A wobbly gait means

Often this condition has no obvious symptoms and can be detected on initial examination. The ethological factors are not clear, but it is assumed that the pathogenetic mechanism is triggered by calcium-phosphorus imbalances.

Shuffling feet when walking - causes of this gait

Sometimes you see a person walking with small steps. You may see a person walking with small steps and their foot hit the pavement and make a shuffling sound. This is called a shuffle or goose step. Such a gait is often attributed to physical fatigue, age (if it is an elderly person) or the desire to stand out from the crowd to attract attention (if it is a teenager). This is fundamentally wrong. There is a causal relationship between this gait and a specific disease.

In normal gait, a human places one foot on the heel, then gently on the instep, and then on the toes. When the foot is on the toes, the person brings the other foot forward and places it back on the foot. The leg is bent at the knee, allowing it to be lifted into the air. In the goose step, you don't have enough strength to move your foot in the air; it becomes a short step, the foot does not rise above the street and it paws at the sidewalk.

If your child walks this way, they may have a larger shoe size than their foot needs, or the shoe may be too heavy. In this case, just look for the right shoe size and fullness.

During puberty, the reason may be the child's desire to 'stand out from the crowd', to attract attention. The psychological aspect comes into play here and the parents should pay attention to the child's gait, explain the causes and explain the consequences of walking.

Such a gait can also be caused by general physical fatigue. In this case, shuffling is observed, as a rule, in the evening after heavy physical activity (long classes at school, university, heavy physical work, etc.). It is then necessary to reconsider the daily schedule, allocate more time for rest, to omit part of the physical work and to ensure adequate sleep. It's important to remember that when you goose step, your hips move with a smaller leg span than nature intended. In the future, such a step guarantees not only major problems with the joints, but also with the spine, which can lead to complete paralysis of the legs.

What doctors say about the shuffling gait.

If a person has a shuffling gait, he needs to see a neurologist, who will order detailed tests: blood and CSF tests, EGF, CT, MRI. After receiving the test results, the doctor will make the exact diagnosis and prescribe treatment. Depending on the diagnosis, this can be pharmacological or radical treatment.

For pharmacological therapy, fibrates and statins (clofibrate, Aromid, Mephacor) are prescribed; of the sudorotransmitter drugs, it's Caventon or Actovegin. Atherosclerosis can also be treated with antidepressants (amitriptyline), tranquilizers (phenozepam, diosepam, cerebrolysin). Multivitamin supplements, micronutrients and vitamin A, C, E and D complexes are also worth mentioning. Patients with blood pressure abnormalities or diabetics should consider medications such as aspirin, cardiomagnesin.

Movement should not be avoided. Some specific exercises can be done in the morning or during the day:

1. Circular movements of the head: 7 times clockwise and backwards.
2. Tilting the head left and right, trying to reach the shoulder (do not raise the shoulder).
3. Tilting the head forwards and backwards.
4. Pull bent knees toward chest.

Watch your breathing during the exercises.

If medication fails and the disease continues to progress, surgery is indicated. With a carotid endarterectomy, the cholesterol coating is removed from the damaged vessel. After the operation under local anesthesia, the patient is discharged from the clinic on the 3rd-4th day.

Rarely, carotid artery bypass surgery (a thin wire between the artery wall and plaque) or angioplasty (expanding the damaged area and restoring blood supply with a special catheter that pushes through the plaque) is done. However, due to the common complications associated with these surgeries, they are rarely performed.

Peculiarities of stiffening when walking

Stiffness on walking or stiffening disorder are recurrent episodes of the inability to start or continue walking. It can be absolute (complete immobility) or partial (steps of a few centimeters or less, or stomping in place). In the latter case, the patient's legs barely move and the body slides forward, sometimes leading to a fall. Partial stiffness also includes a trembling of the legs when starting or walking.

As a rule, this symptom occurs when trying to switch from one mode to another (beginning of walking) or when a change in the movement program is required: when going through a door or a narrow corridor, when turning, when stepping on obstacles , while reaching a chair. Sometimes there is no external cause for the stiffness and the patient stops in a straight line when walking.

