Walking Difficulty

WHEN TO SEE YOUR DOCTOR

* You experience changes in the way you walk?including any difficulty negotiating turns or climbing stairs.

* You also have feelings of numbness, pain, unsteadiness, twitching, muscle stiffness or muscle weakness.

* You frequently fall, stumble or bump into objects.

* You also feel that your muscles seem to be wasting away.

What Your Symptom Is Telling You

Throughout the stages of your life, your walking style may change distinctly. You start off with stumbling baby steps. You plod through the awkwardness of adolescence. In later years, you may cautiously amble along with the help of a cane or walker. But for most of your life, you walk along with confidence, fluidity and ease. So when you find yourself losing control of this fundamental function, it's cause for concern.

Walking involves a harmonious cooperation among your muscles, bones, eyes and inner ears. Coordinating this effort are your brain and central nervous system, says Steven Mandel, M.D., clinical professor of neurology at Jefferson Medical College and an attending physician at Thomas Jefferson University Hospital in Philadelphia. "A problem anywhere in this network can produce shuffling, foot dragging, jerking motions or difficulty bending joints," he explains.

The eyes and inner ears are obvious places to look for problems. Elderly people who are losing their vision may have difficulty walking, and anyone with an inner ear infection could experience balance problems that interfere with walking. (For more information, see Earache on page 136.)

The central nervous system is also a likely spot. Medications, such as sedatives, can affect the central nervous system and create walking problems, says Dr. Mandel. So could alcohol or drug abuse.

Poor nutrition could conceivably be at the heart of the problem as well, particularly in the elderly. "Vitamin B₁₂ deficiency often produces numbness in the extremities and a disturbed sense of balance, which leads to gait changes," says Lawrence Z. Stern, M.D., professor of neurology and director of the Muscular Dystrophy Association's Mycio F. Delgado Clinic for Neuromuscular Disorders at the University of Arizona Health Sciences Center in Tucson.

Finally, almost any disease or condition that affects the nerves or muscles can produce walking problems. The condition could be something as treatable as a herniated disk in the lower back. Among the more serious diseases affecting the gait are amyotrophic lateral sclerosis (Lou Gehrig's disease), multiple sclerosis, muscular dystrophy and Parkinson's disease.

"Diabetes often produces a loss of sensation in both feet," says Peter Cavanagh, Ph.D., director of the Center for Locomotion Studies at Pennsylvania State University in University Park. "Many people with diabetes lose the ability to tell where their legs are in relation to the floor and develop an unsteady stance and gait."

Symptom Relief

A gait abnormality is cause for concern at any age. If these tips don't help, see a physician. Because so many conditions could be responsible, you should expect a battery of tests to diagnose the problem.

Have your medications checked. List all medications you are currently taking?both prescription and over-the-counter. Then ask your doctor whether any alterations in your medications are appropriate.

Keep your eyes forward. "You're much steadier when you're looking forward than when you're head is tilted back or to the side," says Dr. Cavanagh. "Try keeping your head level and square to your shoulders and place objects at eye level so you don't have to crane your neck."

Have your vision checked. Clear vision and depth perception are extremely important factors in walking. "If you can't see the floor clearly, you will walk with an awkward, apprehensive gait," says Dr. Mandel. (For more hints on dealing with vision problems, see Night Blindness on page 380; Vision, Blurry, on page 594 and Vision Loss on page 596.)

Stripe your walls. Many hospitals and institutions whose patients have walking difficulties paint vertical stripes on the walls, according to Dr. Cavanagh. The vertical stripes give people better stabilization of gaze than blank walls or horizontal stripes and have been shown to reduce falls and injuries.

See also Balance Problems