Causes of shuffling feet. Shaky unsteady gait

Difficulty starting to move- a form of akinesia (hypokinesia). In the sitting or lying position, the patient's limb movements are normal. However, the patient experiences difficulty at the moment of initiation of walking: the legs are “rooted to the floor”. Walking in such patients is usually initiated after some delay and several unfinished shuffling steps ("hesitation at the start"). You can also apply special reception, provoking the start of movement by stepping over a mentally represented obstacle or asking to step on a target-spot on the floor. This technique is more effective in patients with hypokinesia due to damage to the basal ganglia (Parkinson's disease, progressive supranuclear palsy). Environmental distractions or obstructions exacerbate the difficulty of starting to move and lead to a sudden stop of movement, the so-called. "freezing" (for example, in a doorway).

Short shuffling steps with difficulty turning are characteristic of lesions of the frontal lobes and basal ganglia. In Parkinson's disease, the limitation of the amplitude of hand movements is more pronounced than the size of the steps when walking. The relative predominance of the range of motion in the arms over the limited range of motion in the legs when walking is observed with the phenomena of parkinsonism with a predominant interest in the lower extremity girdle in patients with multiple small infarctions and degeneration of the subcortical white matter in the basal ganglia and frontal lobes. With a mincing gait, after bending the body forward and moving to walking, the steps become shorter and faster. Mincing gait is more common with idiopathic disease Parkinson's disease than in parkinsonism of a different origin.

Choreic gait characterized by the fact that normal movements of the limbs and changes in body position are interrupted by sudden excessive movements (chorea) in the limbs and trunk. Such a gait may seem pretentious and demonstrative. The most common cause is Huntington's disease. Haloperidol or other antipsychotics may improve gait somewhat, but comorbid postural control disorders persist.

Dystonic gait is a variant of gait disturbance when limb movements and changes in posture are interrupted by tonic (sometimes phasic) contractions of the antagonist muscles of the limbs or trunk. Limbs, torso and neck can take a pretentious position, which depends on the ratio of the strength of contraction of individual muscle groups. Such dystonia can be focal or generalized. It may suddenly appear in some particular phase of the step cycle (for example, with a wave of the leg). In addition to the conditions listed in Table. 8.2, dystonia sometimes exacerbates the typical shuffling gait of Parkinson's disease and is a complication of treatment.

Hemiparetic gait varies depending on the severity and ratio of muscle weakness and spasticity. Restriction of movements of the bent arm or its drooping is observed in combination with the unbent and stretched position of the leg. Flexion restriction in the hip and knee joints, tonic plantar flexion of the foot prevent the appearance of a gap between the floor and the foot during the swing of the leg, although the patient deviates away from the paretic limbs, and also takes the leg outward and forward (circumduction). The toes drag across the floor, and the swing phase ends with the foot hitting the floor instead of the heel touching. Patients with greater mobility in the knee and hip joints (less muscle spasticity) do this movement by increasing hip flexion.

Spastic (paraplegic) gait. Be features depend on the severity and ratio of muscle weakness and spasticity, which are combined with sensory disturbances in the lower extremities. The condition of the hands depends on the level of damage to the pyramidal tract. Movement in the upper extremities may be preserved if the lesion is located below the cervical region. spinal cord. The arms may be bent or hanging down in patients with high cervical or supraspinal lesions. They may be adducted or abducted. Isolated bilateral dysfunction of the pyramidal tract leads to the formation of a "spastic gait". The latter is characterized by intense mechanical "shearing" movements of the overbent lower limbs, which are slightly adducted. With less spasticity, movements in the legs are slower and may not have the features described above. Elderly patients with cervical spondylosis and mild myelopathy may have non-specific variants of cautious gait.

Spasmodic diplegic gait observed in some patients with cerebral palsy with perinatal bilateral damage to the corticospinal tracts. Excessive flexion in the knee and hip joints during walking, combined with a slight adduction of the hips, gives the impression of shearing movements of the lower extremities. At the same time, the upper limbs and speech (pseudo-bulbar disorders) in children suffer much less compared to adults, who, with such lesions, develop bilateral hemiparesis and severe pseudo-bulbar disorders. There are different types of flexion position upper limbs and abduction of the forearms.

Violations and their causes in alphabetical order:

gait disturbance

Walking- one of the most complex and at the same time common types of physical activity.

Cyclic stepping movements trigger the lumbosacral centers of the spinal cord, regulate - the cerebral cortex, basal nuclei, brain stem structures and the cerebellum. This regulation involves proprioceptive, vestibular and visual feedback.

Gait human is a harmonious interaction of muscles, bones, eyes and inner ear. The coordination of movements is carried out by the brain and the central nervous system.

With disorders in certain parts of the central nervous system, various motor disorders can occur: shuffling gait, sharp jerky movements, or difficulty in bending the joints.

Abasia(Greek ἀ- prefix with the meaning of absence, non-, without- + βάσις - walking, gait) - also dysbasia- violation of gait (walking) or the inability to walk due to gross violations of gait.

1. In a broad sense, the term abasia means gait disturbances in lesions involving various levels of the motor act organization system, and includes such types of gait disturbances as atactic gait, hemiparetic, paraspastic, spastic-atactic, hypokinetic gait (with parkinsonism, progressive supranuclear paralysis and other diseases), walking apraxia (frontal dysbasia), idiopathic senile dysbasia, peroneal gait, duck gait, walking with pronounced lordosis in the lumbar region, hyperkinetic gait, gait in diseases of the musculoskeletal system, dysbasia in mental retardation, dementia, psychogenic disorders, iatrogenic and drug dysbasia, gait disorders in epilepsy and paroxysmal dyskinesia.

2. In neurology, the term is often used astasia-abasia, with integrative sensorimotor disorders, more often in the elderly, associated with impaired postural or locomotor synergies or postural reflexes, and often the variant of balance disorder (astasia) is combined with walking disorder (abasia). In particular, frontal dysbasia (gait apraxia) is distinguished in case of damage to the frontal lobes of the brain (as a result of stroke, dyscirculatory encephalopathy, normotensive hydrocephalus), dysbasia in neurodegenerative diseases, senile dysbasia, as well as gait disturbances observed in hysteria (psychogenic dysbasia).

What diseases cause gait disturbance:

A certain role in the occurrence of gait disturbance disorders belongs to the eye and the inner ear.

Elderly people with visual impairment develop gait disorders.

Man with infectious disease the inner ear can detect balance disorders, which leads to disturbances in its gait.

One of the most common sources of gait disturbances are functional disorders central nervous system. These may include conditions associated with sedatives, alcohol, and drug abuse. Poor nutrition appears to play a role in gait disturbances, especially in the elderly. Vitamin B12 deficiency often causes a feeling of numbness in the limbs and imbalance, which leads to changes in gait. Finally, any disease or condition that affects nerves or muscles can cause gait problems.

One of these conditions is the infringement of the intervertebral disc in the lower back. This condition is treatable.

More serious lesions associated with gait changes include lateral amyotrophic sclerosis(Lou Gehrig's disease), multiple sclerosis, muscular dystrophy and Parkinson's disease.

Diabetes often causes loss of sensation in both legs. Many people with diabetes lose the ability to determine the position of the legs in relation to the floor. Therefore, they have instability of position and gait disturbance.

Some diseases are accompanied by impaired gait. If there are no neurological symptoms, the cause of gait disturbance is difficult to find out even for an experienced doctor.

Hemiplegic gait is seen in spastic hemiparesis. In severe cases, an altered position of the limbs is characteristic: the shoulder is adducted and turned inward, the elbow, wrist and fingers are bent, the leg is extended at the hip, knee and ankle joints. The step with the affected leg begins with the abduction of the hip and its movement in a circle, while the body deviates in the opposite direction ("the hand asks, the leg mows").
With moderate spasticity, the position of the hand is normal, but its movements in time with walking are limited. The affected leg is poorly flexed and turned outward.
Hemiplegic gait is a common residual disorder after a stroke.

With a paraparetic gait, the patient rearranges both legs slowly and tensely, in a circle - just like with hemiparesis. In many patients, the legs cross when walking, like scissors.
Paraparetic gait is observed with damage to the spinal cord and cerebral palsy.

The cock's gait is due to insufficient dorsiflexion of the foot. When stepping forward, the foot partially or completely hangs down, so the patient is forced to raise the leg higher - so that the fingers do not touch the floor.
Unilateral violation occurs with lumbosacral radiculopathy, neuropathy of the sciatic nerve or peroneal nerve; bilateral - with polyneuropathy and lumbosacral radiculopathy.

Duck gait is due to weakness of the proximal leg muscles and is usually observed in myopathies, less often in lesions of the neuromuscular synapse or spinal amyotrophy.
Due to the weakness of the hip flexors, the leg lifts off the floor due to the tilt of the torso, the rotation of the pelvis contributes to the movement of the leg forward. Weakness of the proximal leg muscles is usually bilateral, so the patient walks waddling.

With a parkinsonian (akinetic-rigid) gait, the patient is hunched, his legs are half-bent, his arms are bent at the elbows and pressed to the body, pronation-supination tremor of rest (with a frequency of 4-6 Hz) is often noticeable. Walking begins with a forward bend. Then minced, shuffling steps follow - their speed is steadily increasing, as the body "overtakes" the legs. This is observed when moving both forward (propulsion) and backward (retropulsion). Losing balance, the patient may fall (see "Extrapyramidal disorders").

Apraxic gait is observed in bilateral lesions of the frontal lobe due to a violation of the ability to plan and perform a sequence of actions.

