What measures do parents not take to wean their child from walking on tiptoe! Some strictly forbid the baby to rise on his toes, others begin to actively drive the baby to the doctors, take tests and look for the disease that is guilty of everything. And all this is because in this way of moving adults necessarily see some kind of “abnormality”.
With complaints that the child walks on tiptoes, parents also turn to the famous doctor Evgeny Komarovsky, who explains with pleasure what such a gait can mean and how parents should react to it.
Most often, tiptoeing is not a sign of any pathology, says Yevgeny Komarovsky. For children under the age of 2, episodic attempts to walk on tiptoes are an absolute norm, which should not worry mom and dad in any way.
Anatomically, this phenomenon can be explained by the fact that in children, even those who have not yet begun to walk at all, the calf muscle is quite developed. And when the baby gets up on its feet and tries to take the first independent steps, it is the tone in this calf region that can easily put the child on tiptoe. There is nothing to worry about, because as the rest of the muscles develop, the calves will be less muscular, and the foot will take the correct position when walking.
Quite often, parents themselves are to blame for the fact that the baby walks on tiptoes. This may be due to the fact that from a very early age, sometimes even before 6 months, they begin to use devices such as walkers. Dr. Komarovsky spoke about the dangers of these devices from the point of view of the load on the immature spine more than once.
There is another disadvantage in their use - the baby in the walker relies on socks. He does not always reach the floor, and then it is quite difficult for him to get used to the fact that you can lean on the foot in some other way. In such a situation, according to Yevgeny Komarovsky, the child then needs to be retrained, to instill in him a new useful habit of walking correctly.
However, not all 100% of children who walk on their toes have such harmless reasons for walking. There are situations when tiptoeing is a sign of one of the serious neurological disordersassociated with impaired muscle tone and pathologies of the central nervous system:
But when a child has one of these diseases, walking on toes will obviously not be the only symptom. In addition, most likely, parents learn about the disease much earlier than the baby begins to walk. And therefore, if at 2-3 years old the child feels good, nothing hurts him, nothing bothers him, and the only thing that parents complain about is walking on toes, then there is no reason to worry, says Yevgeny Komarovsky.
Such a child does not need treatment, you can not torment him and not drive him to numerous doctor's offices.
Toddlers also have reasons for walking on their toes that are of a different nature - psychological. The peanut sees that he is being praised for the fact that he has grown up, that he is already big. Naturally, he wants to be even bigger and taller, and therefore he rises on his toes from time to time. Often such a gait is characteristic of children who are inquisitive, very mobile, hasty, impressionable, who are always in a hurry and running somewhere.
If the child has no pathologies, as well as neurological diagnoses, then the parents may face the question of how to correct the baby's gait. Evgeny Komarovsky claims that up to 3 years there is no need to do this purposefully. But some measures taken by parents will help the child quickly master the correct foot setting skills:
Unfortunately, the reality is, says Yevgeny Komarovsky, that a mother who turns to a local doctor with complaints that her child walks on tiptoes will most likely receive recommendations to start giving medication to her child. There is nothing wrong with the doctor prescribing vitamins and massage.
But often the child is prescribed not so harmless methods of treatment. So, nootropic drugs, vascular, sedatives can be recommended. Evgeny Komarovsky advises avoiding their use without an obvious reason, that is, the presence of a serious (often congenital) neurological disease. These medicines have a lot of side effects, and a healthy child who just doesn’t walk the way his mother wants, they are completely unnecessary.
For more information about this problem, see a short video by Dr. Komarovsky.
Movements in cerebellar ataxia are poorly commensurate with the characteristics of the surface on which the patient is walking. 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.).
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.
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) are 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.
Main reasons: the vestibular symptom complex is characteristic of the defeat of the vestibular conductors at any level (sulfur plugs in the external auditory canal, labyrinthitis, Meniere's disease, acoustic neuroma, multiple sclerosis, degenerative lesions of the brain stem, syringobulbia, vascular diseases, intoxications, including drugs, craniocerebral 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 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, abnormal foot signs.
The legs are usually extended at the knee 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 pyramidal tract lesion at any level.
Main reasons: Paraspastic gait is most commonly seen under the following circumstances:
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.
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.
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.
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.
