ConditionBrain & nerves
Gait Disorder: Assessment and Treatment
A gait disorder is a persistent problem with walking, such as slowness, unsteadiness, shuffling or a limp, that affects daily life or safety. It affects about 1 in 3 people over 70 and is a leading cause of falls. Most gait disorders in older adults have more than one cause, for example arthritis plus neuropathy plus poor vision. A structured assessment usually finds treatable factors, and targeted exercise, medicine review and the right walking aid often improve walking and cut fall risk.
Also called: Walking disorder, gait and balance disorder, abnormal gait, gait impairment, mobility disorder
At a glance
- What it is
- A lasting change in walking (speed, balance, rhythm or pattern) that limits activity or causes falls.
- How common
- About 1 in 10 adults aged 60 to 69 and more than 6 in 10 over 80.
- Common causes
- Arthritis, neuropathy, Parkinson's disease, stroke, spinal stenosis, hydrocephalus, medicines, fear of falling.
- Assessment
- Watching you walk, timed tests, nerve and joint exam, medicine review, and targeted scans.
- Treatment
- Physical therapy, strength and balance training, fixing the cause, walking aids and home changes.
When to get help
Call 911 or go to the ER
- Sudden inability to walk, or new weakness, numbness or drooping on one side of the body: possible stroke, call 911 or your local emergency number
- New leg weakness with back pain and loss of bladder or bowel control
- A fall with a head injury in someone on blood thinners, or inability to get up or bear weight after a fall
See a doctor within a day or two
- Walking that gets noticeably worse over days to a few weeks
- Unsteadiness with new double vision, slurred speech or severe headache
- Walking problems together with new confusion and loss of bladder control
Book a routine appointment
- Two or more falls in a year, or one fall with injury
- Gradually slower walking, shuffling, or feeling unsteady when turning
- Holding onto furniture to get around the house
- Avoiding going out because you are afraid of falling
What counts as a gait disorder
Walking slows a little with age, but healthy older adults still walk with a steady rhythm and good balance. A gait disorder is diagnosed when walking is slower than expected, unsteady, asymmetrical or effortful enough to limit activity or cause falls.
Gait speed is one of the most useful single measures. A walking speed below about 1.0 m per second (about 2.2 mph) predicts falls, hospital admission and loss of independence. Below about 0.6 m per second, most people need help with daily tasks.
This page covers the medical assessment and management of a gait disorder. For the specific walking patterns (shuffling, waddling, high-stepping and others) and what each one suggests, see gait abnormality.
Common causes
In older adults, more than one cause is present in most cases. Doctors group them by the level of the problem.
| Level | Examples | Typical clues |
|---|---|---|
| Joints and muscles | Hip or knee osteoarthritis, foot problems, sarcopenia (age-related muscle loss) | Pain, limp, stiffness, trouble rising from a chair |
| Nerves | Peripheral neuropathy from diabetes, B12 deficiency or alcohol | Numb feet, worse in the dark or on uneven ground |
| Spinal cord and roots | Cervical myelopathy, lumbar spinal stenosis | Stiff legs, clumsy hands, or leg pain on walking eased by sitting |
| Brain | Parkinson's disease, stroke, small vessel disease, normal pressure hydrocephalus, cerebellar ataxia | Shuffling, freezing, one-sided weakness, broad-based or "magnetic" steps |
| Senses | Poor vision, inner ear (vestibular) disorders | Worse in dim light, with head movement or dizziness |
| Medicines | Sedatives, sleeping pills, antidepressants, antipsychotics, blood pressure drugs, opioids | Started or increased before the problem began |
| Psychological | Fear of falling, depression, functional gait disorder | Cautious, wide, slow steps; reaching for support |
In younger adults and children, causes include injuries, cerebral palsy, muscular dystrophy, multiple sclerosis and inherited neuropathies.
How doctors assess a gait disorder
Questions
- When did walking change, and was it sudden or gradual?
- Have you fallen? What happened just before, and could you get up?
- Is there pain, numbness, dizziness or weakness?
- Bladder problems or memory changes? (Together with gait problems, these suggest normal pressure hydrocephalus.)