The apraxic gait is reminiscent of Parkinson's - the same "beggar's posture" and mincing steps - however, a detailed study reveals significant differences. The patient easily performs the individual movements necessary for walking, both lying and standing. But when he is offered to go, he cannot move for a long time. Having finally taken a few steps, the patient stops. After a few seconds, the attempt to go is repeated.
Apraxic gait is often associated with dementia.

With a choreoathetous gait, the rhythm of walking is disturbed by sudden, violent movements. Due to the chaotic movements in the hip joint, the gait looks "loose".

With a cerebellar gait, the patient spreads his legs wide, the speed and length of steps change all the time.
With damage to the medial zone of the cerebellum, a "drunk" gait and ataxia of the legs are observed. The patient maintains balance both with open and closed eyes, but loses it when the posture changes. The gait may be fast, but it is not rhythmic. Often when walking the patient experiences uncertainty, but it passes if he is at least slightly supported.
With damage to the cerebellar hemispheres, gait disturbances are combined with locomotor ataxia and nystagmus.

Gait with sensory ataxia resembles a cerebellar gait - widely spaced legs, loss of balance when changing posture.
The difference is that with the eyes closed, the patient immediately loses his balance and, if not supported, may fall (instability in the Romberg position).

Gait of vestibular ataxia. With vestibular ataxia, the patient falls on one side all the time - regardless of whether he is standing or walking. There is a clear asymmetric nystagmus. Muscle strength and proprioceptive sensitivity are normal - in contrast to unilateral sensory ataxia and hemiparesis.

Hysteria walk. Astasia - abasia - a typical gait disorder in hysteria. The patient has preserved coordinated movements of the legs - both lying down and sitting, but he cannot stand and move without assistance. If the patient is distracted, he maintains his balance and takes a few normal steps, but then defiantly falls - into the doctor's hands or onto the bed.

Which doctor should I contact if there is a gait disorder:

Have you noticed a gait disorder? Do you want to know more detailed information or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study external signs and will help to identify the disease by symptoms, advise you and provide the necessary assistance. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

Do you have trouble walking? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent terrible disease but also support healthy mind in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need on. Also register on the medical portal Eurolaboratory to be constantly up to date latest news and updates of information on the site, which will be automatically sent to you by mail.

The symptom map is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and how to treat it, contact your doctor. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal.

If you are interested in any other symptoms of diseases and types of disorders or you have any other questions and suggestions - write to us, we will definitely try to help you.

After giving advice on how to teach a child to fight shuffling, I can’t keep secret an exercise that will help mom do the same.

The shuffling is what we hear: the rustle of the sole, which is dragged along by the foot. How does the foot move? So, as if you are skiing on a deep crust. As much slip as possible, as little support as possible.

In this case, the ligaments of the ankle and knee joint do not work. A person who shuffles his feet does not have ligaments working all day long! Inhibition of the function of the ligaments leads to the inhibition of dependent organs. Chinese medicine calls human body small universe, in which, as well as in the big one, the system of relations of U-sin (Five elements) works. The connection between the work of the ligaments, the heart and vascular system from the point of view of Chinese philosophy and medicine is obvious.

Many practitioners of achieving health and longevity recommend devoting time daily to comfortable (non-traumatic) exercises for the ligaments in order to preserve the youth of the heart and the performance of the vascular system. But what is walking if not the most elementary and frequently performed active exercise? A mistake, moreover, fixed and rooted, in the performance of this exercise costs us - careless walkers - health and many years of life.

The easiest way to get rid of a bad habit is to form a new habit. How to stop shuffling your feet? It is necessary to accustom the ligaments of the ankle and knee to work.

When you wake up, before jumping out of bed, make it a rule to do a simple and pleasant exercise. Lying on your back, pull your toe as far as you can, and then stretch your foot, as in ballet. Perform this exercise simultaneously with both legs in opposite directions: right leg towards you, to your left.

Choose a comfortable pace and degree of tension. Remember that overvoltage is worse than undervoltage. And also that all morning activities should bring pleasure. Repeat 10 to 30 times. When performing this exercise, you will feel how all the ligaments of the body work. Focus on these feelings.

The same exercise is recommended by driving instructors to relieve tension and prevent seizures. It is also recommended for pregnant women, especially in the second half of pregnancy. Midwives believe that doing this exercise daily will help to avoid not only cramps, but also swelling of the legs.

Mom can (as part of the fight against shuffling) give up her favorite slippers without backs. The ritual of changing shoes will help to achieve the greatest efficiency in work. Choose shoes that stimulate you to move actively, spur on enthusiasm: sketchers or fashionable shoes that fit comfortably and tightly around the foot, boots made of thin leather, football boots - whatever.

The main thing is that the shoes please you and, at the same time, switch to working condition. Such shoes will not only remind you of the decision to learn how to walk in a new way, but also take you, like Ellie's magic shoes, to the land of free creativity.

Almost all older people suffer from various disorders in the body. Such symptoms are so common that many of us consider them completely natural. But in fact, any disturbances in well-being, appearance and behavior can be the first manifestations of serious health problems. Therefore, they should never be ignored. A common gait disorder may indicate pathological processes that threaten life and health. Let's discuss problems with gait, talk about what shuffling gait may indicate, the causes and consider it in the elderly.

Causes of shuffling gait in old age

Scuffing in old age can be explained by past injuries of the spine, hip joint, patella, etc. Such a gait disorder sometimes indicates an impending stroke, a pinched nerve, or neuromuscular disorders.

A possible explanation for the shuffling of the feet in old age is also considered the developing Parkinson's disease. This is a fairly serious neuromuscular disease. With this problem, patients begin to walk with small steps, their gait often becomes unsteady. The patient seems to be dragging his feet behind him.

The same shuffling gait in the elderly can be observed in dementia, including Alzheimer's disease. In this case, dragging feet is explained by problems with thinking. However, with dementia, shuffling is preceded by other symptoms - impaired memory, thinking, etc.

The shuffling gait in the elderly depends on many factors. Such a breach is not separate disease but only a symptom. Therefore, when it appears, it is necessary to seek medical help - to identify the causes that caused the shuffling.

Parkinson's disease is considered to be a fairly serious and common cause of such a gait disorder. This is a chronic progressive disease of the central nervous system, in which there is damage to the neurons of the substantia nigra in the brain. in such a pathological condition, it is aimed at eliminating the symptoms of the disease and prolonging the active life of patients.

Modern drugs for Parkinson's disease need to be taken daily. The dosage is selected individually only by the doctor.

Most often, patients with this diagnosis are prescribed levodopa drugs, they effectively compensate for the lack of dopamine in the brain. However, prolonged use of such drugs often leads to the development of complications, for example, involuntary movements - dyskinesia. Patients have to come to terms with them.

Also, Parkinson's disease may involve taking other groups of drugs - dopamine agonists, amantadines, COMT inhibitors. These drugs are less effective than levodopa, but they may delay its administration and reduce the complications associated with its use.

If patients have a predominance of the symptom of trembling of the extremities, they are usually prescribed anticholinergic drugs, represented by cyclodol and akinetolon. Patients whose age has exceeded sixty years are prescribed obzidan.

To slow down the death of neurons, the drugs PK-Merz, Midantan, Yumeks and Mirapeks are used.

Also, patients with Parkinson's disease are shown physiotherapy exercises. Such exercises are aimed at training walking and balance, they are performed under the supervision of an instructor.

Folk remedies for Parkinson's disease

Patients with Parkinson's disease may also benefit from traditional medicine. Before using them, be sure to consult a specialist.

St. John's wort - application from Parkinson's. So you can prepare three tablespoons of St. John's wort and brew them with seven hundred milliliters of boiling water. Insist for one night. In the morning, strain the medicine, divide it into four equal parts. Take the infusion half an hour before a meal.

Infusion of oregano - use in Parkinson's. An excellent effect is given by the reception of tea from oregano. Brew a teaspoon of dry grass with a glass of boiling water, then insist for five to ten minutes. Strain and drink like tea. The duration of such therapy is three months.

Syncope and paralysis in Parkinson's disease? If a patient with Parkinson's disease experiences fainting or paralysis, you need to combine equal parts of lavender, snakehead, oregano and garden purslane. Grind the mixture into a powder. Brew four tablespoons of this collection with a liter of boiling water. After three hours, strain and take a third of a glass three times a day. It is best to drink this medicine on an empty stomach.

Rosehip root decoction. In Parkinson's disease, you can also use a medicine based on rosehip roots. Brew a couple of tablespoons of chopped raw materials with a glass of boiling water and boil over a fire of minimum power for twenty minutes. Cool this decoction, then strain it. Take half a glass half an hour before a meal.

Sage infusion - application from Parkinson's. Sage will also help to cope with the symptoms of Parkinsonism. Brew a couple of teaspoons of chopped herbs with half a liter of boiling water. After half an hour, strain the finished infusion. Take it in half a glass on an empty stomach. Repeat this four times a day.

A shuffling gait can be a completely natural symptom of aging in the elderly, but in some cases it indicates a serious health disorder that requires targeted treatment under the supervision of a doctor.

Diseases associated with a shuffling gait.

As a rule, the appearance of shuffling, when a person walks in small mincing steps, will speak rather not about his age, but about an existing illness. There are quite a lot of such ailments that are manifested by the symptom of shuffling legs. The most frequently encountered of them:

• cerebrovascular disease;
• Parkinson's disease;
• loss of sensation in the lower extremities, meaning when a person ceases to feel his legs, joints, all this leads to a violation of the coordination of his movement.

Who belongs to the risk group?

The risk group may include people who have worked in a workplace with harmful influence for a long time. It should also include those who live in an environmentally unfavorable zone.

