Understand why gait matters
Like almost everything else, the way we walk changes as we age. Maybe you’ve noticed it in yourself or a friend: A slower step, a slight stagger, or a limp, a shuffle, a tilt. But how do you know what’s normal and what’s not? While many people experience some slight changes in their gait as they age, for others this doesn’t happen until they are extremely old. However, walking difficulty should not be accepted as an inevitable consequence of aging. It can signal an underlying condition that needs medical attention and whose adverse impact on mobility and independence can be avoided if recognized and treated early enough. A study estimated that about 10% of people aged between 60 and 69, and nearly 62% among people aged between 80 and 97, have a gait, or walking pattern, disorder. Abnormal gait changes can signal a nervous system condition, such as Parkinson’s disease; a bone, muscle, or joint disorder, such as arthritis; psychological factors, such as anxiety or depression; or drug side effects. Some gait disturbances are associated with an increased risk of developing dementia and cardiovascular disease. Any type of gait change predisposes adults to falls and serious injuries. If you notice a change in gait in yourself or a loved one, have the change checked out by a doctor to detect the underlying causes and prevent falls and future immobility.
NORMAL AGERELATED GAIT CHANGES
Several distinct elements determine whether gait is normal in healthy older adults: Speed. Most adults walk more slowly as they age. In people who don’t have significant health problems, gait speed declines by about 0.2% a year up to age 63, and up to 1.6% each year after that. A reason for a slower gait may be decreased strength in the calf muscles, which you use to propel yourself forward. Cadence. For most people, cadence, or rhythm, doesn’t change as they age. Cadence is
related to leg length: Tall people take longer steps at a slower cadence, and short people take shorter steps at a faster cadence. The appearance of deceleration is not due to cadence but to shorter steps as a person ages. Double stance time. The length of time a person has both feet on the ground while walking can double with age. A person with a longer double stance time may look as if he or she is walking on ice. Walking posture. An upright walking position is normal in healthy older adults, although some people may tilt their pelvis forward with an inward curve in the lower back (known as lumbar lordosis) because of tight hip-flexor muscles, weak abdominal muscles, and increased abdominal fat. Joint motion. Because ankle flexibility may be reduced, gait may change slightly as the back foot lifts off the ground when walking. Older adults also have a limited range of motion in the hips. Age-related gait changes can result from a general reduction in fitness, including stiffness, loss of limb strength, a declining sense of balance, and less lung and heart capacity. On average, people with stronger legs or more range of motion in their ankles and hips walk faster. Walking speed has been linked to overall health and life expectancy: Fast walkers (defined as 1 meter per second, or 2.5 mph, or more) are more likely to outlive slower walkers. And having to stop walking while talking is a predictor of future falls. The fear of falling can cause a gait change. Called cautious gait, this change in gait occurs in older adults who have already taken a stumble or who have poor vision. A person with cautious gait may have exaggerated agerelated gait changes and walk with careful, wide-legged movements and minimal arm movement. If a cautious gait isn’t corrected, and fear of falling becomes obsessive, it can lead to a phobic gait disorder in which a person becomes completely unable to walk.
ABNORMAL GAIT CHANGES
A sudden change in gait with no apparent cause is not normal and needs to be evaluated by a doctor right away. Often, however, gait changes are more subtle and develop gradually as a result of a chronic medical condition. An abnormal gait is rarely due to one single factor. Most gait disorders involve multiple contributing factors. For example, it’s not uncommon for one person’s gait to be impaired by a combination of joint pain,
a visual impairment, and the side effects of medication. To determine what’s causing your gait change, your doctor will perform a comprehensive history and a physical exam and review your mediations. Reasons for abnormal gait change include: Parkinson’s disease. Quick, short steps or shuffling, with the knees, hips, and spine bent, could suggest Parkinson’s disease or parkinsonism. Parkinsonism is a condition with symptoms similar to Parkinson’s disease that also affects gait. Arthritis. Knee or hip arthritis can force you to change your gait, often in an effort to relieve pain as you walk. You may appear stiff; take short, slow steps; or seem unable to beat your body’s weight. Back and neck problems. Lumbar spinal stenosis, which is a narrowing of the canal through which the spinal cord travels in the vertebrae of the lower back, can affect gait. Spinal cord compression in the neck region (cervical spondylotic myelopathy) can interfere with gait and cause loss of balance and co-ordination and also result in ‘foot drop’, a weakness in the ankle muscles that causes the toe to drag while walking. Foot drop is sometimes accompanied by a high lifting of the leg to avoid catching the toe on the ground. Other orthopaedic problems. Lower-extremity surgery or trauma, such as a fracture, can cause a deviation from normal gait. A vitamin B deficiency. A stagger or an unsteady
gait can be a sign of a chronic vitamin B deficiency, which can lead to a degeneration of the nerves in the spinal cord and brain. Early detection is crucial: By the time a B deficiency gives rise to difficulty walking, the nerve damage may be irreversible. Peripheral neuropathy. Damage to sensory nerves in the feet can cause numbness, tingling, or pain in the feet and result in an inability to walk properly. Diabetes is a common cause, but many other medical conditions that are amenable to treatment can also cause neuropathy. Other neurologic disorders. Many brain and nervous system disorders can trigger a wide range of gait changes, including unsteadiness; slow, small steps; lack of coordination; feeling as if your feet are stuck to the ground; or difficulty initiating leg movement. Brain tumours, multiple sclerosis, and Huntington’s disease are examples of the many neurologic disorders that can cause gait disturbances. Strokes are a common cause of gait disorder. The term ‘silent strokes’ refers to the fact that a single stroke might not have any symptoms, but multiple small strokes can additively lead to gait problems. Normal pressure hydrocephalus is a buildup of cerebrospinal fluid in the fluid-containing sacs of the brain due to an inability of the fluid to flow normally. Hallmark symptoms include
difficulty initiating walking, the feet becoming frozen in place, and incontinence. It can often be reversed if identified early. Peripheral artery disease (PAD). PAD can cause calf, thigh, and foot pain, which occurs when the arteries to the legs can’t deliver sufficient blood flow, resulting in leg pain after walking short distances. Mental health disorders. A depressed mood may cause you to walk more slowly and shuffle, and anxiety may cause you to walk more cautiously. Drug side effects. Some medications can directly impair walking by causing a Parkinson-like gait disorder. Antipsychotic drugs and metoclopramide are common causes. Drugs that cause blurry vision, confusion, drowsiness, and low blood pressure upon standing – and there are many – can adversely impact gait. Footwear. Don’t overlook your shoes as a possible contributor to an unsteady gait. Ill-fitting shoes with no support can cause you to shuffle your feet. High heels and crepe soles can impair gait. War sturdy, low-heeled shoes instead.
Many causes of the gait disorders listed above can be improved, and treatment can help prevent injuries from falls and improve mobility. Drug therapy can improve symptoms of many conditions that affect gait and surgery may help in conditions such as arthritis and hydrocephalus. Many conditions, such as arthritis and Parkinson’s disease, improve with exercise. Formal physical therapy can lead to dramatic improvements; group activities, such as a tai chi class, can have good results. Resistance exercises, balance training, and walking can help. Physical therapy routines aimed at strengthening and lengthening specific muscles are often effective. Using a cane or a walker can help prevent falls. A physical or occupational therapist can design a programme specific to your needs. Consider installing grip bars and brighter lights, and remove tripping hazards like electrical cords and throw rugs. A change in gait or walking difficulties is not an inevitable consequence of aging. Weakness, unsteadiness, slowness, pain, or stumbling while walking should be assessed by your doctor.