Gait disorder

Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.

More about the experts All content is checked by medical journalists.

A gait disorder is when the gait speed is reduced or the gait pattern is abnormally changed. A gait disorder should always be taken seriously, as serious illnesses can be behind it. On the other hand, gait disorders can have dramatic consequences for the life of an affected person, as the loss of mobility threatens the affected person with a loss of independence, which severely limits their quality of life. Here you can read everything you need to know about the causes and treatment of gait disorders.

Gait disorder: description

Gait disorders can vary in severity. While a slight limp is sometimes hardly noticeable, severe gait disorders can also make walking completely impossible and thus massively limit the mobility of the person concerned. Doctors speak of a gait disorder when a person's gait deviates significantly from the norm in terms of gait speed or gait pattern. While young people walk about 2.5 meters per second when walking normally, older people only walk about 1.5 meters per second. But that is still to be seen as normal age development. However, if the walking speed is significantly lower, it could be a walking disorder.

In addition to the speed, the gait pattern can also be noticeable. Normally, the gait pattern should appear "harmonious", so walking should represent a fluid and symmetrical movement overall. Swinging your arms with you is part of a harmonious gait pattern. A normal gait is also characterized by the fact that the feet have a normal distance from one another, the stride length is normal and the sole of the foot is neither raised too far nor too little when walking when the foot is moved forward.

Since walking is usually intuitive, most people do not worry about the complex processes in the nervous system and muscles that are actually necessary for normal walking. The organ of equilibrium, one's own (unconscious) movement perception, information through the eyes and the precise control of the muscles are particularly important for an undisturbed gait. A disorder in one of these areas can lead to a gait disorder.

Gait disorder: causes and possible diseases

There are many causes for a gait disorder. Basically, most gait disorders can be traced back to two main causes: a disorder of the sense of balance or a disorder of the musculoskeletal system.

In some cases there are several causes that lead to a gait disorder (multifactorial gait disorder). In the following you will find out why the sense of balance is so important for a normal gait and why disorders of the musculoskeletal system can lead to gait disorders. Once one has understood this common origin of gait disorders, it is much easier to understand the multitude of possible causes of a gait disorder.

Impaired sense of balance

In order for a person to be able to stand upright and walk at all, he needs an intact sense of balance. If this is missing, walking disorders and falls can occur.

Three perception systems of the body are primarily involved in the sense of balance: the eyes (visual system), the balance organ in the inner ear (balance system) and the information from the body periphery, which is transmitted via the nerve tracts and the spinal cord to important sensory and motor centers in the brain and there processed (proprioceptive system).

If one of these three systems fails, the two remaining systems can often compensate for this, so that the sense of balance is only slightly disturbed. However, if two of the systems are affected, imbalance inevitably occurs. All these processes have in common that they usually run unconsciously and one only becomes aware of their existence as soon as they no longer function as usual.

• Visual system: The brain constantly receives information about the position of the body in space through the eyes. This information is processed in the brain and contributes significantly to stabilizing the upright position. Many imbalances are only noticed when those affected close their eyes and lose their balance when this information is lost.
• Balance system: The balance organ is located in the inner ear. It registers rotations as well as acceleration and deceleration of the body. Everyone has an organ of equilibrium in the right and left inner ear. For a normal sense of balance it is important that the balance organs on both sides are intact. If one of the two fails, contradicting information will arise. This can seriously disturb the sense of balance and cause dizziness.
• Proprioceptive system: This is understood to mean the sense of touch and the information from the body periphery about the position of the body in space. That sounds complicated at first, but it is actually quite simple: For the sense of balance, it is essential that information from the body is constantly transmitted via the nerve tracts and the spinal cord to the brain and processed there. There are tiny sensors in the skin, muscles and joints that continuously report information about body position to the brain. Even if a person is only standing motionless on both legs, minimal corrective movements of the muscles are necessary to maintain a secure stance. For a normal gait, information must be registered and processed at all times so that the brain can plan the right amount of muscle strength for the next step. The proprioceptive system can be damaged in the area of ​​the peripheral nerve tracts as well as in the spinal cord or even in the important centers in the brain.