It is worth noting that the main root of evil in this case will be damage to the human nervous system, and therefore the consequences of this process in the body develop various diseases, one of the symptoms of which is shuffling of the feet.

Universal means of reducing the risk of these insidious diseases

First of all, it is worth noting that you need to be examined by a neurologist, who will be able to make an accurate diagnosis as a result. The specialist will conduct a thorough examination, MRI and computed tomography, will take blood for tests, cerebrospinal fluid. When the disease, the consequence of which was the shuffling of the feet, is established, the doctor will prescribe the correct course of treatment.

With regard to compliance with the general regimen, it is necessary to include in your diet food that will be rich in vitamins B and E, as well as omega-3 unsaturated fatty acids. Meaning linseed oil, fish, cereals and liver. It will be useful for strengthening the body, for relieving the feeling of fatigue and raising the tone.

As preventive measures you can drink drugs such as Essentiale. The drug will help restore the structure of the cell membrane, liver. As for the reception, you need to drink one or two capsules with plain water. For the course of taking the drug, the state of the nervous system will become many times better. And it is also worth spending as much time as possible in nature, doing a special course of health-improving gymnastics in the morning, trying to worry and cry less. Such methods, though banal, but really work.

IF THEY STARTED TO SHOULD THE LEGS…

The appearance of a shuffling gait is usually associated with age. But is it? Perhaps this is how the body gives a signal that something is wrong with it?

About the symptoms of which diseases is shuffling gait, the correspondent of "HLS" Tatiana Kuznetsova was told by the neurologist Alexander Yuryevich KRIVONOGOV.

Alexander KRIVONOGOV: The appearance of a shuffling gait, when a person begins to move in small, mincing steps, is, of course, not associated with age, but with illness. Moreover, ailments, the manifestation of which can be a shuffling gait, alas, abound. These are Parkinson's disease, and problems with the vessels of the brain, and extensive loss of sensation in the legs, when a person ceases to feel his joints and his coordination of movements is disturbed.

It should be noted that people may also be at risk, for a long time those who worked in hazardous industries, as well as those who live in an environmentally unfavorable zone.

Healthy Lifestyle: Which specialist should be contacted in the first place in such cases?

А.К.: To see a neurologist, because it is necessary to establish the affected area of ​​the nervous system and make an accurate diagnosis. But this requires a thorough examination, including computed and magnetic resonance imaging, an encephalogram, a blood test and cerebrospinal fluid. When the disease that caused the shuffling gait is established, the doctor will prescribe the appropriate treatment.

"HLS": It turns out that the root of evil is in the defeat of the nervous system, which results in a number of diseases, including Parkinson's disease. Are there any universal and affordable means to reduce the risk of these very insidious diseases?

А.К.: Of course, there is.

First of all, there should be food in the diet, rich in vitamins group B, vitamin E, products containing unsaturated omega-3 fatty acids. These are fish of all kinds, linseed oil, liver, cereals. For the purposes of prevention, Essentiale, Essentiale Forte preparations are useful. They restore liver cells, the structure of the cell membrane, and if they are taken in courses of 1-2 capsules with a glass of water, the state of the nervous system will noticeably improve. Trite, but effective - try to be in the bosom of nature as much as possible, do not be lazy to do wellness exercises.

"HLS": Another common cause leading to a shuffling gait, you called a violation of vascular circulation ...

A.K.: Indeed, cerebrovascular diseases, including transient ischemic attacks and stroke, are manifested as a result of arterial hypertension, against the background of diabetes mellitus, smoking, coronary disease heart disease, high cholesterol, alcohol abuse.

Problems with blood vessels can lead to lacunar infarcts, when small blood vessels in the deepest zones of our brain are blocked by blood clots. This can also cause a shuffling gait.

If you spend a lot of time at the computer, sit, constantly hunched over, there is a high risk of circulatory disorders in the cerebellum. Therefore, in no case should you forget about even posture and follow this rule throughout your life. To prevent the occurrence of lacunar infarcts, people with diabetes are advised to be especially vigilant about blood pressure and monitor blood sugar levels. It is clear that the higher the pressure, the greater the damage to the vessels, and in diabetics, the vessels and capillaries are very fragile. Drugs that prevent platelets from sticking together will benefit. These are aspirin, cardiomagnyl, thrombo ACC. They are taken pomg per day.

Scientists have conducted research on the prevention of cerebral artery thrombosis. It has been established that drugs aspirin and dipyridamole (curantyl) in small doses and with prolonged use prevent the formation of blood clots in the arteries of the brain. The dose of admission is from 75 to 200 mg per day.

If you do not take care of the prevention of blood clots, not only gait can be disturbed, but also general coordination of movements. That is why, as soon as you notice that your gait has become shaky, your steps are small and mincing, without delay, start examining the state of your vessels.

"Healthy lifestyle": Are there any natural remedies that help keep blood vessels in a "working" state?

A.K.: Some alternatives to aspirin, curantyl and dipyridamole are herbs that prevent the formation of blood clots. Ginkgo biloba and gotu kola have proven themselves well. Ginkgo biloba has long been well known. In translation, the name of the plant means "silver apricot". An extract from its leaves prevents the fragility of capillaries, improves microcirculation and blood circulation in various organs, and especially in the brain. IN Lately Many drugs from ginkgo leaves appeared in pharmacies: these are tanakan, memoplant, bilobil, ginkgobil, ginkgo forte. In my opinion, it is still better to use an infusion of ginkgo biloba leaves.

To cook it. 1 st. pour 300 ml of boiling water over a spoonful of leaves, let it brew for an hour, strain and drink 0.5 cups 3 times a day after meals.

Gotu kola, having the same properties as ginkgo, also improves arterial blood flow, venous outflow, stimulates the brain.

There are many plants whose decoctions and infusions tone up brain activity. Astragalus has a vasodilating effect and prevents the formation of blood clots, the bark of barberry roots promotes vasodilation. It is harvested during the period of sap flow - in April-May. Grind and dry them, then 1 tbsp. Pour a spoon with 2 cups of boiling water, boil for 20 minutes, leave for 30 minutes, strain and drink this amount in several doses during the day before meals.

Truly unique properties buckwheat has. It also has a vasodilating effect, and improves blood circulation in the capillaries, and prevents the formation of plaques in the vessels. But in our case, we mean not grains, not buckwheat, but the green part of the plant - the flowering tops of the stems. It is the flowering stem that effective tool to reduce pressure and protect capillaries. The easiest way to use is to brew the flowers and drink as much tea as you like.

Cinnamon has a vasodilating effect, clove flowers prevent the formation of blood clots. Garlic, as you know, dilates blood vessels, puts a barrier to the formation of plaques, has a fibrinolytic property, that is, it destroys blood clots that have already appeared and even removes some poisons, in particular, in case of aluminum and cadmium poisoning. With garlic, you can make tinctures, eat it fresh. But keep in mind, if you ate a clove of garlic - do not expect a healing effect right there. It shows its healing effect only after six months of regular use. As for medicines made on the basis of garlic, only those that have a pronounced garlic aroma will be effective. The smell of garlic comes from the biologically active substance allicin. One clove of garlic contains more than 4 mg. It is usually recommended to eat 3-4 cloves a day.

Do not forget about physical education, about walking. It is believed that there will be benefits if you go at an active pace. But it prevents arterial hypertension, develops arterial circulation and promotes the expansion small arteries just a slow and long walk. All this allows to get rid of the shuffling gait to a certain extent.

It is useful to do self-massage of three acupuncture points. The first - he-gu - is on the hand between the large and index fingers. The second - tai chun - on the leg - also between the big and second fingers. If they are massaged together, it will relieve stress and vasospasm, stabilize pressure. The third point - zu-san-li - is located on the left under the knee. I recommend massaging these points clockwise for a minute. In addition, before the wellness gymnastics, for the best effect, massage these points alternately for 1 minute.

What does walking say about your health?

When you walk into a doctor's office, an experienced specialist can tell a lot about you in just a few seconds. Your movements, gait, stride length and posture while walking provide amazing information about your health and how you feel.

“Many doctors, when they see a person walking down the street, determine his diagnosis, they can tell if she is in good health. They notice in his gait such details that speak of what he is ill with ”, says Charles Blitzer, an orthopedic surgeon from Somersworth, New Hampshire, spokesman American Academy of Orthopedic Surgeons.

1) Slow Walking: May Indicate a Short Lifespan

Walking speed is an important predictor of a person's lifespan, research has shown. University of Pittsburgh. About 36,000 people over 65 took part in the research. Actually managed to establish that the walking speed is the same an important factor indicating lifespan, such as age, sex, chronic diseases, smoking, body mass index, hospitalizations and others. The speed of movement is especially important for people over 75 years of age.

The average walking speed is approximately 1 meter per second (3.6 kilometers per hour). Those with a walking speed of less than 0.6 meters per second are at risk of dying earlier. Those who walk faster than 1 meter per second live longer than people of the same age and gender who want to go slower.

In 2006 in the magazine The Journal of the American Medical Association there was information that older people aged 70 to 79 years old, who were not able to move faster than 0.4 meters per second, in most cases after 6 years were no longer alive. They more often suffered from diseases and were incapacitated shortly before death. Earlier studies showed that men aged 71 to 93 who walked at least 3 kilometers a day were 2 times less likely to suffer from heart disease compared to those who walked very little (less than 0.5 kilometers a day) .

Of course, if you intentionally walk faster and faster, it will not cure you of any diseases. Each person has his own natural speed of movement, which is based on the state of health. If you walk slowly, this indicates some kind of health problem that shortens life expectancy.