Freezing is provoked by additional stress on the brain (trying to perform arithmetic calculations or formulate an answer to a question without stopping while walking) when being in the same area with many other people or doing a specific activity in a limited area time (crossing the street when the traffic light is green).

In contrast, rhythmic auditory stimuli, visual landmarks, emotional experiences, and stair climbing transiently decrease the severity and frequency of frictional dysbiosis. The onset of the symptom is often accompanied by a loss of synergistic movement and an increase in instability when standing and walking. The stiffness can occur not only with walking, but also with self-care, writing, or speaking.

Why does the stiffness occur when walking?

Parkinson's disease

There are four main movement disorders: tremor, asymmetric muscle rigidity, hypokinesia (slowing and limitation of movements, reducing their speed and amplitude), and postural abnormalities. Stiffness occurs on average five years after disease onset and is more common in older patients.

The frequency and duration of walking disorders increases with the progression of Parkinson's disease. There is no clear correlation with the severity of other movement disorders, but with the severity of speech, anxiety and depressive disorders. In severe cases, the patient can no longer move without help.

Secondary Parkinsonism

This is a polyetiological disease that differs from Parkinson's disease in that it has a more rapid onset of symptoms and symmetrical movement disorders. The clinical picture is very variable and does not necessarily include all the symptoms characteristic of Parkinson's disease. A combination with other cerebral manifestations may occur: ataxic gait, cerebellar syndrome, premature mental decline. Stiffness when walking and other symptoms of secondary parkinsonism are caused by the following abnormalities:

• Traumatic brain injury: Single severe (compression or contusion of the brain) and repeated mild (multiple concussions) trauma.
• infectious diseases: Encephalitis, Herpes, Measles, Mumps, HIV.
• Toxic Effects.Methanol, hydrogen cyanide, carbon monoxide, heavy metal and manganese poisoning from synthetic drugs.
• Degenerative diseases of the CNS.Multiple sclerosis, progressive supranuclear palsy, dementia with Lewy bodies, Wilson's disease.
• cerebral hypoxia: following attempted strangulation, clinical death, severe acute respiratory failure due to illness and trauma.

Causes of gait changes

In a comprehensive list of factors affecting human gait, doctors mention:

• Neurological disorders - sensory or motor disorders;
• Orthopedic diseases - arthritis and skeletal deformities;
• a variety of pathological conditions - cardiac or respiratory failure, peripheral arterial disease, obesity;
• infections;
• metabolic disorders;
• cardiovascular diseases.

In older people, the gait pattern can also change for the following reasons:

• impairment of proprioception (feeling for one's own body in space) in polyneuropathy;
• visual impairment,
• gait changes associated with vascular encephalopathy;
• Osteoarthritis in the hip (coxarthrosis) or in the knee (gonarthrosis).

If the gait disturbance occurs suddenly, ie begins acutely, the following causes come into question

• Cerebrovascular diseases (diseases related to changes in the blood vessels of the brain);
• spinal cord lesions;
• neuromuscular pathologies;
• side effects of medication;
• psychiatric disorders.

Changes in the gait pattern as a result of diseases of the musculoskeletal system

Characteristic of people with injuries and osteoarthritis. The reason for the gait change is to try to avoid pain. The person tries not to shift body weight to the 'painful' side and rotates the movement. This raises and lowers the painful leg and fixes the ankle in a specific position. But the deviation from normal gait causes pain in the knee, ankle and thigh of the healthy leg. As a result, the sufferer's body bends and the gait becomes more pronounced.

This is characteristic of people with coxarthrosis, which causes pain in the hip joint. The torso moves to the side of the affected limb when the injured leg is supported, reducing stress on the joint.

This can happen when the knee is extended more than it should be in a healthy person. The knee can stretch so much that the sufferer has difficulty walking without a cane. The weakening of ligaments and muscles leads to dangerous instability of the knee joint.

Deformities and contractures of the hip, knee, and different leg lengths lead to limping. When walking, the body begins to move up and down, and the head and trunk move toward the affected body parts. The arm on the 'painful' side is raised steadily higher and the opposite arm is rotated more to compensate.

With back pain, the person moves in jerky, short steps, instinctively straightening the lower back (lordosis). Kyphosis and ankylosing spondylitis cause a characteristic stoop and limit the mobility of the body.

