Locomotion of the limbs -- GAIT
By Vijaya Polavaram, M.D.

The pattern of how a person walks is called one’s gait. Many different types of walking abnormalities are produced unconsciously. Most, but not all, are due to some physical condition. Some gait abnormalities are a reflection of serious diseases. So it is important to know about locomotion of limbs and feet. Gait abnormalities are a common complaint accounting for 4 per 1000 emergency room visits.

Some walking abnormalities are so characteristic that they have been given descriptive names:

• Propulsive gait – a stooped, rigid posture, with the head and neck bent forward
• Scissors gait – legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement
• Spastic gait – a stiff, foot-dragging walk caused by one-sided, long-term, muscle contraction
• Steppage gait – foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking
• Waddling gait – a distinctive duck-like walk that may appear in childhood or later in life

Abnormal gait may be caused by problems or diseases in various areas of the body. Some examples of these problems and diseases are:

• The inner ear is responsible for maintaining balance, and damage to the inner ear may result in dizzy spells and vertigo.
• Disorders of the brain that cause muscular problems which result in gait disturbance such as Multiple Sclerosis, a degeneration of brain (symptoms include stiffness, shakiness, slowness, speech difficulty and gait disturbances); normal pressure hydrocephalus (symptoms include dementia, gait disturbances and urinary incontinence), a disease of brain usually a result of chronic meningitis, massive stroke, overdose of vitamin intake, etc.
• Spinal cord abnormalities (disease, trauma, degeneration)
• Peripheral nerve diseases (nerves from the spinal cord to the muscles may be damaged by disease or trauma and result in gait abnormalities)
• Degenerative muscle diseases such as muscular dystrophy, myositis, etc.
• Neurodegenerative illnesses (Parkinson's disease)
• Skeletal abnormalities and disease
• Arthritis
• Foot conditions  such as plantar warts, bunions, ingrown toenails, pressure ulcers

Nutritional Causes           
Some gait issues may be caused by nutritional issues. Vitamin E deficiency or malabsorption syndromes can cause gait problems. In its early stages, Vitamin E deficiency may be asymptomatic, showing no physical signs of the problem. Severe Vitamin E deficiency may affect gait, memory disturbance, visual disturbance etc. Vitamin B12 deficiency can also affect gait and memory. Since Vitamin B12 is available only in meats, a vegetarian with this deficiency may have gait issues .

Toxicities
Toxicity from some drugs cause peripheral neuropathies (diseases of the central nervous system) which in turn affect gait due to loss of sensations. Chronic alcohol users may develop a staggering gait, altered mental state and visual problems which can be present alone or in combination. Less affected patients walk with a wide-based gait and slow short-spaced steps. Women appeared to be more susceptible for these toxicity issues than men.
In addition to being caused by drugs and alcohol, peripheral neuropathies may be caused by other conditions which can affect gait:

• Anorexia nervosa (nutritionally depleting vitamins)
• Excessive vomiting during pregnancy
• Prolonged intravenous feeding without proper supplementation
• Prolonged fasting and starvation
• Gastric bypass surgery
• Cancers, kidney transplantations, dialysis and HIV.

Finally, a few words on one of the common problems that cause foot pain and gait issues — stress fractures. These fractures are due to loads that stress (either by compression or over-stretching) the bone which would not individually be expected to cause a break. These fractures are commonly seen in military recruits who have marched several miles with heavy back packs and athletes training for long distance. The reported incidence of stress fractures is 1% in the general population and 20% in runners. In general, women have more incidences of stress fractures. Female athletes may have a combination of eating disorders, osteoporosis, and no menstrual periods which all may contribute to fractures. In recent decades, women have become increasingly physically active. All woman athletes should be encouraged to take 1200 to 1500 mg of calcium supplements in their diet plus 400 IU of Vitamin D on a daily basis.

Common causes of gait issues in the elderly population are dizzy spells that may cause loss of coordination. These dizzy spells may be the results of drug interactions, cardiovascular issues, neuropathies (mainly diabetes), etc. Foot and ankle fractures are among the most common non-spinal fractures occurring in older people. The most common occurrence is fracture of the 5th metatarsal, a bone in the foot. A common cause of foot pain in ballet dancers is also the fracture of the 5th metatarsal bone.

In conclusion, we need to take good care of the “base” where we stand and its locomotion.

Dr. Polavaram specializes in internal medicine and is the owner of Capital Primary Care with offices in Cary and Raleigh.

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