2) Weak arm swinging while walking can indicate problems in the lower back

Our body is very interesting. When our left leg moves forward, the spine turns to the right, and right hand moves back and vice versa. This coordination of muscles on both sides supports the lower back area. If a person does not swing their arms much while walking, this indicates that their lower back is not receiving the necessary support due to mobility problems in this area. This can be followed by back pain or even serious injury. Waving your arms while walking is an important indicator of how well your back is functioning.

3) Scuffing your feet may indicate damage to the vertebra

Sometimes the experts don't even need to see you walk, they just need to hear the sound of your footsteps. We are talking about when you are not able to raise your leg high while walking, so the sole of the foot touches the floor. The result is a shuffling gait. This may be due to weakness in the anterior calf muscle or other leg muscles.

A healthy step starts with your heel on the ground, then slowly lowers your foot, bringing your heel up on your toes and off the ground. If you have a drop foot, it is difficult to control the muscles and the foot cannot slowly return to the ground, so it does not leave the ground at all.

“Sometimes it can indicate symptoms of an impending stroke, neuromuscular problems, or a pinched nerve.”, says North Carolina podiatrist and foot specialist Jane E. Andersen. Basically, this is a consequence of damage to the vertebra, which puts pressure on the nerve responsible for the movement of the legs.

4) Confident walking (in women) may indicate sexual satisfaction

Gait can often indicate not only something bad. Studies that have been conducted in Belgium and Scotland have shown that a woman's walk can indicate her ability to have an orgasm. Women with a quick and energetic gait are more likely to have regular vaginal orgasms. The scientists compared the gait of women who were satisfied with their sex lives with those who were not completely satisfied. (In this case, the researchers looked at the ability to have an orgasm during intercourse without direct stimulation of the clitoris.)

What is the connection here? In theory, the ability to have an orgasm is related to the muscles, which should not be weak or too tight. As a result, the walk will be freer, easier, scientists said, and the woman will be more self-confident.

5) Small steps can indicate problems in the knees and hips

When the heel touches the ground at the very beginning of the step, the knee should be straight. But this does not work if you have a knee problem. In this case, you may have a damaged joint that does not move properly in the patella. Such problems can often be corrected with manual therapy.

Another reason for small steps can be a problem with the movement of the hips. During small steps, a person does not need to extend the leg too much. Unfortunately, small steps can be detrimental to the health of the back, as they put pressure on it. If the hip extension is poor, it can lead to back pain and nerve problems in that area, among other problems.

6) Shoulder drooping to one side while walking can indicate spinal problems

Muscles on the inside of the thighs, called abductors, keep the pelvis level while walking. Thus, when we lift one leg and push it forward while standing firmly on one leg, the abductors keep the body straight, but only if they function correctly. In a normal gait, when the heel touches the ground, the pelvis moves slightly to the same side to reduce pressure on the muscles on the other side. Sometimes the shoulder also moves to the side, which indicates problems in the back.

7) Wheeled Feet May Indicate Osteoarthritis

"Imagine an old feeble man with crooked legs, - says the orthopedic surgeon Blitzer, - He looks like this because he suffers from arthritis in his knees.". 85 percent of people with osteoarthritis, which mostly appears with age, have wheeled feet, he says. The legs are twisted due to the fact that the body cannot be supported properly. Vitamin D deficiency and genes can cause crooked legs, but this is more common in children than adults. Usually when children grow up, the problem disappears, but sometimes it is corrected with a special bandage.

8) Xsom Feet May Indicate Rheumatoid Arthritis

Rheumatoid arthritis- this is one of the inflammatory diseases in which the legs are curved inward. Approximately 85 percent of people with rheumatoid arthritis, X legs, says Blitzer. In this condition, people have a peculiar slightly awkward gait, the shins are tightly shifted, and the ankles are at a great distance from each other. In some cases, X-foot is also seen in people with osteoarthritis, depending on which joints are affected.

9) The person does not fit into the turns: may indicate poor coordination of movements

Balance is a function of coordination between the three systems of the body: vision, inner ear and what is called the feeling of one's own posture in space. The joints give the ability to sense position through the connective tissue receptors around them. The quality of the receptors is related to how much movement a joint can produce. If you move a lot, you will activate a large number of receptors and as a result you feel your body better.

In this case, your body balance is better. This is why people who are out of balance often look rather frail and their health suffers. If your balance is off, you may not fit into turns, easily bump into something while walking. You may also have trouble climbing stairs, as it requires you to be able to balance freely while standing on one leg.

Some patients who are unsteady on their feet do not want to use a stick or other balance aids because they are afraid of looking old. For such patients, it is better to use improvised means and move more, rather than lead a sedentary lifestyle, in order to get better, doctors say.

Balance problems can also result from peripheral neuropathy, nerve damage due to diabetes. Other causes are excessive alcohol consumption and vitamin deficiencies.

10) A straight foot when walking can indicate flat feet, problems with the big toe, neuromas

A straight foot can be seen from the side. When a person walks, his foot practically does not bend. This is often caused by flat feet. However, there are other reasons for this phenomenon. This type of movement is a person's attempt to maintain balance when they experience pain when walking due to thumb problems. This may be an abnormal increase in bone or tissue around the big toe. Also, the cause may be a neuroma, a tumor of the nervous tissue on the leg. This is a rather painful thickening of the nerve between the third and fourth toes. A person changes the style of walking in order to avoid pain.

11) Leg Dragging May Indicate Parkinson's Disease

In this condition, it is difficult for a person to move his legs when walking and therefore he seems to be dragging his legs behind him. Sometimes such a gait indicates Parkinson's disease. An unsteady gait and small steps may also be observed. “Usually, when a person begins to drag their feet, this is a clear sign of Parkinson's disease, a neuromuscular disease.”, says Blitzer. In addition to tumors, such a gait is the first symptom of the disease.

People with dementia, such as Alzheimer's, can also often drag their feet due to thinking problems. In this case, the connection between the brain and muscles is broken. However, by the time a person acquires such a gait, he already has more obvious signs of the disease - problems with memory, thinking, and others.

12) Tiptoe Walking May Indicate Central Paralysis or Spinal Injury

With this walk, the toes touch the ground before the heel touches it. This is due to the overactivity of muscle tone, which is caused by wrong work stretch receptors. If you're tiptoeing, you're more likely to have spinal or brain damage, such as an injury or cerebral palsy.

Sometimes small children who are just starting to walk also stand on tiptoe for a while, but this is not associated with any health problems. If you are still worried, consult your doctor.

13) A limp gait may indicate a stroke or that a person has one leg shorter than the other.

Doctors often pay attention to the symmetry of the gait. For example, if a person steps with one foot correctly, and presses the other a little. If the problem is symmetry, it may indicate a stroke, which affects one half of the body.

If you have one leg shorter than the other, you can tell by how you walk, experts say. The person seems to be lame: he steps on one leg normally, but does not bend the foot of the other leg when walking. This may be a birth defect or the result of a kneecap or hip replacement surgery. If one leg is no more than 2 centimeters longer than the other, this does not cause health problems. The difference in length can be corrected with appropriate footwear. If the difference is greater, resort to surgical intervention.

14) A bouncing gait may indicate overly tight calf muscles.

Sometimes while walking a person jumps. Doctors say that tense calves can be the cause of this phenomenon. This usually happens in women due to the fact that they constantly walk in high heels. Sometimes it happens that women who old age doctors advise to go in for sports, they cannot do it just because it is difficult for them to put on flat shoes. Sometimes this can happen to younger ladies who have been constantly wearing heels since their teenage years.

Causes of shuffling feet

Here comes a woman, not young, but not advanced either. He doesn’t walk, but swims: his head is slightly raised, his shoulders are straightened, his gait is “from the hip”, as they said in one film. Not only men look at her, but also women. Nice to look at. And her whole appearance suggests that she is healthy and successful.

What does walking say? It turns out that by walking we can judge a person, whether a person is healthy or sick, and what diseases he has. An experienced doctor can immediately determine by gait what diseases his patient has. And even by walking you can find out what kind of character a person has.

Reasons for changing gait

Walking disorder is a very common syndrome. And this is not only an aesthetic flaw, but rather a physical one. Among people over 60 years of age, gait disturbance occurs in 15% of cases, it can be various walking disorders and even periodic falls if the vestibular apparatus is disturbed.

Walking is a complex process that involves many levels of the nervous system. First of all, the nervous and musculoskeletal systems are involved here. And if nerve impulses do not pass to the right muscles or the joints do not make the proper range of motion, then this affects the person's gait.

Dysbasia is a gait disorder.

There are several factors that sometimes change our gait. These may be features of the musculoskeletal system (physical defects - one leg is shorter than the other, for example).

A stooped figure affects the gait. Stooped people walk hunched over, head and shoulders down. In this physiological state, the chest organs are compressed. "Clamped" lungs cannot work in the correct mode, when they are inhaled, they cannot fully expand, thereby less oxygen enters the blood, and the heart drives blood through the vessels with a small supply of oxygen, which is so necessary for the normal functioning of the body. This is how stoop in adolescents affects their physical development.

Sometimes gait is genetically transmitted. In particular, "clubfoot". People walk in different ways: someone puts their feet straight when walking, someone turns their feet outward, and someone, on the contrary, inward. Women are more likely to suffer from clubfoot, but it is also observed in men, but less often.

Women who wear high heels for a long time begin to complain of heaviness in the legs, especially after a long walk or standing, fatigue, pain in the calf muscles and joints of the lower extremities. Over time, the lower back begins to hurt, numbness in the legs and cramps appear.

