Walking is a complex movement requiring the coordination of the central nervous system, the peripheral nervous system and the musculoskeletal system (= muscles).

Gait abnormalities or instability are frequent reasons for consultation, especially in the elderly. Observing the walking of people coming for consultation is a key moment for the doctor to establish his diagnosis: pace of walking, length of steps, span of strides.

Walking disorders can result, among other things, by:

• a slowdown in the speed of walking

• a lack of symmetry or synchronization of movements 

• stiffness or weakness in a leg that does not respond to central command

• a precarious balance

• numbness in the lower limbs

The main risk factors for reduced mobility, in other words difficulty in walking, are:

• aging

• lack of physical activity

• obesity

• or chronic diseases such as diabetes, osteoarthritis or neurological diseases

The factors that can cause difficulty in walking are extremely numerous and varied:

• Vascular damage:
  • hypotension or orthostatic hypotension (= drop in blood pressure when going from lying to standing)
  • stroke causing brain damage

• Neurological damage:
  • multiple sclerosis
  • compression or injury to the spinal cord
  • spinal cord tumors
  • Parkinson’s disease
  • tumors of the cerebellum
  • any type of ataxia (= lack of coordination of movements and loss of balance), whether genetic or not
  • Wernicke’s encephalopathy
  • peripheral neuropathy, even damage to peripheral nerves
  • Huntington’s chorea, which can even lead to inability to walk (or abasia)

• Orthopedic or rheumatic disorders:
  • arthritis, polyarthritis (inflammation of the joints)
  • osteoarthritis (destruction of cartilage due to progressive wear)
  • fracture or injury in the leg (feet, tibia, knee, etc.), sprain
  • affections of the feet, such as hallux valgus which is also called “bunions” (deformation of the front of the foot characterized by a deviation of the big toe towards the second toe)

• Balance disorders:
  • Alzheimer’s disease
  • labyrinthitis (inflammation of the labyrinth, part of the inner ear) causing dizziness
  • degeneration of the inner ear

• Muscle or neuromuscular damage:
  • Myopathies and other neuromuscular diseases
  • muscle weakness, for example in the calves

• Metabolic disorders:
  • 2 type diabetes
  • thyroid involvement

We can also mention the consumption of drugs, alcohol, certain anti-hypertensive drugs, sedatives or psychiatric illnesses such as depression, which can impair motor skills.

In addition to the pain it can cause, difficulty walking affects the ability to perform tasks or classic everyday movements.

This disorder affects the independence of the affected person and can cause social isolation, or a more or less marked feeling of loss of freedom.

Side effects due to lack of physical activity can also occur.

Note that the treatments vary depending on the cause of the difficulty in walking. These can be medicinal, surgical or even based on physiotherapy (physiotherapy).

The doctor will conduct a detailed interview to understand the causes of difficulty walking and may perform neurological, bone and joint, muscle and sensory organ examinations to learn more. Sometimes imaging tests are necessary.

The main goal of treatment will be to restore an acceptable gait pattern and stability of movement, with or without the use of technical aids. Thus, it is a question of proposing or not a functional rehabilitation, as well as any specific modifications, or devices helping to walk. Occupational therapy management can help compensate for the difficulties.