symptoms

Difficulty walking, gait disorders - causes, symptoms, therapies

Difficulty walking, gait disorders - causes, symptoms, therapies / symptoms

Problems when walking

Difficulty walking and gait disorders occur especially in the elderly. It is believed that general age-related deposition in the vessels, and especially in the brain, leads to reduced perfusion and decreased movement function, thus limiting the ability to coordinate. In addition, there are numerous medical conditions and symptoms that can cause problems while walking. Therefore, it must first be examined whether the walking difficulties are of neurological, internistic, psychogenic or orthopedic origin. In principle, difficulty walking is felt by sufferers as severely limiting and quality of life diminishing. Therefore, it is particularly important to get to the cause of the cause and to initiate a promising therapy.


contents

  • Problems when walking
  • Gait Disorders - A Brief Overview
  • definition
  • What does a normal gait look like??
  • Neurological causes of walking difficulties
  • Gait disorders in orthopedic causes
  • Difficulty walking with internal causes
  • Difficulty walking with psychogenic causes
  • Risk factors that can lead to walking difficulties
  • diagnosis
  • Treatment options for walking difficulties
  • Treatments for mental causes
  • Naturopathic treatment
  • Own measures against walking disorders
  • 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 will be discussed in more detail below:

  • definitionWhen the gait pattern or walking speed deviates from the typical movement pattern for age and height, it is called a gait disorder. This can range from a slight limp to the loss of independent walking.
  • symptoms: Reduced walking speed, discrepancies, deviations or abnormalities in the gait pattern, such as waddle, limp, trip or limp.
  • causes: There are many different diseases and medical conditions that can cause walking problems. The causes may be neurological, internal, psychological or orthopedic nature.
  • Neurological causes: Parkinson's disease, multiple sclerosis, peripheral nerve damage (polyneuropathy), inner ear complaints, B12 vitamin deficiency, stroke, brain tumor, inflammation (eg due to Lyme disease), brain damage due to alcoholism.
  • Internal causes: Changes in the blood vessels in the legs, peripheral arterial disease (PAOD), arteriosclerosis (arteriosclerosis).
  • Psychogenic causes: Psychogenic tremor, psychogenic dystonia (movement disorder), psychogenic myoclonus (muscle twitching), psychogenic parkinsonism, psychogenic gait disorder, posttraumatic stress disorder (PTSD).
  • Orthopedic causesArthritis, spinal stenosis, rheumatic diseases, muscle weakness, disc herniation, injuries such as femoral neck fracture or other fractures of leg and foot.
Many people have difficulty walking during their lifetime. (Image: lassedesignen / fotolia.com)

definition

Walking difficulties and gait disturbances are movement disorders, which become noticeable especially when walking. The cause may be due to neurological, orthopedic, internal or psychogenic problems and disorders. Frequently, in addition to the problems in walking further complaints, for example in diseases such as Parkinson's disease or multiple sclerosis. With difficulty walking, in many cases therapies can only alleviate the symptoms, but can not remedy the cause.

What does a normal gait look like??

A healthy gait is characterized firstly by the walking speed and secondly by a harmonious gait pattern. In a healthy walk, adults spend an average of around 2.5 meters per second. In old age, this value can fall to around 1.5 meters. This is not questionable and is part of the normal aging process. If regular discrepancies, abnormalities or abnormalities are noticed at the speed or gait pattern, walking difficulty may be present. A harmonious gait pattern is characterized by the following aspects:

  • Fluid and symmetrical motion sequence,
  • Swinging of the arms,
  • Foot distance is normal (neither too wide-legged, nor too close together),
  • the stride length is normally long and consistent (persons between 1.5 and 1.7 meters have an average stride length of 60 cm, persons between 1.7 and 1.9 meters average 70 cm),
  • the feet are neither raised nor raised too much during the movement.

Walking problems can have many causes

Difficulty walking can be very different for those affected. The problems range from a slight limp or an unsteady gait to very noticeable gait patterns in which the affected are hardly able to walk. As a trigger of difficulty walking accordingly many causes in question, the doctor must first clarify.