If no measures are taken, then later deforming arthrosis of the joints of the lower extremities, heel spurs and bones on the big toes develop. Already these symptoms affect the posture and gait, due to which the metabolism is disturbed with the deposition of salts on the articular surfaces. Such people walk in small steps, trying not to bend their knees, which further disturbs their gait. Due to insufficient motor activity, obesity and premature old age develop.

With cervical osteochondrosis, there is tension in the muscles of the neck and upper shoulder girdle. Such people walk with caution, trying to turn their whole body.

With vegetative-vascular dystonia, dizziness is a common symptom. The same symptom can be with low blood pressure. Such people experience insecurity when walking, looking for support for themselves, whether it be a wall or a ladder handrail, or the hand of a person walking nearby.

In people suffering from gout or polyarthritis, the gait is trembling, as if a person were walking on hot coals. Patients with diabetes mellitus walk carefully, as their blood supply to the lower extremities is disturbed, they experience instability of the position.

Patients with Parkinson's disease walk hunched over, while the legs are bent at the knee joints, the arms are pressed to the body. They walk in mincing little shuffling steps. Their torso is tilted forward, as the legs remain away from the body when walking. Fearing to lose their balance, they try to walk faster.

An interesting situation with hysteria. The movements in this state are coordinated, but the legs cannot move without assistance. If such a patient is distracted by some questions, then he can quite independently take a few steps.

Loss of balance and therefore gait disturbance is noted in people who have had inflammatory diseases of the inner ear.

Serious disturbances in gait are caused by a stroke; multiple sclerosis. Elderly people walk unsteadily due to poor eyesight or poor diet, especially if the diet lacks foods rich in vitamin B 12.

Well, the familiar uncertain gait with excessive intake alcoholic beverages or taking sedatives. With such a gait, everyone will make a diagnosis.

It turns out that by walking you can determine the character of a person. This relationship has been studied by the Japanese scientist Hirosawa for more than 30 years, who studied the condition of soles on shoes. Similar observations were noted by the French shoemaker Jean Baptiste de André and the Italian Salvatore Ferragama.

They believe that if the sole is worn out over the entire width, then this person is quiet, if the inside is worn out, then it is greedy, and, conversely, the outer side is worn out, then this is a wasteful person. If the heel is worn inward, then the man is not decisive, and the woman has a good character. An evenly worn heel indicates friendliness.

How to make a light walk

A beautiful gait should be not only for women, but also for men. It is the gait that gives us the first impression of a person. If a woman is stylishly dressed, she has a beautiful hairstyle and beautiful makeup, but she walks uncertainly, then the image immediately collapses. A beautiful walk is a calling card that works for the image and informs others about the confidence and success of a person.

It's no secret that a beautiful walk requires healthy joints. As long as our joints work well and do not hurt, then our youth and health are prolonged. For this there are special exercises for joints and spine. Do Pilates, Collanetics, stretching or yoga, these classes will help you get a good muscle corset and, accordingly, a beautiful posture.

It should be noted that excessive consumption of meat, especially red and fatty, leads to the development of gout. Therefore, it is better to use more dairy products in your diet, calcium is necessary for strong bones. And vegetables and fruits are a source of vitamins, which are also necessary for the normal functioning of many of our organs and systems.

Get in the habit of controlling how you walk. Try not to slouch, stretch slightly, straighten your shoulders when walking, your back should be straight, your chin should be directed in the direction of your gaze, try to walk straight, the step should not be large and not too small. The leg should move first, and only then the body.

Psychologists say that not the correct posture and not a beautiful gait develop a sense of self-doubt and various complexes. Do not forget what our gait says, control yourself. Over time, this style of walking will be fixed and you will no longer need to control yourself.

A person's gait can say a lot about a person's health. For an experienced doctor, it can be the key to the correct diagnosis.

Scientists from the University of Pittsburgh published the results of a large-scale study, from which it follows that a person who walks more slowly than 2 km / h on average has an increased risk of death. This is explained very simply - usually a person's gait slows down in the presence of severe somatic diseases (for example, myocardial ischemia or chronic heart failure).

This gait is characteristic of damage to the peroneal nerve. When walking, the patient is forced to raise the affected leg, and it, roughly speaking, "falls" or "flaps". The clinical picture is complemented by sensory disturbances and the inability to dorsiflex the foot.

Sometimes such a gait is a manifestation of more serious illnesses: herniated disc, amyotrophic lateral sclerosis, muscular dystrophies, etc.

But walking is not always a bad sign. For example, the results of one Belgian-Scottish study suggest that a confident, quick and energetic gait in a woman is a sign of regular vaginal orgasms and a quality sex life in general.

This configuration of the knee joints is called varus deformity. It is very characteristic of osteoarthritis - a disease of the joints, which is characterized by the progressive destruction of articular cartilage. In children, varus deformity is possible with rickets.

This is the so-called valgus deformity of the knee joint. It occurs in 85% of people with rheumatoid arthritis. This is a disease in which the immune system for reasons not entirely clear, it attacks its own joints and destroys them.

Coordination of movements provides friendly activity of three systems: vision, vestibular analyzer and proprioception. The last word means "muscular and joint feeling." This is an important type of sensitivity, which is carried out through special receptors located in muscles, ligaments and tendons. In people with poor physical development, these receptors are poorly developed, so complex maneuvers, sharp turns and a change in direction of movement are difficult for a person.

Many people think that the shuffling gait is an essential sign of old age, but this is not true. Very often, shuffling is a manifestation of Parkinson's disease - a serious neurological disease, which is also characterized by tremor (trembling) and rigidity (muscle tension).

In Alzheimer's disease, there may also be a shuffling gait due to poor communication between the brain and muscles.

Tiptoe walking, both feet

Usually a person first puts his foot on the heel, and then on the toe. The reverse situation occurs with an increase in muscle tone, which is characteristic of cerebral palsy or spinal cord injury.

Important! In infants, tiptoeing may be normal and temporary. But if it still worries you, contact your pediatrician.

Tiptoe walking, one leg

If a person puts his foot on the toe on only one side, most likely he had a stroke. In this disease, only one half of the body is usually affected, opposite the lesion in the brain.

The displacement of the pelvis relative to the horizontal plane may indicate different lengths of the lower limbs. This anomaly can be congenital or develop as a result of joint replacement. Usually, different leg lengths do not cause significant inconvenience - a thick insole is enough for short leg. Only with a significant difference may require the help of a surgeon.

Gait disturbance (dysbasia)

In humans, ordinary "bipedal" walking is the most complexly organized motor act, which, along with speech ability, distinguishes a person from his predecessors. Walking is optimally realized only under the condition of the normal functioning of a large number of physiological systems. Walking, as a voluntary motor act, requires the unhindered passage of motor impulses through the pyramidal system, as well as the active participation of the extrapyramidal and cerebellar control systems that perform fine coordination of movements. The spinal cord and peripheral nerves ensure the passage of this impulse to the corresponding muscles. Sensory feedback from the periphery and spatial orientation through the visual and vestibular systems are also necessary for normal walking, as is the preservation of the mechanical structure of bones, joints, and muscles.

Since many levels of the nervous system are involved in the implementation of a normal gait, then, accordingly, there are a large number of reasons that can violate normal act walk. Some diseases and injuries of the nervous system are accompanied by characteristic and even pathognomonic gait disorders. The pathological pattern of gait imposed by the disease erases its normal sex differences and determines one or another type of dysbasia. Therefore, careful observation of gait is often very valuable in the differential diagnosis and should be performed at the start of the neurologic examination.

During the clinical study of gait, the patient walks with open and closed eyes; walks forward face and back; demonstrates flank gait and walking around a chair; gait on toes and heels is examined; along the narrow passage and along the line; slow and fast walking; run; turns while walking; climbing stairs.

There is no generally accepted unified classification of types of dysbasia. In addition, sometimes the patient's gait is complex, since several of the following types of dysbasia are simultaneously present in it. The doctor must see all the components that make up dysbasia and describe them separately. Many types of dysbasia are accompanied by symptoms of involvement of various levels of the nervous system, the recognition of which is also important for diagnosis. It should be noted that many patients with a variety of gait disorders complain of "dizziness".

Walking disorders are a common syndrome in the population, especially among the elderly. Up to 15% of people over the age of 60 experience some form of walking disorder and occasional falls. Among the elderly, this percentage is even higher.

Gait in diseases of the musculoskeletal system

Consequences of ankylosing spondylitis and other forms of spondylitis, athrosis large joints, tendon retractions on the foot, congenital anomalies etc. can lead to a variety of gait disorders, the causes of which are not always associated with pain (clubfoot, halux valgus deformities, etc.). Diagnosis requires consultation with an orthopedist.

The main types of gait disorders (dysbasias)

1. Atactic gait:
   1. cerebellar;
   2. stamping ("tabetic");
   3. with vestibular symptom complex.
2. "Hemiparetic" ("mowing" or by the type of "triple shortening").
3. Paraspastic.
4. Spastic-atactic.
5. Hypokinetic.
6. Apraxia of walking.
7. Idiopathic senile dysbasia.
8. Idiopathic progressive "freezing dysbasia".
9. Skater gait in idiopathic orthostatic hypotension.
10. "Peroneal" gait - unilateral or bilateral steppage.
11. Walking with hyperextension in the knee joint.
12. "Duck" gait.
13. Walking with pronounced lordosis in the lumbar region.
14. Gait in diseases of the musculoskeletal system (ankylosis, arthrosis, tendon retractions, etc.).
15. hyperkinetic gait.
16. Dysbasia with mental retardation.
17. Gait (and other psychomotor) in severe dementia.
18. Psychogenic gait disorders of various types.
19. Dysbasia of mixed origin: complex dysbasia in the form of gait disturbances against the background of various combinations of neurological syndromes: ataxia, pyramidal syndrome, apraxia, dementia, etc.
20. Iatrogenic dysbasia (unsteady or "drunk" gait) with drug intoxication.
21. Dysbasia caused by pain (antalgic).
22. Paroxysmal gait disorders in epilepsy and paroxysmal dyskinesias.