Most frequent etiological factors this type of gait include:
In young patients, torsion dystonia can sometimes debut with an unusual stiff and 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 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.
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.
"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.
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 - 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 frequent cause unilateral paresis of the extensors of the foot is a violation of the function of the peroneal nerve (compression 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 disorders such as stockings, absence or decrease in Achilles reflexes), with Charcot-Marie-Tooth peroneal muscular atrophy - a hereditary disease of three types (high arch of the foot, atrophy of the muscles of the lower leg (“stork” legs), absence of Achilles reflexes, sensory disturbances are slight or absent), with spinal muscular atrophy - (in which paresis is accompanied by atrophy of other muscles, slow progression, fasciculations, lack of sensory disturbances) and with 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 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 unilateral paresis includes femoral nerve lesion (patellar reflex prolapse, impaired sensation in the n. saphenous innervation area]) and lumbar plexus lesion (symptoms similar to those of femoral nerve lesion, but 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.
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 no longer sufficient, 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 dislocation of the hip.
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 increased lumbar lordosis. With unilateral paresis m. gluteus maximus, it is impossible to abduct the affected leg backwards, even in the pronation position.
Cause there 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 is observed with different types of 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.
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 palsy, autism, epilepsy, etc.
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, stomps around, spins, 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).
There are gait disturbances, often resembling those described above, but developing (most often) in the absence of current organic damage to the 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 diagnosis of this type of dysbasia often requires specialized clinical experience.
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 its careful clinical analysis is needed in each individual case in order to assess the contribution of each of them to the manifestations of dysbasia.
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.
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. The typical cause is stenosis or occlusion of blood vessels in the upper thigh (typical history, vascular risk factors, absence of foot pulsation, murmur over proximal blood vessels, no other cause for pain, sometimes sensitive stocking disturbances). Under such circumstances, there may be additional pain in the perineal or thigh region 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 with a change in 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 can be a manifestation of spondylosis or damage to the intervertebral discs (history of acute back pain radiating 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 that occurs when walking should raise the suspicion 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 increased sensitivity to pressure from 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 sweating on sole, inability to abduct toes 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.
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.
It will not be difficult to notice something wrong in your gait. But - more than that: according to it, in many cases, he will be able to "by eye" determine what is wrong with your body.
Can show: flat feet, bump on the finger, neurinoma.
Flat feet are obvious at first glance: there is almost no visible arch in the foot. But other illnesses can also lead to flat walking. When a person takes a step, the foot flattens out even as the heel lifts off the ground and is about to move into an "arched" position. The heel may move slightly inwards. This kind of movement is an attempt to create more stability for a painful bunion (an abnormal expansion of the bone or tissue at the base of the thumb) or a neuroma (nerve disease) in the foot.
Can show: Parkinson's disease.
Scuffing your feet - leaning forward, barely lifting your feet off the ground - is not an inevitable aspect of aging. This type of gait may mean that a person has Parkinson's disease. A person's steps can also be short and hesitant.
"Shuffling is one of the most common manifestations of Parkinson's disease," says American podiatrist Dr. Blitzer. Along with tremors, this can be an early sign of illness.
Can show: cerebral palsy or spinal cord injury.
The toe reaches the ground to the heel, not the other way around. This is due to overactive muscle tone caused by improper excitation of stretch receptors in the brain. When tiptoeing occurs on both sides, it is almost always due to damage to the spine and brain, as in cerebral palsy or spinal cord injury.
Note: Sometimes babies walk on tiptoe when they first learn to walk, but that doesn't mean they have paralysis. If you are concerned about this, talk to your child's doctor.
Can show: stroke.
Doctors evaluate tiptoe walking for symmetry: does it happen on both sides or just one? When a person walks like this on only one side, it is an indicator of a stroke, which usually damages one side of the body.
Can show: unusually stiff calf muscles.
Unusual is the gait, in which the walker literally bounces. This is due to tense calf muscles. Women are most vulnerable to this condition because they often walk in heels (a chronically elevated heel position), says orthopedist Dr. Andersen.
"I've seen women in their 60s who can't wear flat shoes," she says. "The same thing could happen much earlier, for example, with 25-year-old girls who wore stilettos as teenagers."