Musculoskeletal disorder

In order for a person to be able to walk normally, he or she is dependent on a functioning musculoskeletal system in addition to a sense of balance. This means that his muscle strength is sufficient and mobility is not restricted by normal joint function. If the muscle strength is too low, normal movement is only possible to a limited extent.

A muscle only moves when it is stimulated to do so by a nerve impulse. In the case of muscle weakness, the cause can on the one hand lie in the muscle itself. However, it can also be due to a problem in the nerve tracts that activate the muscle. If a joint does not move normally, it blocks movement.

Very often a joint is damaged by signs of wear and tear or by chronic inflammation, which means that it can no longer be moved normally. In gait disorders, problems with muscles and joints in the foot, leg and hips are particularly important.

Overview of common causes of gait disorders

In order to get a certain order into the numerous possible causes of a gait disorder, a subdivision into neurological, orthopedic and psychogenic reasons for the gait disorder makes sense. These areas certainly overlap one another quite often, so that, for example, a gait disorder can be assigned to not just one, but often several of these three categories.

Neurological reasons for a gait disorder

This category primarily includes diseases of the brain and nervous system in which a gait disorder can occur:

Parkinson's disease	Typical for Parkinson's disease is a small step, leaning forward gait.
multiple sclerosis	In multiple sclerosis, balance disorders occur in particular, which lead to an unsteady gait pattern.
Polyneuropathy	Polyneuropathy is an umbrella term for the damage to the peripheral nerves, for example through diabetes (diabetes mellitus), alcohol, medication, etc. A typical gait pattern is a gait in which the tips of the feet drop down when walking and the feet therefore have to be raised especially. (Stork walk / stepper walk).
Inner ear damage	Damage to one of the two equilibrium organs in the inner ear, for example due to medication, inflammation or diseases such as Menière's disease, lead to balance disorders and dizziness.
Vitamin deficiency	For example, a lack of vitamin B12 can lead to funicular myelosis, in which, in addition to paresthesia in the arms and legs, gait disorders also occur.
stroke	Damage to the brain from a stroke can lead to various manifestations of a gait disorder, depending on which area of ​​the brain is affected.
Medication Side Effects	Drugs that act on the brain, such as neuroleptics, anti-epileptics and benzodiazepines, can be the cause of a gait disorder.
Brain tumor / Spinal cord tumor	Depending on the location of the tumor, the sensory and / or motor functions are disturbed.
Inflammatory diseases	For example, with borreliosis in the central nervous system (neuroborreliosis), movement disorders such as gait disorders are possible.
Enlargement of the cerebral ventricles due to increased CSF pressure	Diseases in which the nerve water presses on the nerve cells in the brain and thereby damages them can cause gait disorders ("Hakim Trias"). Examples are the so-called pseudotumor cerebri or normal pressure hydrocephalus.
alcoholism	Chronic alcohol consumption leads to brain damage (Wernicke-Korsakoff syndrome).

Orthopedic reasons for a gait disorder

This category primarily includes musculoskeletal disorders that can lead to gait disorders:

Joint wear (osteoarthritis)	Osteoarthritis can severely restrict the mobility of a joint and thus lead to gait disorders - especially if the knees, hips or ankles are affected.
Spinal stenosis	When the spinal canal is narrowed by the bony structures, severe pain occurs when walking (especially downhill).
Rheumatic diseases	Diseases from the so-called rheumatic group can make normal gait impossible due to joint destruction and chronic pain.
Muscle weakness	Inherited diseases with muscle weakness (muscular dystrophy, myotonic muscular dystrophy, etc.) are primarily responsible for gait disorders.
disc prolapse	A herniated disc (disc prolapse) often means severe pain for those affected, who can also develop gait disorders as a result.
Peripheral arterial disease	Not an orthopedic disease in the narrower sense: circulatory disorders cause pain in the legs, which means that those affected can only walk short distances.
Muscular spasticity	An increase in muscle tension (muscle tone) can result from damage to the brain and make normal walking difficult.
Injuries	For example, a fracture of the femoral neck is very often a reason for a gait problem in old age.

