One of the greatest tools of the podiatric physician is an acute eye for disturbances in gait. Walking requires an enormous amount of input from the central and peripheral nervous systems, the musculoskeletal system, and the vestibular and visual systems. A change to anyone of these inputs may alter the gait, and a keen eye for changes may lead the observer to a diagnosis.
Most commonly, described changes to gait are attributed to disorders of the nervous system. These compensatory gait patterns include:
The shuffling, slow, festinating gait seen in Parkinson’s disease
Steppage gait with foot drop commonly attributed to stroke, peripheral neuropathy, or lumbar radiculopathy
“Scissors” gait often seen in cerebral palsy
Cerebellar ataxic gait seen with alcoholism, neurotoxic poisoning, and inherited ataxia
Stooped gait from a history of lumbar spinal stenosis
Changes in gait may also be due to disturbances of the musculoskeletal system. These changes are often much more subtle than the changes attributed to neurological disorders.
To understand the changes in the musculoskeletal system that cause gait disturbances, a thorough understanding of biomechanical function is required. The human body can be thought of as a chain of linked joints that help us move, from the tips of our toes all the way up to the head. A minor change in one of the joints, bones, muscles or ligaments can have a rippling effect through the body.
Proper visual gait analysis uses a methodical approach, analytically evaluating key elements to the gait pattern. Areas of interest include the head, shoulders, pelvis, hips, knees, ankles, joints of the foot, heels, and toes. The observer will take note of things like range of motion, symmetry, speed, stride length, position of body parts, and other factors. The changes can often be very subtle, but may cause great disturbances in gait as well as painful or limited ambulation.
For the podiatric physician, musculoskeletal changes are often the area of most interest. Gait changes and positional deformities of the musculoskeletal system can often cause pathological conditions to develop in the foot and ankle, as well as the exacerbation of existing conditions. To combat these problems, orthotic devices and shoe modifications are often prescribed to the patient.
The vestibular system and visual system are the two special sensory systems that have the greatest influence on the gait cycle. The vestibular system, which is located in the inner ear, gives us the ability to balance. Disturbances to the vestibular system can cause vertigo and a los of balance, as well as dizziness, nausea, and other physical findings.
The visual system, stated quite simply, allows us to see where we are going. It relays information to the vestibular system, as well as to a number of areas of the brain that aid in walking.
Gait analysis is a vital tool, and can often help in the diagnosis of different disorders and diseases. A keen eye and understanding of the body are essential to proper gait analysis. Inversely, an understanding of gait analysis is essential to the understanding of the body.