Immediately after the baby is born, they check if he has hip dysplasia or congenital shortening of the hips or legs. If neonatologists missed defects, then an orthopedist or surgeon at a medical examination in 1 month will correct the situation. But the mother herself should pay attention to important signs: if the baby is placed on the back, and then its legs are bent so that the child's feet stand on the changing table, then the knees should be at the same level. Asymmetric folds under the buttocks and on the hips should also be discussed with the doctor.
Exit. Immobilization splints, pads, and stirrups fitted before 6 months of age should correct hip dysplasia, and surgery will lengthen the shortened portions.
Clubfoot in a child can be a serious problem and a temporary phenomenon. In the first case, the child's foot (one or both) and the ankle are turned inward strongly, almost 90°. And you can notice this feature almost immediately after birth. The second situation is absolutely natural, by the age of 2 it corrects itself, but sometimes the process is delayed up to 3-4 years.
Exit. The treatment of severe clubfoot in a child is started from 2 weeks of age. Usually they practice massage and physiotherapy exercises. If after six months there is no result, they think about the operation.
In some children up to 3-4 years old, when walking, the legs are located in the letters O, X, or both knees look in different directions. It is important to ensure that after two years this feature does not worsen, there is no pain in the joints and discomfort when walking. The child manages to finally adapt to life in an upright state only by adolescence, which means that everything that happens before that fits into the concept of the norm.
Exit. In any case, consultations with a specialist once every six months, massage and physiotherapy exercises will not interfere.
Doctors diagnose "flat feet" not earlier than 5 years, and before that they use the terms "flat-valgus foot" - the feet strongly "fall over" on the inside, and "varus" - the outer edges serve as a support. The first deformation can develop into flat feet in a child. It becomes difficult for the baby to walk for a long time, and his new shoes are trampled on the inside in just 1-2 months. The second situation never leads to flat feet in a child, but it also gives an increased load on the joints of the legs and the spine, turning into at least a stoop.
Exit. With timely correction with the help of physiotherapy, the defect can most often be eliminated in a few years.
There are several abnormal gait patterns in children. One - the child leans on his toes, lifts and twists his heels outward, slightly bends his legs at the knee and hip joints, brings the hips together. The second is identified by dragging the right or left leg, as well as the arm bent and pressed to the body on the same side. At the next gait, the child is distinguished by excessive, inappropriate, pretentious movements of the limbs, for example, the knees rise high, and the feet “slap”.
Exit. With any deviation from the norm, the baby should be shown to the surgeon, orthopedist and neurologist. Most of these features are associated with failures in the development of the brain or spinal cord and require timely adjustment.
Doctor's advice
If you notice that the baby for no apparent reason (uncomfortable shoes) began to limp, drag his leg or take unusual postures when he sits, lies or stands, urgently contact a specialist - a surgeon or an orthopedist. The same should be done if the joints are swollen and hot to the touch. Sometimes colds and flu cause inflammation in the musculoskeletal system. And successful recovery depends on how quickly treatment is started. Until the child is examined, it is important to minimize the load on the affected leg.
Exit. Traditional medicine offers many methods for treating sweaty feet in children - foot baths with infusions of oak bark, sage, string, hardening (walking barefoot, dousing with cold water), foot massage, various ointments and powders.
Parents need to pay due attention to children's complaints of pain in the lower extremities, ask where exactly and what is happening, monitor changes in the child's gait. Most of the complaints are due to bruises and sprains during active games. Smaller - becomes the result of uneven growth of bone and muscle tissue. Zones of more intensive development are ahead of those that are lagging behind, causing them discomfort. One fifth of children experience leg pain in the evening. The blood circulates well during the day, but at night the blood flow is reduced and pain occurs. A light massage should relieve the discomfort.
Exit. As soon as the child reported pain in the legs, it is necessary to examine him. Pay attention to general well-being, appetite, body temperature, mood. However, not all cases are so harmless, and it is better to discuss the situation with a doctor.
According to statistics, 95% of children are born with healthy legs, but with age, about a third of them acquire various pathologies of the musculoskeletal system. With the help of orthopedic shoes for children, many defects in the bones and joints of the legs can be corrected. You can’t buy such things without a doctor’s prescription, you can harm the proper development of the child’s feet or aggravate existing problems.
Exit. The best way to correct with the help of orthopedic shoes for children is flat feet in a child, as well as valgus and varus deformities of the feet.
