Walking problems

Definition

Walking problems result from conditions or disabilities that impair the ability to walk without experiencing discomfort or pain .

Description

Besides direct injuries to the spine, legs or feet, almost any disease or condition that affects the nerves or muscles can result in walking problems. Muscle weakness, joint problems, pain, disease, and neurological disorders can all contribute to walking problems. It is also often the case that more than one disease or condition contributes to their development. Walking problems are also much more common in the elderly population than in people younger than 65.

Demographics

Problems with walking are commonly associated with falls and disability in senior adults. The American Geriatrics Society estimates that walking problems affect approximately 20% of older adults living in the community and 50% of the elderly, aged 85 years old and older. Most of these problems are associated with underlying diseases, especially severe diseases. In the United States, each year, falls occur in over 33% of persons over age 65, and in 50% of persons over age 75. About a third of the older population reports some difficulty with balance or walking, and this percentage also increases in frequency and severity after age 75.

Causes and symptoms

Many conditions can cause walking problems, and these problems increase with age. Chronic disease conditions often lead to walking problems, such as movement disorders. Though it seems simple and effortless, walking in fact requires an astonishingly complex system of control. Disruption of any portion of this system, resulting from movement disorders, can cause a person to produce movements that are too uncoordinated, or too poorly controlled to maintain the ability to walk without discomfort or pain. Parkinson 's disease and ataxia are two movement disorders that can significantly affect walking. As symptoms of Parkinson's disease get worse, patients often experience trouble walking. People with ataxia experience a failure of muscle control in their arms and legs, resulting in a lack of balance and coordination or a disturbance of gait.

The ability to walk can also be impaired by a wide variety of injuries or other illnesses. Common injuries caused by falls include fractures to the spine, legs or feet. Falls are most often caused by home hazards, such as slippery floors and rugs, weak muscles, unstable balance, and side effects from medications, such as dizziness and confusion. Common illnesses associated with difficulty walking include osteoporosis and arthritis. Osteoporosis is a disease in which the density and quality of bone is reduced, which significantly increases the risk of fracture. Arthritis is a disease that damages the lining of joints and causes pain and swelling in the joints. Multiple sclerosis is also associated with muscle weakness and trouble with coordination and balance. Complications after orthopedic surgery or stroke can also impair walking. Vitamin B12 deficiency has also been associated with numbness in the extremities and a disturbed sense of balance, leading to gait problems.

Symptoms of walking problems vary depending on the underlying cause. They may include changes in gait, difficulty negotiating turns or climbing stairs, feelings of numbness, pain, unsteadiness, twitching, muscle stiffness or weakness in the legs, and frequent falls or loss of balance.

Diagnosis

A complete medical history is usually taken to identify health factors that may be causing problems with walking and mobility, such as past medical problems, episodes of acute illness, poor vision, or other conditions that can affect stability, coordination, strength, or posture. The examination may include specific tests to evaluate walking speed, balance, coordination, strength, body position, and gait.

Treatment

Treatment depends on the number, type, and severity of the underlying conditions that contribute to walking problems and will first seek to treat the disorder or disease associated with the walking difficulty. The goal of treatment is usually to improve standing and walking function and often feature therapies that combine a variety of different exercises such as leg resistance training, balance, and flexibility exercises.

Nutrition/Dietetic concerns

Healthy bones are important for walking. Among the nutrients important for bone health are calcium , phosphorus, magnesium, fluoride, vitamins D , ^B12, and K, and macronutrients such as protein, carbohydrate, and fat. Calcium is the most critical mineral for a healthy bone mass and is found in milk and other dairy products, green vegetables, and calcium-enriched foods. Vitamin D also helps the body absorb calcium and other minerals while vitamin K has been shown to increase bone mineral density in osteoporotic people while reducing fracture rates.

Therapy

Therapy can help people who experience difficulty walking. It may involve a combination of services and assistive technology, such as having a physical therapist use a special massage to restore a wider range of motion to stiff leg muscles. The use of lift inserts to correct for different leg lengths, ankle braces, and various shoe modifications can also help relieve walking problems. Leg braces can also help maintain proper foot alignment for standing and walking.

Various assistive devices are also available to help people who require assistance to walk or stand:

• Canes: Canes are meant to provide light support to help people maintain balance and avoid falls while walking.
• Crutches: Crutches provide more support than canes as they allow a person to support the entire weight of the body.
• Standing Aids: These are designed to be propelled by the user, and usually support standing from non-weight-bearing to full-weight-bearing.
• Walkers: Walkers provide a higher level of support than canes to help people avoid falls while walking, as they can support up to 50% of a person's weight.

QUESTIONS TO ASK YOUR DOCTOR

• What is the cause of my walking problem?
• Is there a cure?
• What treatments are available?
• What kinds of walking aids are available and whom should I contact about getting the right one?
• What type of walker would best help me maintain mobility?
• Are my walking problems permanent?
• How can I improve my strength and fitness level?

Changes can also be made to the home to adapt living spaces to meet the needs of people with walking problems so that they can continue to live independently and safely. Modifications can range from something as simple as installing handrails in bathrooms to full-scale construction projects that require building wheelchair ramps and widening doorways.