What the gait of an elderly person tells you

• Long, irregular strides;
• Poorly controlled movements, legs 'out of control' when walking;
• Noticeable sagging of the feet when walking;
• Constant looking under feet while walking;
• Unsteady gait in poor light conditions.

• the person crouches;
• has difficulty moving
• often stops when moving forward;
• short, shuffling steps.

• creeping gait;
• half-bent legs and bent arms;
• short, shuffling steps;
• shorter arm span than usual;
• The center of gravity is shifted forward when moving.

What can you do for an elderly person with an unsteady gait?

Since unsteady gait increases the risk of a fall, it is important to secure the elderly person's home:

• Remove all objects from the aisles (shoes, furniture, extension cords, etc.).
• The corridors should be well lit (especially the way to the bathroom, toilet and kitchen).
• Put non-slip mats on the bathroom floor and at the bathroom exit.
• Provide comfortable slippers with non-slip soles.
• Keep a flashlight by the bed and use it if you need to get up in the night.

Older people should seek advice from their doctors:

Shuffling walk

Sluggish feet can have various causes - heavy, too small shoes, habits or diseases. From a medical point of view, a shaky gait is most commonly caused by limited mobility of the foot, where it is difficult to lift the toes. To compensate for the lack of mobility, patients begin elevating their knees slightly higher than is required for a normal, healthy gait. Such a gait may be related to changes in the foot nerve.

The appearance of a shuffling gait in the elderly requires special attention. Dementia is associated with impaired brain function, affecting clarity of thought and the ability to care for oneself, as well as impaired motor activity. Notably, changes in gait occur long before the onset of memory loss. Timely intervention can influence and significantly delay the onset of dementia.

duck-like gait

Only ducks, penguins and pregnant females move from side to side in a cute and fascinating way. Shifting the center of gravity, the precious 'weight' beneath the heart, is one of the reasons for this walk. Otherwise, the development of this duct can indicate a pinched nerve in the lumbar spine. A pinched nerve cannot do its job of transmitting a signal. When the muscles involved in the gait receive an 'incomplete' signal, the gait changes and the body rolls from side to side.

When a pathology forms, even at an early stage, the body sends signals. However, these often go unnoticed and are ignored due to their apparent insignificance. It is important to learn to read the changes, listen to the signals and take the necessary steps to correct them in time.

There are the following variants of gait disorders.

Depending on the way certain symptoms appear, the following types can be distinguished:

• ataxia or instability. This occurs when the cerebellum or thalamus is damaged. The patient spreads his legs and walks constantly swaying, periodically losing his balance.
• Stutter. Occurs as a result of damage to the conduction fibers of the nervous system. When walking, the patient puts his foot down immediately, as if stamping with each step.
• Shuffle. This gait is characteristic of older people and develops against the background of multiple neurological pathologies and general weakness. It is characterized by a reduction in stride length, with the foot barely leaving the ground as if dragging.
• A valgus foot (bony, striding). Occurs with nerve problems in the ankle, multiple sclerosis, polio and some other pathologies. The foot dangles downward and the patient has to bend the knee sharply to avoid hitting the floor with the dangling sock.
• Duck-like gait (Duchenne claudication). When walking, the patient appears to roll from one leg to the other, much like a duck. This unsteady gait occurs in people suffering from paresis or mechanical injury to the adductor group of the thigh.
• paretic. It occurs as a result of paralysis of the muscles of the lower limbs. The specifics depend on which muscle group is involved in the pathological process.
• Hemiparetic gait. Accompanying hemiparesis of any kind: stroke, congenital injuries, brain abscesses and tumors. During the movement, the affected arm is pressed against the body, the affected leg is stretched and makes a semicircle during the movement, with the body always leaning towards the healthy side of the body.
• hypokinetic. Shown by rigidity of movement. Develops in people with Parkinson's disease or occurs against the background of hydrocephalus.
• Hyperkinetic. Characterized by chaotic, abrupt movements. Occurs with chorea, foot dystonia and hyperkinesia.
• Iatrogenic. Occurs as a result of alcohol poisoning or taking certain medications. Patients feel that their legs do not obey them when walking.
• paraspastic. Characteristic of people with hypertension, it also occurs in patients with cerebral palsy, severe or critical B vitamin deficiency, and myelopathy.
• Idiopathic senility. Occurs in old age and is associated with degenerative-dystrophic changes in the musculoskeletal system.
• Friction imbalance (freezing when walking) and propulsion (acceleration when walking due to a small involuntary jolt). They occur in patients suffering from Parkinson's disease. Sometimes the stiffness occurs after multifocal strokes or simply in older people with no signs of neurological disorders.
• Skater Stance. The person walks with a slight body inclination and widely spaced movements. Such instability can occur with orthostatic hypotension.

