Gait Disturbance

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Gait disturbances may occur for a variety of reasons. Gait may be changed by local pain in the foot, pain in a joint, claudication of the hip or leg, bone disease, vestibular problems, and extrapyramidal disorders. Interruption of the corticospinal tracts in the cerebrum after a stroke produces a spastic weakness in the contralateral leg. The foot is dragged, and the whole leg appears stiff and extended. Lesions in the spinal cord may produce a spastic paralysis affecting both legs. The gait is slow and stiff, with small steps. Patients with Parkinson's disease walk stooped over, with short, quick, shuffling steps. Any patient with a gait disturbance should be asked the following:

' 'Do you have pain in your leg or hip when you walk?'' Do you have diabetes?''

''Have you ever had syphilis?''

''What do you eat? Tell me everything you ate yesterday.''

Patients with vascular occlusive disease of the hip or leg may experience pain while walking and may alter their gait. Diabetes, syphilis, and pernicious anemia may produce a sensory loss, and each condition can result in gait abnormalities.

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