Treatment of Gait Disorders
Common Problem | Treatment | Comments |
|---|---|---|
Bone structure | ||
Kyphotic posture due to compression fractures of the thoracic spine or poor posture | Thoracic extension, shoulder rotation, chin tuck exercises Osteoporosis treatment to prevent new fractures | Compression fracture can be diagnosed by x-ray, and osteoporosis can be identified by bone mineral density testing. |
Leg length differences | Heel lift | Usually, heel lift correction is not 100%. |
Severe genu varus or valgus | Orthotics, bracing, strengthening of quadriceps | Knee replacement criteria should be reviewed. |
Foot abnormality or pain Hallux valgus (bunion) Loss of longitudinal arch | Orthotics, podiatry care, custom shoes | Testing for plantar neuropathy with monofilament nylon is always done to detect risk of plantar ulceration. |
Joint range of motion | ||
Decreased hip internal rotation | Stretching of adductors, strengthening of abductors | Attempting to increase internal rotation by stretching is not usually effective but may prevent further loss of range of motion. |
Decreased hip extension | Stretching of hip flexors, strengthening of hip extensors | Lying prone, arching back, and extending hip is often recommended. |
Decreased ankle dorsiflexion | Stretching of calf muscles | Height of high-heel shoes is reduced. |
Hallux rigidus (loss of dorsiflexion of the great toe) | Podiatry or orthopedic referral | An orthotic should be considered. |
Muscle power | ||
Weak hip extension | Chair rise exercises | Chair rise test may be helpful in diagnosis. |
Weak knee extension | Chair rise exercises, knee extension with ankle sandbags, squats | Chair rise test may be helpful in diagnosis. |
Weak ankle plantar flexion | Heel raises (using body weight) | To increase resistance during heel raises, patients can wear a weighted vest, backpack, or waist belt; they may need to stabilize themselves against a wall. |
Weak ankle dorsiflexion | Muscle strengthening (eg, toe rises), ankle foot orthotic for footdrop | Patients place sandbag weights over their metatarsals. With their back to the wall for safety, patients rise on their heels (ie, lift toes off the floor). |
Weak hip abduction | Hip abduction with ankle weights, side-lying position on the floor | — |
Sensory systems | ||
Decreased or impaired position sense or balance when eyes are closed during a Romberg test | Appropriate footwear | Vitamin B12 level should be checked. |
Decreased or impaired plantar touch sensation as measured by Semmes-Weinstein monofilaments | Appropriate footwear | Assess for diabetes and alcohol abuse and, if none, consider nerve conduction studies. |
Dizziness or vertigo | — | |
Motor control/balance | ||
Tandem stance or single-leg stance < 5 seconds or turning 360° (both to right and left) requires > 10 steps or patient is unsteady during turning | Balance training involving static and dynamic balance, tai chi, or the equivalent | |
Forward lean Bradykinesia Leg hypertonia Parkinsonian signs | Physical therapy training to maintain or improve motor control/balance | Assess for Parkinson disease. CT or MRI can detect lacunar infarcts, cerebellar changes, and white matter disease. |
Physical and cardiovascular fitness | ||
Dizziness due to postural hypotension | Review of medications for possible cause, compression stockings | |
Fatigue, shortness of breath, inability to walk > 300 m at usual pace | Regular walking program | Patients should be assessed for angina, heart failure, pulmonary disease, and claudication. A 6-minute walking distance is measured. |