Most children learn to walk somewhere between 12-15 months of age, and once they get the first month’s wobble and unsteadiness under control, they don’t think about walking the rest of their lives. Barring injuries, walking is second nature and taken for granted – that is until the aging process catches up with them somewhere in their late 60s.
At that age or earlier, people develop gait disorders for a wide range of reasons – knee, foot or ankle injury, neurological disorders, an inner ear problem, or something as simple as poorly fitted shoes.
Dr. Xabier Beristain, a neurologist with Cleveland Clinic Indian River Hospital, stresses the importance of seeing a doctor if you are feeling off balance or dizzy when you walk. “An abnormal gait may be a precursor to a serious neurologic disorder like Parkinson’s disease or MS,” he said. “A mini stroke in the brain or a pinched nerve in the back can also affect your gait. Or it may be as simple as a reaction to a medication or an inner ear infection.
“Regardless of the cause, there is a link between gait disorders and memory problems like dementia down the road,” Dr. Beristain continued. “The sooner your doctor can determine the cause and start a treatment, the sooner you can get back to living your life.”
Some elements of gait normally change with aging while others do not, according to a study published in Merck Manual. Gait velocity or the speed of walking remains stable until about the age of 70, and then it declines about 15 percent a decade for casual gait and 20 percent for fast walking. Gait velocity is as powerful a predictor of mortality as an older person’s medical conditions. After age 75, slow walkers die an average of six years earlier than normal velocity walkers and an average of 10 years earlier than fast velocity walkers.
According to ClevelandClinic.org common gait disorders include:
“Propulsive gait. This type of gait is seen in patients with parkinsonism. It is characterized by a stooping, rigid posture, and the head and neck are bent forward. Steps tend to become faster and shorter.
“Scissors gait. This type of gait gets its name because the knees and thighs hit or cross in a scissors-like pattern when walking. The legs, hips, and pelvis become flexed, making the person appear as though he or she is crouching. The steps are slow and small. This type of gait occurs often in patients with spastic cerebral palsy.
“Spastic gait. Common to patients with cerebral palsy or multiple sclerosis, spastic gait is a way of walking in which one leg is stiff and drags in a semicircular motion on the side most affected by long-term muscle contraction.
“Steppage gait. A ‘high stepping’ type of gait in which the leg is lifted high, the foot drops (appearing floppy), and the toes points downward, scraping the ground, when walking. Peroneal muscle atrophy or peroneal nerve injury, as with a spinal problem (such as spinal stenosis or herniated disc), can cause this type of gait.
“Waddling gait. Movement of the trunk is exaggerated to produce a waddling, duck-like walk. Progressive muscular dystrophy or hip dislocation present from birth can produce a waddling gait.”
“Most people who come to me feel unsteady when they walk or have fallen down a few times,” said Dr. Beristain. “In some cases, the fear of falling is more debilitating than the issue in the first place. Some patients are so afraid of falling that they won’t even try to walk.
Unfortunately, not walking is the worst thing they can do because exercise and physical therapy is the first line of treatment.
“The first thing I do is assess the gait disorder with a serious of balance and walking tests. If the patient has neuropathy, or loss of feeling in the legs, an MRI of the brain may be necessary to make a diagnosis. If the patient is shuffling and shaking it may be the beginning of Parkinson’s or MS disease. The imbalance may also be caused by a physical problem like having one leg shorter than another or a bad knee.
“I take on the role as doctor and detective in figuring out why the gait disorder is happening and what the best treatment is to solve the problem,” Dr. Beristain added. “It’s not easy to diagnose the problem. We have to look at the entire body to find answers.
“Strength and balance training help older adults with mobility problems and assistive devices like canes and walkers may be necessary to maintain mobility. Physical therapy will also help the patient learn how to use the devices correctly. The earlier the problem is addressed, the more we can help. It might be reversible, or we might be able to at least improve your function.
“If it’s underlying neurological problem like Parkinson’s, there are medications that can improve your quality of life. If it is simply an aging issue, we can teach you how to adapt and live comfortably.
“The most important thing you can do to prevent age related gait irregularities is to take good care of yourself. Eat well, exercise and control your risk factors by not smoking and drinking alcohol,” Dr. Beristain said.
“Genetics play a key role and can increase risk for having strokes and mental disorders. Unfortunately, there is nothing that can be done to prevent a genetic predisposition, but living a healthy lifestyle can limit many of the ailments we have as we grow older.”
“I advise my patients to get up and dance, box, bike or walk. One type of exercise isn’t necessarily better than another.
“They just have to keep moving. Living with a gait disorder is like switching from driving a car with an automatic transmission all your life, to driving with a manual transmission. It’s all about reconditioning and learning new tricks and ways to avoid problems. It’s manageable – just different.”
Dr. Beristain received his medical degree and completed his internship and residency at the University of the Basque Country Faculty of Medicine. He then completed a residency in neurology, and his fellowship in movement disorders at Indian University in Indianapolis. He has been in practice for more than 20 years.
Dr. Xabier Beristain’s offices are located at 3450 11th Court, Suite 395B, Vero Beach. 772-770-6848.