Which doctor treats gait disorders?

Successful treatment of unsteady gait and coordination disorders requires that the actual cause is determined. If there is an underlying disease or disorder of the musculoskeletal system, the patient is treated by an orthopaedist/traumatologist. In other cases, a general practitioner or neurologist should be consulted, since gait disturbances are mostly caused by various diseases of the nervous system.

The diagnosticians assess the symptoms, determine the cause of the pathology and, if necessary, refer to other specialists: rheumatologists, oncologists, angiosurgeons, psychiatrists and other doctors.

clinic and symptoms

The diagnosis of Fahr's disease is complicated by an unclear clinical picture. The disease is often asymptomatic. Even when a person is diagnosed with the syndrome, they often don't feel it. The pathological accumulation of calcium in the brain region is expressed, among other things, by

• impairment of motor function
• mental deterioration up to dementia;
• spastic paralysis;
• Headache;
• abnormal eye movements;
• dysarthria;
• seizure syndrome.

When Fahr syndrome occurs with signs of parkinsonism, the following symptoms may occur:

• Tremble;
• constant muscle tension;
• unsteady gait;
• immobile face resembling a mask;
• involuntary clenching of the fingers that mimics rolling a pill.

These symptoms are characteristic of the late stage of the disease. In addition to the neurological and psychiatric manifestations of the disease, signs of skull anomalies, glaucoma, retinal pigmentosis and endocrine pathology (hypoparathyroidism) are also possible, although much less often.

The forms of the disease - their symptoms

A common feature of all neurodegenerative diseases is the slowly progressive death of nerve cells, but this can occur in different forms and variations.

The most common symptom is parkinsonism, or increasing muscle stiffness. Dysfunction of the parathyroid gland, either primary or after surgery, alters parathyroid hormone production, which in turn increases blood levels of phosphorus and calcium.

Diagnostic criteria and methods

The diagnosis is confirmed on the basis of imaging tests, but only after the absence of malformations and calcium abnormalities have been established.

When making a diagnosis, medicine relies primarily on general data resulting from the observations and complaints of the patient.

CT and MRI are the most important tools for diagnosing neurodegenerative diseases. Most images show specific areas of lesions that are difficult to see with skull x-rays. The diagnosis is confirmed by qualitative determination of plasma parathyroid hormone and thyrocalcitonin.

Image of an MRI scan showing brain degeneration in Fahr's disease

Treatment of Parkinson's disease

Although there is no cure for Parkinson's disease, there are a number of methods that can enable you to live a full and productive life for many years. Many symptoms can be relieved with medications, but these become less effective over time and can cause unwanted side effects (such as involuntary movements known as dyskinesia).

There are several treatments that delay the onset of motor symptoms and improve motor function. All of these treatments aim to increase the amount of dopamine in the brain, either by replacing dopamine or by prolonging the effects of dopamine by inhibiting its breakdown. Studies have shown that early therapy can delay the development of motor symptoms and thus improve quality of life. [5]

Many factors influence the type and effectiveness of treatment:

1. The severity of the functional deficit;
2. The patient's age;
3. Cognitive and other non-motor impairments;
4. the individual sensitivity to drugs;
5. pharmacoeconomic considerations.