Atactic gait

Movements at cerebellar ataxia poorly commensurate with the features of the surface on which the patient walks. The balance is disturbed to a greater or lesser extent, which leads to corrective movements, giving the gait a random-chaotic character. Characteristic, especially for lesions of the cerebellar vermis, walking on a wide base as a result of instability and staggering.

The patient often staggers not only when walking, but also when standing or sitting. Sometimes titubation is detected - a characteristic cerebellar tremor of the upper half of the trunk and head. As accompanying signs, dysmetria, adiadochokinesis, intentional tremor, and postural instability are detected. Other characteristic signs may also be detected (scanded speech, nystagmus, muscle hypotension, etc.).

The main reasons: cerebellar ataxia accompanies a large number of hereditary and acquired diseases that occur with damage to the cerebellum and its connections (spinocerebellar degeneration, malabsorption syndrome, alcoholic cerebellar degeneration, multiple system atrophy, late cerebellar atrophy, hereditary ataxias, OPCA, tumors, paraneoplastic degeneration of the cerebellum and many other diseases).

With the defeat of the conductors of deep muscle feeling (most often at the level of the posterior columns), sensitive ataxia develops. It is expressed especially strongly when walking and is manifested by characteristic movements of the legs, which are often defined as a “stamping” gait (the leg falls with force with the entire sole to the floor); in extreme cases, walking is generally impossible due to the loss of deep sensitivity, which is easily detected by examining the muscular-articular feeling. A characteristic feature of sensitive ataxia is its vision correction. The Romberg test is based on this: when the eyes are closed, the sensitive ataxia increases sharply. Sometimes, with closed eyes, pseudoathetosis is revealed in outstretched arms.

The main reasons: sensitive ataxia is characteristic not only for lesions of the posterior columns, but also for other levels of deep sensitivity (peripheral nerve, posterior root, brain stem, etc.). Therefore, sensitive ataxia is observed in the picture of such diseases as polyneuropathy (“peripheral pseudotabes”), funicular myelosis, dorsal tabes, complications of vincristine treatment; paraproteinemia; paranesplastic syndrome, etc.)

With vestibular disorders, ataxia is less pronounced and more pronounced in the legs (staggering when walking and standing), especially at dusk. A gross lesion of the vestibular system is accompanied by a detailed picture of the vestibular symptom complex (systemic dizziness, spontaneous nystagmus, vestibular ataxia, autonomic disorders). Mild vestibular disorders (vestibulopathy) is manifested only by intolerance to vestibular loads, which often accompanies neurotic disorders. With vestibular ataxia, there are no cerebellar signs and impaired musculo-articular feeling.

The main reasons: the vestibular symptom complex is characteristic for lesions of the vestibular conductors at any level (sulfur plugs in the outer ear canal, labyrinthitis, Meniere's disease, acoustic neuroma, multiple sclerosis, degenerative lesions of the brain stem, syringobulbia, vascular diseases, intoxications, including drugs, traumatic brain injury, epilepsy, etc.). A peculiar vestibulopathy usually accompanies psychogenic chronic neurotic conditions. For the diagnosis, the analysis of complaints of dizziness and associated neurological manifestations is important.

"hemiparetic" gait

Hemiparetic gait is manifested by extension and circumduction of the leg (the arm is bent at the elbow joint) in the form of a "squinting" gait. A paretic leg is exposed to body weight for a shorter period than a healthy leg when walking. Circumduction (circular movement of the leg) is observed: the leg unbends at the knee joint with a slight plantar flexion of the foot and performs a circular movement outward, while the body deviates somewhat in the opposite direction; the homolateral arm loses some of its functions: it is bent at all joints and pressed against the body. If a stick is used when walking, then it is used on the healthy side of the body (for which the patient bends over and transfers his weight to it). With each step, the patient raises the pelvis to tear the straightened leg off the floor and hardly moves it forward. Less often, the gait is upset by the type of "triple shortening" (flexion in the three joints of the leg) with a characteristic rise and fall of the pelvis on the side of paralysis with each step. Associated symptoms: weakness in the affected limbs, hyperreflexia, pathological foot signs.

The legs are usually extended at the knees and ankle joints. The gait is slow, the legs “shuffle” on the floor (the sole of the shoe wears out accordingly), sometimes they move like scissors with their crossing (due to an increase in the tone of the adductor muscles of the thigh), on the toes and with a slight tucking of the fingers (“pigeon” fingers). This type of gait disturbance is usually due to a more or less symmetrical bilateral lesion. pyramidal pathways at any level.

Main Causes: Paraspastic gait is most commonly seen under the following circumstances:

• Multiple sclerosis (characteristic spastic-atactic gait)
• Lacunar condition (in elderly patients with arterial hypertension or other risk factors for vascular disease; often preceded by episodes of small ischemic vascular strokes, accompanied by pseudobulbar symptoms with speech disorders and bright reflexes of oral automatism, gait with small steps, pyramidal signs).
• After spinal cord injury (indications in history, level of sensory disorders, urinary disorders). Little's disease (a special form of cerebral palsy; symptoms of the disease are present from birth, there is a delay in motor development, but normal intellectual development; often only selective involvement of the limbs, especially the lower ones, with scissor-like movements with legs crossing while walking). Familial spastic spinal palsy (hereditary slowly progressive disease, symptoms often appear in the third decade of life). In cervical myelopathy in the elderly, mechanical compression and vascular insufficiency of the cervical spinal cord often cause a paraspastic (or spastic-atactic) gait.

As a result of rare, partially reversible conditions such as hyperthyroidism, porto-caval anastomosis, lathyrism, damage to the posterior columns (with vitamin B12 deficiency or as paraneoplastic syndrome), adrenoleukodystrophy.

Intermittent paraspastic gait is rarely observed in the picture of "intermittent claudication of the spinal cord".

Paraspastic gait is sometimes mimicked by lower extremity dystonia (especially in so-called dopa-responsive dystonia), which requires a syndromic differential diagnosis.

Spastic-atactic gait

With this gait disorder, a clear atactic component joins the characteristic paraspastic gait: unbalanced body movements, slight overextension in the knee joint, and instability. This picture is characteristic, almost pathognomonic for multiple sclerosis.

The main reasons: it can also be observed in subacute combined degeneration of the spinal cord (funicular myelosis), Friedreich's disease and other diseases involving the cerebellar and pyramidal tracts.

Hypokinetic gait

This type of gait is characterized by slow, stiff leg movements with reduced or no friendly arm movements and a tense posture; difficulty initiating walking, shortening the step, "shuffling", difficult turns, marking time before starting to move, sometimes - "pulsation" phenomena.

The most common etiological factors for this type of gait include:

1. Hypokinetic-hypertensive extrapyramidal syndromes, especially parkinsonism syndrome (in which there is a slight flexor posture; there are no friendly hand movements during walking; there is also rigidity, a mask-like face, quiet monotonous speech and other manifestations of hypokinesia, rest tremor, a phenomenon gear wheel; gait is slow, "shuffling", rigid, with a shortened step; possible "impulsive" phenomena when walking).
2. Other hypokinetic extrapyramidal and mixed syndromes, including progressive supranuclear palsy, olivo-ponto-cerebellar atrophy, Shy-Drager syndrome, strio-nigral degeneration ("parkinsonism-plus" syndromes), Binswanger's disease, vascular "parkinsonism of the lower half of the body". In the lacunar condition, there may also be a “marche a petits pas” gait (small, short, irregular, shuffling steps) against the background of pseudobulbar paralysis with swallowing disorders, speech disorders, and parkinsonian-like motor skills. "Marche a petits pas" can also be seen in normotensive hydrocephalus.
3. Akinetic-rigid syndrome and a corresponding gait are possible in Pick's disease, corticobasal degeneration, Creutzfeldt-Jakob disease, hydrocephalus, frontal lobe tumor, juvenile Huntington's disease, Wilson-Konovalov's disease, posthypoxic encephalopathy, neurosyphilis, and some other rarer diseases.

In young patients, torsion dystonia can sometimes debut with an unusual, stiff, stiff gait due to dystonic hypertonicity in the legs.

The syndrome of constant activity of muscle fibers (Isaacs syndrome) is most often observed in young patients. Unusual tension of all muscles (mainly distal), including antagonists, blocks the gait, like all other movements (armadillo gait)

Depression and catatonia may be accompanied by hypokinetic gait.

Apraxia of walking

Apraxia of walking is characterized by a loss or decrease in the ability to properly use the legs in the act of walking in the absence of sensory, cerebellar, and paretic manifestations. This type of gait occurs in patients with extensive cerebral damage, especially in the frontal lobes. The patient cannot imitate some movements of the legs, although certain automatic movements are preserved. The ability to consistently compose movements during "bipedal" walking is reduced. This type of gait is often associated with perseveration, hypokinesia, rigidity, and sometimes hegenhalten, as well as dementia or urinary incontinence.

A variant of walking apraxia is the so-called axial apraxia in Parkinson's disease and vascular parkinsonism; dysbasia in normotensive hydrocephalus and other diseases involving fronto-subcortical connections. The syndrome of isolated apraxia of walking has also been described.