Psychological reasons for a gait disorder (psychogenic gait disorder)

In addition to the above-mentioned physical reasons for a gait disorder, emotional problems can also be responsible for a disturbed gait. The underlying mental illnesses are very diverse. The psychogenic gait disorder became known through research work on those returning from the war after the First World War.

Some war returnees were so traumatized by the events of the war that they showed conspicuous and very bizarre gait disorders. This traumatization of soldiers would be called post-traumatic stress disorder (PTSD) today.

A psychogenic gait disorder does not only occur in the context of PTSD. The psychological causes can be very different. However, they all have in common that they are not primarily caused by a malfunction of the nervous system or the musculoskeletal system, but are actually primarily of a psychological nature.

Often the severity of the gait disorder in psychogenic gait disorders can fluctuate very strongly (fluctuation). It can happen that on some days a normal gait is not possible at all, while a few days later the gait pattern is hardly or not at all impaired. Psychogenic gait disorders have not yet been adequately researched, so that therapy is often difficult. In some cases, an improvement can be achieved through inpatient treatment with physiotherapy and behavioral approaches.

Gait disorders: when should you see a doctor?

A gait disorder can occur in numerous diseases. For many of these, timely diagnosis and treatment can prevent the disease from progressing. Apart from that, gait disorders can be the result of serious, possibly life-threatening illnesses. This is especially the case if the gait disorder occurs suddenly and there is no obvious cause (such as joint wear and pain). Therefore, if you have an acute gait disorder, you should see a doctor straight away.

When normal walking is no longer possible, it extremely restricts a person in their daily life. Many people with gait disorders are often very afraid of falling, which can further worsen their gait problems. Therefore, a gait disorder is also a common cause of loneliness and social isolation when those affected can no longer leave the house. It can often be treated (depending on the cause). To do this, however, it is first necessary for the doctor to find the cause of the gait disorder.

Gait disorders: what does the doctor do?

In the case of a gait disorder, it depends on the suspected cause which doctor is the right person to contact. If the gait disorders are more neurologically caused by damage to the nervous system (nerve tracts, brain, spinal cord), a specialist in neurology can help you.

If, on the other hand, it is an obvious disorder of the musculoskeletal system (for example a joint problem), a specialist in orthopedics is a suitable contact person. If you go to your GP first, you are certainly not going wrong. If necessary, he will refer you to the appropriate specialist.

Medical history (anamnesis)

At the beginning of the visit to the doctor, there is a detailed discussion between the patient and the doctor, through which important information about the cause of the gait disorder can be obtained. Your doctor will ask you a variety of questions. For example:

• How long have you had the gait disorder?
• Did the gait disorder come on suddenly, or did it come slowly?
• Is the walking disorder always present, or do the symptoms change?
• In which situations does the gait disorder occur?
• Do you have pain when walking? If yes, where?
• Do you take any medicine? If yes, which?
• Do you have previous illnesses (e.g. heart attack, stroke, orthopedic diseases)?
• Aside from gait disorders, do you have any other complaints such as dizziness or sensory disturbances in your arms or legs?

Physical examination

Physical, orthopedic and neurological examinations are particularly important in the case of a gait disorder. First and foremost, the doctor looks at yourself as you walk. By observing the gait pattern, the doctor can roughly estimate what type of gait disorder you are.

In addition, the “Timed up and go test” (time taken to get up and walk) is used.You will be asked to get up from a chair, walk ten feet, and then sit back on the chair. The doctor measures the time they need for this. It usually takes no more than 20 seconds to complete this exercise. If it lasts longer than 30 seconds, this should be rated as conspicuous and a gait disorder likely.

The next step is to test your sense of balance. This is achieved, among other things, with the so-called "Romberg standing attempt". They are asked to stretch their arms forward while standing and to close their eyes when prompted.