The goal of therapy for Parkinson's disease is to restore impaired motor function and maintain optimal motor function for as long as possible, while minimizing the risk of adverse drug reactions. [1]

There are also surgical procedures such as deep brain stimulation, which involves implanting electrodes into the brain. Because of the risks involved, most patients avoid this treatment modality until the medications they are taking no longer provide significant relief. This treatment is typically used in patients who have had the disease for four years or more and who are receiving the effects of medication but have motor complications, such as: B. Significant 'blackouts' (periods when medication is not working well and symptoms return) and/or dyskinesia (uncontrolled, involuntary movements). Deep brain stimulation works best for symptoms such as stiffness, slowness, and tremors; Stability, stiffness when walking, and non-motor symptoms cannot be corrected with it. This treatment can even worsen memory problems, which is why it is not recommended for people with cognitive impairments. [6]

forecasts. prevention

Parkinson's disease is unique to every person and no one can predict what symptoms will appear and when. There are general similarities in the course of the disease, but there is no guarantee that what occurs in one person will be seen in everyone else with a similar diagnosis. Some people are in wheelchairs, others are still running marathons. Some can no longer close a necklace, while others make necklaces by hand.

There is everything the patient can do to actively influence the course of Parkinson's disease, and for at least one very good reason: the worsening of symptoms is often much slower in people who show a positive and active attitude towards their disease than in people who do those who don't. Above all, it pays to find a doctor who the patient trusts and who will support the evolving treatment plan. Stress reduction is essential - stress makes every symptom of Parkinson's disease worse. Educational activities are recommended: painting, singing, reading poetry, handicrafts, learning languages, travelling, teamwork, social activities.

Unfortunately, even adequate drug treatment cannot guarantee that cells in Parkinson's disease will stop dying. Therapy should be focused on creating favorable conditions for physical activity, taking into account the individual characteristics of the clinical picture. Numerous studies have shown that occupational motor rehabilitation is a prerequisite for slowing down the progression of the disease and improving the prognosis of the disease. The LSVT LOUD and LSVT BIG protocols, which rely on brain neuroplasticity, have been shown to be effective in clinical trials. They aim to correct tremor, gait, posture, balance, muscle tone and speech. [10]

Loss of balance in the dark

A loss of balance in the dark is possible. This disorder can be caused by chronic dysfunction of the vestibular system. The severity of symptoms in the dark is due to the inability of vision to compensate for the disturbance in this situation. As a result, even walking on water at night causes considerable difficulties and often ends in a fall. Loss of balance in the dark is caused by drug intoxication, cerebellar damage, and cervical spine disorders. When the cerebellum is damaged, visual control is irrelevant and the person experiences a constant loss of balance.

Approximately 30 % of the complaints of dizziness and balance disorders are described as false or unsystematic. This is not related to the progression of the disease and can occur in the following situations:

• A sudden change of position when standing up after sitting or lying down for a long time, or a sudden turn of the head. The feeling of losing balance lasts for seconds and is related to the redistribution of blood in the blood vessels;
• anxiety or dizziness. The dizziness is caused by a psychological factor;
• overwork, lack of sleep;
• nutrient deficiencies in unreasonable diet;
• Dizziness in pregnancy can be caused by the development of anemia, overwork, changes in the body during the birth of the fetus;
• Being intoxicated by drugs, alcohol or illegal substances causes dizziness and impaired balance due to the toxic effect on the vestibular system.

Where to go and which doctor to see

If you feel dizzy and constantly lose your balance, you should see a neurologist. The doctor will establish the cause of this condition and prescribe the necessary treatment. If the diagnosis reveals that the cause of the dizziness and imbalance is not a neurological disease, the doctor will refer the patient to an appropriate specialist (cardiologist, otolaryngologist, etc.) to correct the problem.

The Yusupov Hospital is equipped with the latest technology. The latest devices from manufacturers from all over the world are used here. As a result, all diseases can be diagnosed quickly and in the shortest possible time. Early diagnosis greatly facilitates the treatment process and prevents possible complications and unpleasant consequences.

Yusupovsky Hospital is located near the center of Moscow and receives patients 24 hours a day. By calling, you can make an appointment and get a consultation with a specialist.

• Unsteady gait in the elderly.
• Unsteady gait in the elderly.
• The gait of the knee in osteoarthritis.
• What does Ortho mean?.
• What putting your feet up means.
• The pronator muscle - what it means.
• Pronator - what does that mean?.
• stages of walking.