Difficulty Walking: Causes and When to Worry

What doctors look for: walking patterns

How someone walks often points straight to the cause. Doctors watch the length and width of steps, arm swing, posture, how the feet land, turning and balance.

Common causes of difficulty walking

Pain

• Hip and knee osteoarthritis: pain and stiffness on walking, worse after rest. The most common cause in older adults.
• Foot problems: plantar fasciitis, bunions, Morton's neuroma, gout and stress fractures.
• Back problems: sciatica causes pain shooting down the leg.
• Injuries: sprains, fractures and muscle strains.

Spinal stenosis

Spinal stenosis is narrowing of the spinal canal in the lower back. It causes pain, heaviness, numbness or weakness in the buttocks and legs when standing or walking, eased by sitting or bending forward, for example leaning on a shopping cart.

Peripheral artery disease

Narrowed leg arteries cause cramping calf pain when walking that stops within minutes of rest. The distance you can walk before pain is often fairly consistent.

Nerve damage in the feet

Peripheral neuropathy, most often from diabetes, but also from alcohol, vitamin B12 deficiency and chemotherapy, causes numbness, tingling or burning in the feet. With less feeling in the feet, balance worsens, especially in the dark.

Brain and nerve conditions

• Stroke: sudden weakness of one side. Later, a stiff leg that swings out in a circle.
• Parkinson's disease: shuffling, slowness, freezing and tremor.
• Normal pressure hydrocephalus: a magnetic, shuffling gait with memory problems and urinary urgency or leakage. Treatable with a shunt.
• Multiple sclerosis: weakness, stiffness, numbness and balance problems that may come and go.
• Cerebellar disorders: a wide, unsteady gait from alcohol, medicines, stroke or degenerative conditions.

Balance and dizziness

Inner ear disorders, vertigo and low blood pressure on standing all make walking unsteady. See balance problems.

Weakness

Muscle loss with aging (sarcopenia), deconditioning after illness or bed rest, muscle diseases, and foot drop from nerve compression all impair walking.

Other factors in older adults

• medicines, especially sedatives, sleeping pills, antidepressants, blood pressure drugs and opioids
• poor vision
• fear of falling, which leads to a cautious, stiff gait
• dementia, which affects planning of movement

Sudden difficulty walking

Walking problems that start over minutes to days need prompt assessment. Causes include stroke or TIA, cauda equina syndrome, spinal cord compression, Guillain-Barre syndrome, hip fracture, joint infection, severe infection or dehydration (particularly in older adults), and medicine side effects.

How doctors find the cause

A doctor will ask when the problem started, whether it is pain, weakness, unsteadiness or stiffness, about falls, numbness, bladder changes, memory and medicines. They will watch you walk, turn and stand from a chair, and may time a short walk. A full neurological and joint examination follows.

Tests depend on the findings:

• X-rays of painful joints
• MRI of the brain or spine
• blood tests: blood count, glucose, vitamin B12, thyroid function, kidney function
• nerve conduction studies for neuropathy
• ankle-brachial index for artery disease
• vision and hearing checks, and a medicines review

Treatment and support

Treatment targets the cause: joint replacement or injections for arthritis, surgery or physical therapy for spinal stenosis, controlling diabetes and replacing B12 for neuropathy, Parkinson's medicines, or a shunt for normal pressure hydrocephalus.

For almost everyone, these help:

• Physical therapy: strength, balance and gait training. Programs such as tai chi reduce falls.
• Walking aids: a cane, walker or rollator, properly fitted.
• Ankle-foot orthosis: a brace that holds up the foot in foot drop.
• Footwear: low, wide heels, thin firm soles and good grip.
• Home safety: remove trip hazards, add grab rails and night lights.
• Medicine review: reduce drugs that cause drowsiness or dizziness.

Frequently asked questions

What causes sudden difficulty walking?

Sudden difficulty walking can be caused by stroke, a spinal cord or nerve root problem such as cauda equina syndrome, a fracture, a joint infection, Guillain-Barre syndrome, or, in older adults, an infection or medicine side effect. It needs urgent assessment, and emergency care if there is one-sided weakness or bladder loss.

Why do older adults have trouble walking?

The most common reasons are hip and knee arthritis, spinal stenosis, nerve damage in the feet, weakened muscles, medicines that cause dizziness, poor vision and Parkinson's disease. Several causes often combine. A gait assessment and physical therapy can improve walking and prevent falls.

Why do my legs feel heavy and hard to walk on?

Heavy legs when walking can come from spinal stenosis, peripheral artery disease, nerve problems, muscle weakness or deconditioning. Legs that feel heavy after a short walk and recover with rest or bending forward suggest stenosis or artery disease and should be checked.

What doctor should I see for difficulty walking?

Start with your primary care doctor, who can examine you and order initial tests. Depending on the cause, you may be referred to a neurologist, orthopedic surgeon, rheumatologist, vascular specialist or physical therapist.