord.
  • History of accident resulting in brain or spinal cord injury
  • History of fracture or dislocation of lower extremities.
  • History of blood or liver disorders.

Family History

  • History of similar gait disorder or rule out congenital diseases of brain and spinal cord.

Examination-

  • Examination of nervous system to evaluate the pain, touch and temperature sensation as well as motor function.
  • Examination of liver, kidney and other organ system to rule out systemic diseases.
  • Examine the fracture and dislocated joint to evaluate the mal-alignment of the bones and joint resulting in pain and gait abnormalities.

Investigations And Lab Studies To Diagnose Unsteady Gait or Abnormal Gait

Urine Examination-

  • Urine screen for mercury exposure
  • Bilirubin level

Blood Examination-

  • White Blood Cell Count- Increased in infection affecting brain and spinal cord

Image Studies-

  • Magnetic Resonance Image (MRI) or Computed Tomogram (CT)-
    • Test is performed to check the brain ischemic changes, brain damage and brain tumor.
    • MRI of joint and bones are performed to rule out fracture, dislocation and mal-alignment of healed fracture bone or dislocated joint.
  • X-ray-
    • Test is performed to rule out or diagnose fracture, dislocation and bone tumor.

Electrophysiological Testing

  • Electromyography- Muscle functions are checked to evaluate neuro-muscular diseases.
  • Nerve Conduction Velocity Testing - The test is performed to evaluate nerve degenerative diseases.
  • Electroencephalography (EEG)- EEG studies are performed to evaluate brain function and abnormalities.

What Are Treatments For Unsteady Gait or Abnormal Gait?

Exercises For Unsteady Gait- Gait Training Exercises3

Physical Therapy- Extensive Physical Therapy and Rehabilitation.4

Supportive Therapy For Unsteady Gait or Abnormal Gait- 1

  • Use of Orthotics
  • Braces and splints
  • Walkers and cane for balance and support

Medications For Unsteady Gait or Abnormal Gait-

  • Acetazolamide
  • 5-hydroxytryptophan (5-HTP),
  • Debenone,
  • Trimethoprim–sulfamethoxazole,
  • Physostigmine,
  • L-carnitine or derivatives,
  • Vigabatrin, phosphatidylcholine,
  • 4-aminopyridine, buspirone, and
  • Vitamin E

Neuro-rehabilitation For Unsteady Gait or Abnormal Gait-

  • Teach balancing technique
  • Muscle exercise
  • Speech therapy
  • Robot assisted neuro-rehabilitation5

Occupational Therapy For Unsteady Gait or Abnormal Gait-

  • Adaptive equipment
  • Driver safety training

Also Read About:

References:

1. Gait disorders.

Fasano A, Bloem BR.

Continuum (Minneap Minn). 2013 Oct;19(5 Movement Disorders):1344-82.

2. Effects of different focus of attention rehabilitative training on gait performance in Multiple Sclerosis patients.

Shafizadeh M1, Platt GK, Mohammadi B.

J Bodyw Mov Ther. 2013 Jan;17(1):28-34.

3. Gait and participation outcomes in adults with cerebral palsy: a series of case studies using mixed methods.

Gannotti ME1, Gorton GE 3rd, Nahorniak MT, Masso PD.

Disabil Health J. 2013 Jul;6(3):244-52.

4. Functional recovery and rehabilitation of postural impairment and gait ataxia in patients with acute cerebellar stroke.

Bultmann U1, Pierscianek D, Gizewski ER, Schoch B, Fritsche N, Timmann D, Maschke M, Frings M.

Gait Posture. 2014;39(1):563-9.

5. Does robot-assisted gait rehabilitation improve balance in stroke patients? A systematic review.

Swinnen E1, Beckwée D2, Meeusen R3, Baeyens JP4, Kerckhofs E1.

Top Stroke Rehabil. 2014 Mar-Apr;21(2):87-100.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 9, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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