Idiopathic senile dysbasia

This form of dysbasia (“gait of the elderly”, “senile gait”) is manifested by a slightly shortened slow step, slight postural instability, a decrease in friendly hand movements in the absence of any other neurological disorders in the elderly and old people. Such dysbasia is based on a complex of factors: multiple sensory deficit, age-related changes in the joints and spine, deterioration of vestibular and postural functions, etc.

Idiopathic progressive "freezing dysbasia"

"Freezing dysbasia" is commonly seen in the picture of Parkinson's disease; less commonly, it occurs in a multi-infarct (lacunar) condition, multi-system atrophy, and normotensive hydrocephalus. But elderly patients are described in whom "freezing dysbasia" is the only neurological manifestation. The degree of "freezing" varies from sudden motor blocks when walking to a total inability to start walking. Biochemical analyzes of blood, cerebrospinal fluid, as well as CT and MRI show a normal picture, with the exception of mild cortical atrophy in some cases.

Skater gait in idiopathic orthostatic hypotension

This gait is also observed in Shy-Drager syndrome, in which peripheral autonomic failure (mainly orthostatic hypotension) becomes one of the leading clinical manifestations. The combination of symptoms of parkinsonism, pyramidal and cerebellar signs affects the features of the gait of these patients. In the absence of cerebellar ataxia and severe parkinsonism, patients try to adapt their gait and body posture to orthostatic changes in hemodynamics. They move with wide, slightly to the side quick steps on legs slightly bent at the knees, with their torso low forward and head down (“skater posture”).

"Peroneal" gait

Peroneal gait - unilateral (more often) or bilateral steppage. Steppage gait develops with the so-called hanging foot and is caused by weakness or paralysis of dorsoflexion (dorsiflexion) of the foot and (or) fingers. The patient either “drags” the foot when walking, or, trying to compensate for the drooping of the foot, raises it as high as possible to tear it off the floor. Thus, there is increased flexion in the hip and knee joints; the foot is thrown forward and falls down on the heel or the whole foot with a characteristic spanking sound. The walking support phase is shortened. The patient is unable to stand on his heels, but can stand and walk on his toes.

The most common cause of unilateral paresis of the extensors of the foot is dysfunction of the peroneal nerve (compressive neuropathy), lumbar plexopathy, rarely damage to the roots of L4 and, especially, L5, as in a herniated disc ("vertebral peroneal palsy"). Bilateral paresis of the extensors of the foot with bilateral "stepping" is often observed with polyneuropathy (paresthesia, sensory disturbances like stockings, absence or decrease in Achilles reflexes), with Charcot-Marie-Tooth peroneal muscular atrophy - a hereditary disease three types(there is a high arch of the foot, atrophy of the muscles of the lower leg (“stork” legs), the absence of Achilles reflexes, sensory disturbances are insignificant or absent), with spinal muscular atrophy - (in which paresis is accompanied by atrophy of other muscles, slow progression, fasciculations, absence of sensory disturbances) and in some distal myopathies (scapulo-peroneal syndromes), especially in Steinert-strong atten-Gibb dystrophic myotonia.

A similar pattern of gait disturbance develops when both distal branches of the sciatic nerve are affected (“drooping foot”).

Walking with hyperextension in the knee joint

Walking with unilateral or bilateral hyperextension in the knee joint is observed with paralysis of the knee extensors. Paralysis of the knee extensors (quadriceps femoris) leads to hyperextension when resting on the leg. When the weakness is bilateral, both legs are overextended at the knee joint while walking; otherwise, shifting weight from foot to foot can cause changes in the knee joints. Descent down the stairs begins with a paretic leg.

Causes of unilateral paresis include femoral nerve damage (loss of the knee jerk, loss of sensation in the n. saphenous innervation area]) and lumbar plexus damage (symptoms similar to those of the femoral nerve, but the abductor and iliopsoas muscles are also involved). The most common cause of bilateral paresis is myopathy, especially progressive Duchenne muscular dystrophy in boys, as well as polymyositis.

"Duck" gait

Paresis (or mechanical insufficiency) of the hip abductors, that is, the hip abductors (mm. Gluteus medius, gluteus minimus, tensor fasciae latae) leads to an inability to keep the pelvis horizontal with respect to the load-bearing leg. If the insufficiency is only partial, then hyperextension of the trunk towards the supporting leg may be sufficient to shift the center of gravity and prevent pelvic tilt. This is the so-called Duchenne's lameness, when there are bilateral disorders, this leads to an unusual waddle gait (the patient, as it were, rolls over from foot to foot, "duck" gait). With complete paralysis of the hip abductors, the transfer of the center of gravity described above is already insufficient, which leads to a skew of the pelvis with each step in the direction of leg movement - the so-called Trendelenburg lameness.

Unilateral paresis or insufficiency of the hip abductors can be caused by damage to the superior gluteal nerve, sometimes as a result of intramuscular injection. Even in an inclined position, there is insufficient force for external abduction of the affected leg, but there are no sensory disturbances. Such insufficiency is found in unilateral congenital or post-traumatic hip dislocation or postoperative (prosthetic) damage to the hip abductors. Bilateral paresis (or insufficiency) is usually the result of myopathy, especially progressive muscular dystrophy, or bilateral congenital hip dislocation.

Walking with pronounced lordosis in the lumbar region

If the hip extensors are involved, especially m. gluteus maximus, then climbing the stairs becomes possible only when you start moving with a healthy leg, but when going down the stairs, the affected leg goes first. Walking on a flat surface is disturbed, as a rule, only with bilateral weakness m. gluteus maximus; such patients walk with a ventrally tilted pelvis and with an enlarged lumbar lordosis. With unilateral paresis m. gluteus maximus, it is impossible to abduct the affected leg backwards, even in the pronation position.

The cause is always a (rare) lesion of the inferior gluteal nerve, eg due to intramuscular injection. Bilateral paresis m. gluteus maximus is found most often in progressive pelvic girdle muscular dystrophy and Duchenne form.

Occasionally, the so-called femoral-lumbar extensional rigidity syndrome is mentioned in the literature, which is manifested by reflex disorders of muscle tone in the extensors of the back and legs. In the vertical position, the patient has a fixed, unsharply pronounced lordosis, sometimes with a lateral curvature. The main symptom is the “board” or “shield”: in the supine position with passive lifting of both feet of the outstretched legs, the patient does not have flexion in the hip joints. Walking, which is jerky in nature, is accompanied by compensatory thoracic kyphosis and forward tilt of the head in the presence of rigidity of the cervical extensor muscles. The pain syndrome is not leading in the clinical picture and often has a blurred, abortive character. A common cause of the syndrome: fixation of the dural sac and the terminal thread by a cicatricial adhesive process in combination with osteochondrosis against the background of dysplasia of the lumbar spine or with a spinal tumor at the cervical, thoracic or lumbar level. Regression of symptoms occurs after surgical mobilization of the dural sac.

hyperkinetic gait

Hyperkinetic gait is seen with different type hyperkinesis. These include diseases such as Sydenham's chorea, Huntington's chorea, generalized torsion dystonia (camel gait), axial dystonic syndromes, pseudoexpressive dystonia, and dystonia of the foot. More rare causes of walking disorders are myoclonus, trunk tremor, orthostatic tremor, Tourette's syndrome, tardive dyskinesia. Under these conditions, the movements necessary for normal walking are suddenly interrupted by involuntary, erratic movements. A strange or "dancing" gait develops. (This gait in Huntington's chorea sometimes looks so strange that it may resemble psychogenic dysbasia). Patients must constantly struggle with these disorders in order to move purposefully.

Gait disorders in mental retardation

This type of dysbasia is still an understudied problem. Clumsy standing with an excessively bent or unbent head, frilly position of the arms or legs, awkward or strange movements - all this is often found in children with mental retardation. At the same time, there are no disturbances in proprioception, as well as cerebellar, pyramidal and extrapyramidal symptoms. Many motor skills that develop in childhood are age dependent. Apparently, unusual motor skills, including gait in mentally retarded children, are associated with a delay in the maturation of the psychomotor sphere. It is necessary to exclude comorbid conditions with mental retardation: cerebral paralysis, autism, epilepsy, etc.

Gait (and other psychomotor) in severe dementia

Dysbasia in dementia reflects the total disintegration of the ability to organize purposeful and adequate action. Such patients begin to draw attention to themselves with their disorganized motor skills: the patient stands in an awkward position, stomping around, spinning, being unable to purposefully walk, sit down and gesticulate adequately (decay of "body language"). Fussy, chaotic movements come to the fore; the patient looks helpless and confused.

Gait can change significantly in psychoses, in particular in schizophrenia (“shuttle” motor skills, movements in a circle, stamping and other stereotypes in the legs and arms while walking) and obsessive-compulsive disorders (rituals while walking).

Psychogenic gait disorders of various types

There are gait disturbances, often resembling those described above, but developing (most often) in the absence of current organic damage nervous system. Psychogenic gait disorders often begin acutely and are provoked by an emotional situation. They are variable in their manifestations. They may have agoraphobia. Characterized by the predominance of women.

Such a gait often looks strange and difficult to describe. However, a careful analysis does not allow us to attribute it to the known samples of the above types of dysbasia. Often the gait is very picturesque, expressive or extremely unusual. Sometimes it is dominated by the image of falling (astasia-abasia). The whole body of the patient reflects a dramatic call for help. During these grotesque, uncoordinated movements, patients seem to periodically lose their balance. However, they are always able to hold themselves and avoid falling from any awkward position. When the patient is in public, his gait can even acquire acrobatic features. There are also quite characteristic elements of psychogenic dysbasia. The patient, for example, demonstrating ataxia, often walks, “weaving a braid” with his feet, or, presenting paresis, “drags” his leg, “dragling” it along the floor (sometimes touching the floor with the back surface of the thumb and foot). But psychogenic gait can sometimes outwardly resemble gait in hemiparesis, paraparesis, diseases of the cerebellum, and even parkinsonism.