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

Neurological causes of walking difficulties

With gait difficulties, which are to be attributed to a neurological problem, dizziness and general Gehunsicherheiten occur concomitantly frequently. The balance may be so disturbed that sufferers 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 persons usually has wide-legged, insecure and tapsig. Other complaints of this disease are bladder disorders such as bladder weakness to incontinence and subcortical dementia.

Trendelenburg gait and Parkinson's disease

Another neurological gait disorder is the so-called Trendelenburg gait, in which patients waddle due to paralysis of the middle gluteal muscle. This is often caused by damage to the supplying nerves. By contrast, a small, tippy gait pattern may be indicative of Parkinson's, a neurological, degenerative disease that primarily affects the motor skills of those affected. A typical symptom of Parkinson's is also the tremor, which was previously often spoken of shaking disease.

Stroke and spastic hemiplegia

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

Other neurological causes

Staggering "as if drunk" indicates a cerebellar gait pattern in which disorders of the cerebellar function are present, for example in ataxia, a disorder of movement coordination. Another neurological brain disorder is the so-called "stepper gait", which is colloquially referred to as stork walk. This gait disorder is caused by a paralysis of the foot lifter.

Gait disorders in orthopedic causes

Most walking problems 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 (osteoarthritis).

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

relief claudication

One of the orthopedic complaints of walking disorders is the Duchenne limp (relief hitching), in which sufferers tend their torso to the foothold. Cause can be a malposition in the hip joint, a hip dysplasia or a hip dislocation. A weakened gluteal muscle can also trigger a limp.

Waddling gait pattern (Trendelenburg gait)

The waddling gait pattern in the Trendelenburg gait can be caused not only neurologically but also orthopedically, for example, in a child's hip dysplasia or dislocation of the joint. Also with joint stiffening or pain the affected persons limp frequently.

Easy walking difficulties

In mild gait difficulties, sufferers often complain of a numbness in the calves to the feet. This is usually a nerve compression, with the neurological examination, the measurement of the nerve conduction velocity, sometimes no result.

tarsal tunnel syndrome

When numbness occurs in the feet, it may be the tarsal tunnel syndrome, where there is compression of the N. tibialis nerve that runs along the medial malleolus. The causes include bone fractures, tendonitis in the affected area and disorders in the arterial supply of the lower leg and thus also of the nerve in question.

Problems of the lumbar spine

The nerves that supply the legs and feet can also severely restrict the ability to walk through compression. They originate from the lumbar spine and should be included in the diagnosis and treatment of walking difficulties. In osteopathy, not only the back and the general static of the body, but also pre-existing conditions such as eddy gliding, back pain, back pain or buttocks pain are considered. In case of suspected nerve compression, a polyneuropathy (certain diseases of the peripheral nervous system) as well as venous diseases should definitely be excluded.

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

Difficulty walking with internal causes

Walking problems 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, also known as "intermittent claudication", because sufferers have to stop at certain intervals, such as in front of a shop window, because they have leg pain. Rarely are the arms affected. Peripheral arterial disease is one of the chronic vascular diseases of the arteries. It is caused by stenosis (narrowing) or occlusion (occlusion) of the arteries, which are responsible for the care of the extremities.

hardening of the arteries

In rarer cases also the main artery is affected. Arteriosclerosis (arteriosclerosis) is one of the main causes of the disease, whose symptoms range from symptom-free, easy walking difficulties to gangrene, an amputation-dependent tissue necrosis. There is a high risk of myocardial infarction.

Difficulty walking with psychogenic causes

Psychogenic gait difficulties, are problems with the counter, which are conditioned by the psyche of those affected. They belong to the 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. Frequently, comorbidities such as anxiety disorders and depression occur.

Risk factors that can lead to walking difficulties

Because of difficulties in walking, among other things, circulatory disorders, which are often associated with smoking, diabetes mellitus, hypertension and lipid metabolism disorders such as hyperlipidemia and hypercholesterolemia, the main risk factors for peripheral arterial disease, a healthy lifestyle is recommended. These include a non-fat, balanced diet and abstaining from nicotine (Help: Quit Smoking).