Actress Katie Holmes and model Heidi Klum caused a public outcry when they allowed their 4-year-old daughters to wear high-heeled shoes. Such antics have been called "parental failure." According to experts, the consequences of such a violation are sprains and curvature of the shape of the foot in a child, as well as spinal deformity, which will inevitably lead to malfunctions in the internal organs.
Exit. Shoes of fashionistas under 7 years old should have a heel no higher than 5–7 mm.
The first shoes are put on as soon as the baby begins to learn to walk. Children's first shoes should have a high, stiff heel counter, arch support, and a roomy toe that doesn't compress the forefoot.
Exit. Buying the first shoes for a child is a must-have with him. We suggest the following course of action. Let the baby put on an update and walk a little in it, and you watch if his gait has changed.
Charging game for legs
A good prevention of flat-valgus deformity and flat feet can be simple gymnastics, which can easily be turned into a fun game. Exercises should be performed daily, 5-7 times each.
Undress the baby and offer him:
* alternately and synchronously bend and straighten the toes on each leg;
* rotate feet clockwise and counterclockwise;
* walk on toes, heels and leaning on the outer part of the foot;
* collect small objects from the floor with your toes: pebbles, balls, parts from a designer with a diameter of 3–4 cm (a complicated version of this exercise looks like this: scatter small objects on the floor, cover them with a scarf and offer the crumbs to collect everything without removing the cover);
* sitting on a chair, alternately roll a tennis ball or a gymnastic stick with your right or left foot;
* walk slowly, holding a tennis ball between the feet;
* stand, holding the hands of an adult, on a fitball, trying to maintain balance;
* walk on a narrow log and climb the rungs of a rope ladder.
Gait is the physiognomy of the body, according to Balzac. By walking a person, you can determine not only his gender and age, but also his mood, character, social affiliation. How to determine the meaning of gait?
Let's start with the simplest - with the gait of a confident person. If a person walks smoothly, straight, swiftly, the pace of his steps is fast, this indicates the confidence of the owner of such a gait.
If a person shuffles his feet, his hands dangle out of time, and his head is lowered, it seems that he is going to an execution or carrying a heavy burden, this indicates a disorder of feelings, deep depression. Perhaps a person is in a state of crisis or he will not have a very pleasant meeting. Therefore, if you notice that a person is going to meet you, shuffling his feet, this may indicate his unwillingness to see you, he does this out of necessity.
A bouncing gait (a person, as it were, springs on his legs) can have a double meaning. First. The direct meaning of such a walk is a happy, unclouded mood, joyful events occur in a person’s life, he is satisfied and cheerful, cheerful, set to positive. The second meaning is more hidden: a person deliberately tries to be cheerful and carefree, although in reality he is depressed by something. Calculating imaginary joy is very easy, just pay attention to facial expressions and gestures.
If a person does not unbend his knees, walks on half-bent legs, this may be evidence of his venerable age and pain in the joints, but if the owner of such a gait is young, then this feature indicates that he is unsure of himself, closed, suspicious.
If a person strongly throws his legs to the sides, his hands can rest in his pockets, or prop up his sides, his posture resembles the letter "F". This is either a sign of excessive self-confidence or carelessness, lack of employment, constant idleness. He paces in this way, because he simply has nowhere to rush, he is not burdened with any duties.
A cautious person very often, when walking, first steps on his heels and gently rolls onto his toe, you will never see him resting on his entire foot. He is cautious in everything, including in his gait.
If a person knocks his feet very hard while walking, this means that he wants to attract as much attention as possible to others. He feels like a very important person, wanting to loudly announce his appearance.
Women's gait should be discussed separately. By the way a woman moves, one can determine her goal, her life orientation. If a woman walks slowly, taking small steps, gently shaking her hips, then she is currently set to search for a satellite, her goal is to attract surrounding men.
If a woman walks confidently, beating with her heels, her hips go from side to side very sharply, this indicates her attitude towards business communication. This is a firm, businesslike woman who is unlikely to easily give up her principles.
A woman rolls from one foot to another, which means she has not learned how to use the most important female tool - gait. Such a woman is used to doing housework. Her destiny is home, life, family. Perhaps she is a mother of many children.