As a rule, there are other conversion manifestations, which is extremely important for diagnosis, and false neurological signs (hyperreflexia, Babinski's pseudo-symptom, pseudo-ataxia, etc.). Clinical symptoms should be assessed comprehensively, it is very important in each such case to discuss in detail the likelihood of true dystonic, cerebellar or vestibular gait disorders. All of them can cause sometimes erratic changes in gait without sufficiently clear signs of organic disease. Dystonic gait disorders more often than others may resemble psychogenic disorders. Many types of psychogenic dysbasia are known and even their classifications have been proposed. The diagnosis of psychogenic movement disorders should always be subject to the rule of their positive diagnosis and the exclusion of an organic disease. It is useful to involve special tests (Hoover's test, weakness of the sternocleidomastoid muscle, and others). The diagnosis is confirmed by the placebo effect or psychotherapy. Clinical diagnostics this type of dysbasia often requires special clinical experience.

Psychogenic gait disorders are rare in children and the elderly.

Dysbasia of mixed origin

Often there are cases of complex dysbasia against the background of certain combinations of neurological syndromes (ataxia, pyramidal syndrome, apraxia, dementia, etc.). Such diseases include cerebral palsy, multiple systemic atrophy, Wilson-Konovalov disease, progressive supranuclear palsy, toxic encephalopathy, some spinocerebellar degenerations, and others. In such patients, the gait carries the features of several neurological syndromes at the same time and it needs careful attention. clinical analysis in each individual case in order to assess the contribution of each of them to the manifestations of dysbasia.

Dysbasia iatrogenic

Iatrogenic dysbasia is observed with drug intoxication and often has an atactic (“drunk”) character, mainly due to vestibular or (less often) cerebellar disorders.

Sometimes such dysbasia is accompanied by dizziness and nystagmus. Most often (but not exclusively) dysbasia is caused by psychotropic and anticonvulsant (especially difenin) drugs.

Pain-induced dysbasia (antalgic)

When there is pain while walking, the patient tries to avoid it by changing or shortening the most painful phase of walking. When the pain is unilateral, the affected leg bears weight for a shorter period. Pain may occur at a certain point in each step, but may be observed during the entire act of walking or gradually decrease with continuous walking. Gait disturbances caused by pain in the legs most often manifest outwardly as "limping".

Intermittent claudication is a term used to describe pain that only occurs when walking a certain distance. In this case, the pain is due to arterial insufficiency. This pain regularly appears when walking after a certain distance, gradually increases in intensity, and over time occurs at shorter distances; it will appear sooner if the patient is ascending or walking rapidly. The pain causes the patient to stop, but disappears after a short period of rest if the patient remains standing. The pain is most often localized in the shin area. A typical cause is stenosis or occlusion of blood vessels in the upper thigh (typical history, vascular risk factors, lack of pulsation in the foot, noise over the proximal blood vessels, the absence of other causes for pain, sometimes sensitive disorders such as stockings). Under such circumstances, there may be additional pain in the perineum or thigh caused by occlusion of the pelvic arteries, such pain must be differentiated from sciatica or a process affecting the cauda equina.

Intermittent claudication of the cauda equina (caudogenic) is a term that is used to refer to pain with compression of the roots, observed after walking for various distances, especially when descending. Pain is a consequence of compression of the roots of the cauda equina in a narrow spinal canal at the lumbar level, when the attachment of spondylosis changes causes an even greater narrowing of the canal (canal stenosis). Therefore, this type of pain is most often found in older patients, especially men, but can also occur at a young age. Based on the pathogenesis of this type of pain, the observed disorders are usually bilateral, of a radicular nature, mainly in the posterior region of the perineum, upper thigh and lower leg. Patients also complain of back pain and pain when sneezing (Naffziger sign). Pain during walking causes the patient to stop, but usually does not completely disappear if the patient is standing. Relief comes when you change the position of the spine, for example, when sitting, leaning forward sharply or even squatting. The radicular nature of the disorders becomes especially evident if there is a shooting character of the pain. In this case, there are no vascular diseases; radiography reveals a decrease in the sagittal size of the spinal canal in the lumbar region; myelography shows impaired passage of contrast at several levels. Differential diagnosis is usually possible, given the characteristic localization of pain and other features.

Pain in the lumbar region when walking may be a manifestation of spondylosis or damage to the intervertebral discs (indications in the history of sharp pains in the back with irradiation along the sciatic nerve, sometimes the absence of Achilles reflexes and paresis of the muscles innervated by this nerve). Pain may be due to spondylolisthesis (partial dislocation and "slipping" of the lumbosacral segments). It can be caused by ankylosing spondylitis (Bekhterev's disease), etc. X-ray examination of the lumbar spine or MRI often clarify the diagnosis. Pain due to spondylosis and intervertebral disc disease often increases with prolonged sitting or awkward posture, but may decrease or even disappear with walking.

Pain in the hip and groin area is usually the result of arthrosis of the hip joint. The first few steps cause a sharp increase in pain, which gradually decreases as you continue walking. Rarely there is a pseudoradicular irradiation of pain along the leg, a violation of the internal rotation of the thigh, causing pain, a feeling of deep pressure in the area of ​​the femoral triangle. When a cane is used while walking, it is placed on the side of the opposite pain to transfer body weight to the non-painful side.

Sometimes while walking or after standing for a long time, pain in the groin may be observed, associated with lesions of the ilioinguinal nerve. The latter is rarely spontaneous and is more often associated with surgical interventions (lumbotomy, appendectomy), in which the nerve trunk is damaged or irritated by compression. This reason is supported by a history of surgical manipulations, improvement in hip flexion, maximally severe pain in the area two fingers medial to the anterior superior iliac spine, sensory disturbances in the iliac region and the scrotum or labia majora.

Burning pain along the outer surface of the thigh is characteristic of paresthetic meralgia, which rarely leads to a change in gait.

Local pain in the area of ​​long tubular bones, which occurs when walking, should raise the suspicion of the presence of a local tumor, osteoporosis, Paget's disease, pathological fractures, etc. Most of these conditions, which can be identified by palpation (palpation pain) or x-rays, also have back pain. Pain on the anterior surface of the lower leg may appear during or after a long walk, or other excessive tension of the muscles of the lower leg, as well as after acute occlusion of the vessels of the leg, after surgical intervention on the lower limb. Pain is a manifestation of arterial insufficiency of the muscles of the anterior region of the lower leg, known as anterior tibial arteriopathic syndrome (pronounced increasing painful edema; pain from compression of the anterior sections of the lower leg; disappearance of pulsation on the dorsal artery of the foot; lack of sensitivity on the dorsal surface of the foot in the zone of innervation of the deep branch of the peroneal nerve; paresis of the extensor muscles of the fingers and short extensor of the thumb), which is a variant of the syndrome of the muscle bed.

Foot and toe pain is especially common. The cause of most cases is a deformity of the foot, such as flat feet or a wide foot. This pain usually appears after walking, after standing in hard-soled shoes, or after wearing heavy weights. Even after a short walk, a heel spur can cause pain in the heel and hypersensitivity to the pressure of the plantar surface of the heel. Chronic tendonitis of the Achilles tendon is manifested, in addition to local pain, by palpable thickening of the tendon. Pain in the forefoot is seen with Morton's metatarsalgia. The cause is a pseudoneuroma of the interdigital nerve. At the beginning, pain appears only after a long walk, but later it can appear after short episodes of walking and even at rest (pain is localized distally between the heads of the III-IV or IV-V metatarsal bones; it also occurs when the heads of the metatarsal bones are compressed or displaced relative to each other; lack of sensitivity on the contact surfaces of the toes; disappearance of pain after local anesthesia in the proximal intertarsal space).

Sufficiently intense pain along the plantar surface of the foot, which forces you to stop walking, can be observed with tarsal tunnel syndrome(usually with a dislocation or fracture of the ankle, pain occurs behind the medial malleolus, paresthesia or loss of sensation on the plantar surface of the foot, dryness and thinning of the skin, lack of perspiration on the sole, inability to abduct the fingers compared to the other foot). Sudden onset of visceral pain (angina pectoris, pain in urolithiasis, etc.) can affect the gait, significantly change it, and even cause walking to stop.

Paroxysmal gait disorders

Periodic dysbasia can be observed in epilepsy, paroxysmal dyskinesia, periodic ataxia, as well as in pseudo-seizures, hyperekplexia, psychogenic hyperventilation.

Some epileptic automatisms include not only gesticulation and certain actions, but also walking. Moreover, such forms of epileptic seizures are known, which are provoked only by walking. These seizures sometimes resemble paroxysmal dyskinesias or walking apraxia.

Paroxysmal dyskinesia, which began during walking, can cause dysbasia, stop, fall of the patient or additional (violent and compensatory) movements against the background of continued walking.

Periodic ataxia causes intermittent cerebellar dysbasia.

Psychogenic hyperventilation often not only causes lipothymic conditions and syncope, but also provokes tetanic convulsions or demonstrative movement disorders, including periodic psychogenic dysbasia.

Hyperekplexia can cause gait disturbances and, in severe cases, falls.

Myasthenia is sometimes the cause of periodic weakness in the legs and dysbasia.