Those who minimize risk factors and frequently take walks can remain mobile until old age despite certain limitations. (Image: oneinchpunch / fotolia.com)

Footwear as a risk factor

Wearing mismatched, too tight shoes can also cause nerve compression on the feet, causing those affected to develop gum uncertainties due to a numbness in the legs.

diagnosis

In the diagnosis of walking difficulties, it must first be determined whether the cause is neurological, orthopedic, internistic or psychogenic. First, the clinician will review the patient's gait by observing speed, pace, start and stop, contact with the floor, rolling and movement in the large joints, and feet and toes while 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 a tightrope walk, in which one foot is placed in front of the other on an imaginary line. To detect possible paralysis, the patient may be asked to walk on the toes or verses.

More walking tests

Doctors also use the so-called Romberg standing test to test their balance. Patients with tight feet have to stand for a few minutes. The first part is done with the eyes open, the second half with the eyes closed. Another way to check the gait, offers the so-called Unterberger Tretversuch in which sufferers with closed eyes and outstretched arms about 60 times on the spot must.

Find out about previous illnesses

Pre-existing conditions such as injuries, myocardial infarction, stroke or herniated disc have to be taken into account in order to find out the cause of the walking difficulties. The doctor usually conducts a detailed discussion with the patient in order to be able to better restrict the symptoms. This includes questions about emotional and balance disorders. In addition, it may be necessary to perform further investigations, such as:

  • eye tests,
  • hearing tests,
  • a blood test,
  • a CSF function (brain water examination),
  • Computed tomography (CT),
  • Magnetic Resonance Imaging (MRI),
  • Electroencephalographies (EEG),
  • Electromyography (EMG).
Walking difficulties can limit the quality of life, but this need not always be the case. Especially with orthopedic causes can often achieve good results through manual therapy and physiotherapy. (Image: Ljupco Smokovski / fotolia.com)

Treatment options for walking difficulties

The way of treating walking difficulties depends on the cause of the condition. For orthopedic problems, good results can often be achieved with physiotherapy, manual therapy or physiotherapy. In more severe cases, immobilization or surgery may be necessary. Usually followed by a movement therapy.

Therapies for circulatory disorders

If circulatory disorders are the cause of difficulty walking is often a drug therapy, depending on the diagnosis and surgery may be necessary. Reasonable exercise is also beneficial.

Overweight and obesity

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

Therapies for neurological causes

In a neurological disorder such as Parkinson's disease or multiple sclerosis as the cause of walking disorders, only symptomatic therapy is possible, as the course of the disease progresses and on the basis of currently available therapies no cure is expected. Patients can be relieved of their symptoms through targeted movement therapy (physiotherapy, physiotherapy) and physical treatments such as massages or electrical treatments.

Treatments for mental causes

If the disorder is due to a psychogenic cause, psychotherapy may assist, possibly accompanied by medication.

Naturopathic treatment

In natural medicine, osteopathy is considered a particularly promising method due to the holistic view of the patient's complaints. Many statutory health insurance funds now take over the costs of osteopathic treatments. Even acupuncture can be used successfully. In addition, massages and thermal therapies have positive effects on some gait complaints.

Back-friendly training, a healthy lifestyle with lots of exercise and low alcohol levels can help alleviate gangrene or even prevent it from developing. (Image: metamorworks / fotolia.com / heilpraxis.de)

Own measures against walking disorders

In order to prevent walking difficulties due to back pain, for example in herniated discs, suitable, back-friendly training is suitable, such as a 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 aches and pains

A healthy lifestyle with enough exercise can mitigate 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

In case of an acute danger of falling or if the affected person has already fallen, it is essential to ensure a good fall prophylaxis, because falls often require care. As the gang becomes more and more insecure and those affected lose confidence in their ability to walk, many are less and less able to move and isolate themselves. This aggravates the course of the disease and the symptoms of the gait disorder. A suitable fall prophylaxis can counteract this. For this purpose, all potential fall trigger such as carpets or rugs from the apartment should be removed. Special trousers with hip protectors additionally protect patients in the event of a fall. In addition, walking aids such as walking sticks or rollators can be used. (no, vb, updated on 22.07.2018)