- Alcohol use, and a full list of prescription and over-the-counter medicines
Examination
- Watching you walk normally, turn, walk heel-to-toe and walk while talking or counting backward (dual-task walking reveals hidden instability)
- Timed Up and Go (TUG) test: rise from a chair, walk 3 m (10 ft), turn, return and sit. Taking 12 seconds or longer suggests higher fall risk.
- 30-second chair stand test for leg strength
- Romberg test (standing with feet together, eyes closed) for position sense
- Checking muscle strength, tone, reflexes, sensation in the feet, joints, feet and footwear, vision and blood pressure lying and standing
Tests
Tests depend on the findings: blood tests for B12, thyroid and blood sugar; nerve conduction studies; MRI of the brain or spine; and sometimes formal gait analysis in a specialist lab.
Treatment
Treat the causes
- Joint replacement or injections for painful arthritis
- Vitamin B12 replacement or better diabetes control for neuropathy
- Parkinson's medicines, which mainly improve stride length and speed
- Decompression surgery for severe spinal stenosis or myelopathy
- A shunt for normal pressure hydrocephalus, which can dramatically improve walking in selected people
- Cataract surgery and updated glasses
Review medicines
Cutting down or stopping drugs that cause drowsiness, dizziness or low blood pressure on standing is one of the most effective single steps. Do not stop a medicine without talking to your doctor.
Exercise and physical therapy
Balance and strength training is the best-proven intervention. Programs that challenge balance, done at least 3 times a week for several months, reduce falls by about a quarter. Tai chi is an effective option. A physical therapist will tailor exercises and teach how to get up safely after a fall.
Walking aids and footwear
| Aid | Best for |
|---|---|
| Single-point cane | Mild imbalance or one painful hip or knee (held in the opposite hand) |
| Quad cane | More support on one side |
| Wheeled walker | Moderate imbalance, Parkinson's disease, general weakness |
| Ankle-foot orthosis | Foot drop |
Shoes should be low-heeled, with thin, firm soles and secure fastening. Have aids fitted by a therapist, because the wrong height can worsen posture.
Make the home safer
Remove loose rugs, add grab bars and rails, improve lighting (including night lights), and keep frequently used items within easy reach. An occupational therapist can do a home safety visit. See falls in older adults for more prevention steps.
Outlook
Outcomes depend on the cause. Gait problems from pain, medicines, B12 deficiency or hydrocephalus can improve substantially. Progressive conditions such as Parkinson's disease cannot be cured, but therapy and walking aids help people stay active and independent longer. Even in frail older adults, strength and balance training improves walking speed.
Frequently asked questions
What is the most common cause of gait disorders in the elderly?
There is rarely a single cause. Arthritis of the hips and knees, nerve damage in the feet, and brain changes such as small vessel disease and Parkinson's disease are among the most common contributors. Medicines that cause drowsiness or dizziness often add to the problem and are easy to fix.
How is a gait disorder diagnosed?
A doctor watches you walk and turn, times simple tests such as the Timed Up and Go, checks strength, sensation, joints, vision and blood pressure, and reviews your medicines. Blood tests, nerve studies or MRI scans of the brain or spine are added when the exam points to a specific cause.
Can a gait disorder be treated?
Yes, often. Treating pain, replacing vitamin B12, adjusting medicines, using the right walking aid and doing regular strength and balance training all help. Some causes, such as normal pressure hydrocephalus or spinal stenosis, respond to surgery. Physical therapy benefits almost everyone.
What exercises help improve gait and balance?
Programs that include balance practice (standing on one leg, heel-to-toe walking, stepping in different directions), leg strengthening (sit-to-stands, step-ups) and walking are the most effective. Tai chi is also well supported. Do them at least 3 times a week, ideally under guidance from a physical therapist at first.
Is a gait disorder a sign of dementia?
It can be an early clue. Slow walking and difficulty walking while talking are linked to a higher risk of cognitive decline. Walking problems with memory loss and bladder urgency suggest normal pressure hydrocephalus, which is treatable. Many gait disorders, however, have nothing to do with dementia.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Family Physicians: Gait and Balance Disorders in Older Adults
- CDC STEADI: Stopping Elderly Accidents, Deaths and Injuries
- American Geriatrics Society and British Geriatrics Society: Clinical Practice Guideline for Prevention of Falls in Older Persons
- World Falls Guidelines: World guidelines for falls prevention and management for older adults
- National Institute on Aging: Falls and Fractures in Older Adults