If you get problems with your balance when you close your eyes and start to sway, this indicates a disruption of the information conduction in the spinal cord, which leads to a balance disorder ("spinal ataxia"). If you already have problems doing this exercise with your eyes open and closing your eyes does not affect the stability of your posture, this is more an indication of damage to the cerebellum.

Another investigation is the "Unterberger Tretversuch". You stand in a similar way to the Romberg standing attempt and close your eyes. In addition, they should step in place about 50 times and try to maintain the same position.

After the exercise, it is determined how far she has turned her position in one direction by pedaling. A rotation of more than 45 degrees in relation to the starting position is noticeable and indicates damage to the cerebellum or organ of equilibrium. In addition to assessing the gait pattern and sense of balance, the doctor also performs a general neurological examination. He assesses reflexes, muscle strength and sensitivity.

Further investigations

The medical history and physical examination provide the doctor with valuable information about the possible cause of the gait disorder. If necessary, further examinations are necessary in order to be able to make a reliable diagnosis. Further examinations to clarify a gait disorder include:

• Computed tomography (CT) or magnetic resonance imaging (MRI)
• Measurement of nerve conduction velocity with electroneurography (ENG)
• Examination of blood and / or nerve fluid (liquor)
• Measurement of brain waves (electroencephalography, EEG)
• Measurement of nerve-muscle conduction (electromyography, EMG)
• Eye test, hearing test

Therapies

Once the cause of the gait disorder has been determined, the doctor will explain to you which therapy is necessary. The treatment of the gait disorder depends entirely on the underlying cause. While some causes (such as vitamin deficiency or drug side effects) are sometimes reversible, other diseases are more about stopping the progression (Parkinson's, multiple sclerosis).

Surgical intervention is occasionally necessary, especially with orthopedic causes. In many cases, supportive therapy measures such as physiotherapy (physiotherapy) and physical treatment methods (such as exercise baths, massages, heat applications, etc.) are useful in the case of gait disorders in order to strengthen muscle strength and improve movement coordination.

Gait disorders: you can do that yourself

In the case of gait disorders, you can also have a positive influence on the symptoms through your own commitment. As with many other diseases, it is important to maintain a healthy lifestyle with sufficient exercise. Regular training of muscles and a sense of balance is extremely important for gait disorders: This can greatly reduce the severity of a gait disorder, even if it is a cause for which there is currently no cure (for example, Parkinson's disease).

As part of the treatment of a gait disorder, physiotherapy teaches you some gait exercises. These should be done regularly at home. Even if the progress is slow and “step by step” in the truest sense of the word. By strengthening and mobilizing existing reserves, defects in the nervous system can often be compensated for.

In addition to walking exercises, regular gymnastics and walks are recommended and easy for most people to do. In particular, gait training through "Nordic Walking" can be very effective. Nordic walking sticks also protect against falls. A conscious and cautious consumption of alcohol is part of a healthy lifestyle.

In the case of an existing gait disorder, alcohol should be avoided altogether, as alcohol damages the brain and nerve tracts. Polyneuropathy caused by diabetes mellitus (diabetes) is one of the common causes of a gait disorder. If the diabetes is discovered and treated in good time by a doctor, serious consequences such as a gait disorder can often be avoided.

Important for gait disorders: fall prophylaxis

To a certain extent, falls are also avoidable. Not only do they pose a risk of serious injury, but they often also lead to fear of walking. For fear of another fall, those affected avoid walking more and more, as a result of which their physical reserves continuously decrease. In addition, they leave the house less and less often and can sometimes get into social isolation, which has a particularly negative effect on the overall prognosis.

If a person with a gait disorder has already fallen or a fall could occur at any time, preventive measures should always be taken to minimize the risk of falling and the possible consequences of a fall.

For example, special, padded pants (“hip protectors”) can protect the hip joints and thigh bones from a fracture in the event of a fall. Further tips and information on how to furnish your home in order to avoid falls if you have a gait disorder can be found on the Internet in abundance. For example, the association "Barrier-free life e.V.“In Hamburg, we offer free online advice on how you can reduce the risk of falling in your own home.

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