What Are the Most Common Causes of a Unsteady Gait?

Pathological gait (abnormal gait) refers to an abnormal state of walking that is uncoordinated. It can be caused by diseases of the human nervous system and motor system, pelvic skew, unequal length of both lower limbs, lateral flexion of the trunk, weakened or weak physical strength, etc. The main clinical symptoms are: (1) straddling gait, due to the diseased foot sag, the knee and hip joints must be flexed to raise the leg before walking, so as to drag the foot; (2) spastic gait, hemiplegia walking When the affected foot is thrown outward, it is in a circle shape. When the paraplegic person walks, his legs cross inward, and they are scissors-like; (3) Sensory ataxia gait, when walking, the stride is large, and the distance between the legs is wide. Lift the foot high, the legs fall quickly and hard when landing; (4) cerebellar ataxia gait, the distance between the legs widens when walking, the body swings unstable to the sides after lifting the legs, like a drunk; (5) Panic gait, slow start, stiff limbs, leaning forward, small stride, but walking faster and not stopping immediately; (6) duck step, hips shaking left and right while walking; (7) hysterical gait , Gait is different. ^[1]

Pathological gait

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Pathological gait (abnormal gait) refers to an abnormal state of walking that is uncoordinated. It can be caused by diseases of the human nervous system and motor system, pelvic skew, unequal length of both lower limbs, lateral flexion of the trunk, weakened or weak physical strength, etc. The main clinical symptoms are: (1) straddling gait, due to the diseased foot sag, the knee and hip joints must be flexed to raise the leg before walking, so as to drag the foot; (2) spastic gait, hemiplegia walking When the affected foot is thrown outward, it is in a circle shape. When the paraplegic person walks, his legs cross inward, and they are scissors-like; (3) Sensory ataxia gait, when walking, the stride is large, and the distance between the legs is wide. Lift the foot high, the legs fall quickly and hard when landing; (4) cerebellar ataxia gait, the distance between the legs widens when walking, the body swings unstable to the sides after lifting the legs, like a drunk; (5) Panic gait, slow start, stiff limbs, leaning forward, small stride, but walking faster and not stopping immediately; (6) duck step, hips shaking left and right while walking; (7) hysterical gait , Gait is different. ^[1]

Common pathological gait manifestations can be divided into the following categories: hemiplegic gait, paraplegic gait, gluteus maximus gait (posture with raised waist and abdomen), mid-gluteal muscle gait (duck step), quadriceps gait Gait, cross-domain gait, joint rigidity gait, hobbling gait, panic gait (forward gait), short leg gait (both legs differ in length), pain gait, etc. The principle of correction is to find out as much as possible the causes of gait abnormalities and conduct targeted gait training. However, we must pay attention to the abnormal gait caused by some muscle paralysis, such as gluteal muscle gait, gluteal muscle gait and so on. It is a functional compensation phenomenon. It cannot be corrected by gait training. Instead of muscle function exercises, improve gait.

Reason: The lower limb is rotated externally or internally, and the knee cannot be flexed. Performance: When swinging the leg to move forward, the affected leg often rotates forward through the outer side, so it is also called circling step or circle gait.

Cause: The lower limb adductor spasm. Performance: bilateral hip adduction when walking, knees rub against each other, gait instability, also known as cross step or scissors step. Can also be seen in patients with cerebral palsy.

Reason: Weak hip extensors. Performance: The trunk leans back hard when walking, the line of gravity passes behind the hip joint to maintain passive hip extension, and controls the trunk's inertia forward. Form a posture of raising your chest and belly.

Reason: The hip abductor muscle group is weak and cannot maintain the lateral stability of the hip. Performance: The upper body is bent toward the affected side, the line of gravity passes through the outside of the hip joint, relying on the adductor muscles to maintain lateral stability, and prevent the contralateral hip from sinking, which drives the contralateral lower limb to swing. If both sides of the gluteal muscles are weak, the upper body swings left and right when walking, which looks like a duck step, also known as a duck step.

Cause: Knee extensor weakness. Performance: The affected leg cannot maintain the stability of knee extension during the support period, the upper body leans forward, and the line of gravity passes through the front of the knee joint to passively straighten the knee. Sometimes patients flex their hips slightly to strengthen the gluteal and posterior femoral muscles, so that the lower end of the femur can be swung backwards to help passive knee extension. If the hip extensor is weak at the same time, the patient needs to lean forward and press the thigh with his hand to stretch the knee straight.

Reason: weakness of ankle extensor. Performance: Feet sag, increase hip flexion and knee flexion during swing to prevent tiptoe dragging.

Cause: Contracture and rigidity of the joints of the lower limbs. Performance: Modern compensatory pelvic anteversion with flexion contracture of the hip joint, hyperextension of the lumbar spine, shortened step length. Short-leg gait can occur when knee flexion contracture exceeds 30 °. When the knee is stretched and contracted, the affected leg is abducted or the ipsilateral pelvis is raised to prevent the toes from dragging. When the ankle and plantar flexion contracture, the heel cannot touch the ground, and the hip flexion and knee flexion are often added to compensate for the swing period.

Cerebellar ataxia, unstable walking, unable to walk in a straight line, like a drunk man, also known as gait gait.

In Parkinson's disease or basal ganglia lesions, the gait is short and fast, and there is paroxysmal acceleration. It cannot be stopped or turned at will, and the upper limb swing is reduced or stopped.

If one side of the lower limb is shortened by more than 3cm, the ipsilateral pelvis and shoulder subsidence can be seen during the support period of the affected leg, and the foot can sag during the swing period.

When various reasons cause pain in the affected leg, the patient should try to shorten the support period of the affected leg as much as possible.