Prognosis

Outcomes for walking problems depend on the underlying cause. Treatment can generally improve some walking problems, such as those associated with vitamin B12 deficiency, knee arthritis, Parkinson's disease, or nerve inflammation. In many cases, physical therapy has proven effective to improve or recover walking function. For example, therapy for knee arthritis or stroke often leads to improvement.

Prevention

Problems with walking can be prevented with good, preventive health care on a routine basis, and lifestyle choices that maintain health. For example, wearing well-fitting walking shoes with low heels and firm soles help maximize balance and prevent falls. Loss of bone density and osteoporosis can be delayed or prevented with a balanced diet and regular exercise . The National Osteoporosis Foundation also recommends bone density testing for all women over age 65, and for all women under the age of 65 who have one or more risk factors for osteoporosis in addition to menopause . Accidental injuries can also be prevented by removing hazards in the home to reduce the risk of falls. Besides treatment, the health of people who already have a disease can often be improved by regular screening to ensure that treatment options are effective and identify potential walking problems.

KEY TERMS

Arthritis —Disease that damages the lining of joints and causes pain and swelling in the joints.

Ataxia —Disorder that damages the parts of the nervous system that control movement.

Gait —A particular way or manner of moving on foot.

Movement disorders —Group of diseases and syndromes affecting the ability to produce and control movement.

Multiple sclerosis —Chronic inflammatory disease of the central nervous system that primarily affects the myelin sheath, the fatty white matter that covers and protects the nerve cells.

Osteoporosis —Disease in which the density and quality of bone is reduced, which significantly increases the risk of fracture.

Parkinson's disease —Disorder that affects nerve cells, or neurons, in a part of the brain that controls muscle movement.

Caregiver concerns

It is important to realize that walking problems are not an automatic and irreversible consequence of aging. Rather, they most often result from other conditions that become more common and severe as a person gets older. Proper treatment of any medical condition and appropriate follow-up of patients in this age group is accordingly crucial to ensure that walking problems are identified and addressed before they seriously affect mobility.

Resources

BOOKS

Harrington, Candy B. Barrier-Free Travel: A Nuts and Bolts Guide for Wheelers and Slow Walkers. 2nd ed., New York, NY: Demos Medical Publishing, 2005.

Iezzoni, Lisa. When Walking Fails: Mobility Problems of Adults with Chronic Conditions. Berkeley, CA: University of California Press, 2003.

PERIODICALS

Cooper, K. M., et al. “Health barriers to walking for exercise in elderly primary care.” Geriatric Nursing 22, no. 5 (September–October 2001): 258–262.

Ingemarsson, A. H., et al. “Walking ability and activity level after hip fracture in the elderly—a follow-up.” Journal of Rehabilitation Medicine 35, no. 2 (March 2003): 76–83.

Kubo K., et al. “Effects of 6 months of walking training on lower limb muscle and tendon in elderly.” Scandinavian Journal of medicine & science in sports 18, no. 1 (February 2008): 31–39.

Lindemann, U., et al. “Distance to achieve steady state walking speed in frail elderly persons.” Gait & Posture 27, no. 1 (January 2008): 91–96.

Melzer, I., et al. “Effects of regular walking on postural stability in the elderly.” Gerontology 49, no. 4 (July–August 2003): 240–245.

Rhudy, J. L., et al. “Efficacy of a program to encourage walking in VA elderly primary care patients: the role of pain.” Psychology, Health & Medicine 12, no. 3 (May 2007): 289–298.

OTHER

Canes and Walkers: Which One Is Right for You? American Geriatrics Society, Foundation for Health in Aging, Information Page (March 08, 2008) http://www.healthinaging.org/public_education/tools/10_canes_walkers.pdf

Crutches: A “How-To” Guide. American College of Foot and Ankle Surgeons, Healthy Feet for an Healthy Life, Information Page (March 08, 2008) http://www.footphysicians.com/footankleinfo/crutches.htm

Falls and Balance Problems. American Geriatrics Society, Foundation for Health in Aging, Information Page (March 08, 2008) http://www.healthinaging.org/public_education/pef/falls_and_balance_problems.php

Home Modification. U.S. Department of Health and Human Services, Administration on Aging Information Page (March 08, 2008) http://www.aoa.gov/press/fact/pdf/fs_home_mod.pdf

How to Choose and Use a Cane. University of Michigan Health System, Information Page (March 08, 2008) http://www.med.umich.edu/1libr/sma/sma_caneuse_sha.htm

Walking Aids. National Institute on Disability and Rehabilitation Research, AbleData Page (March 08, 2008) http://www.abledata.com/abledata.cfm?pageid=19327&top=14223

ORGANIZATIONS

American College of Foot and Ankle Surgeons (ACFAS), 8725 West Higgins Rd., Chicago, IL, 60631-2724, (773) 693-9300, (800)421-2237, (773) 693-9304, [email protected], http://www.acfas.org.

National Center on Physical Activity and Disability (NCPAD), 1640 W. Roosevelt Rd., Chicago, IL, 60608-6904, (800)900-8086, (312)355-4058, [email protected], http://www.ncpad.org.

National Institute of Arthritis and Musculoskeletal Diseases (NIAMS), 1 AMS Circle, Bethesda, MD, 20892-3675, (301)495-4484, (877)22-NIAMS, (301)718-6366, [email protected], http://www.niams.nih.gov.

Monique Laberge Ph.D.