gait

https://www.telegraphindia.com/1170821/jsp/knowhow/story_168290.jsp

Talk the walk

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Your Health - Dr. Gita Mathai

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As infants grow, their motor skills develop in a certain set, sequential pattern. They first turn over, then sit, crawl, stand and walk. Some give the crawling stage a miss. Others, very efficient at crawling, may learn to walk later. Most children are mobile by 14-16 months of age.

The first steps of a baby are wide-based, wobbly, short and rapid with the arms outstretched for balance. Like every activity, walking improves with practice. Though falls are frequent, they need not be feared unless they are from a height or down steps.

The adult gait is different. The heel of one leg first touches the ground then the whole foot is placed flat. The heel then rises, the weight is transferred onto the toes. The body swings off the toes with arms swinging in a reciprocal manner. Children start to develop this gait around 18 months and perfect it by the age of eight.

Some children may have a "toe-in" gait, with the toes pointing inwards as they walk. Others may walk with a "toe out" gait. This may run in the family or be due to a cramped position in the uterus. This seldom interferes with running or sports activities. Some children walk on their toes.

As children get older, their posture, muscle power, and control spontaneously improve. The abnormal gait begins to correct itself. In toeing usually improves by the age of three, flat feet by six years, bow legs by 18 months and knock knees by seven years. There is cause for concern if the abnormality is not symmetrical and appears to affect one foot more, if it is accompanied by limping or pain, or if there are mental developmental delays.

Some gaits are definitely abnormal and need to be evaluated. Children may refuse to bear weight on one leg. They may complain of pain or there may be obvious shortening. The legs may swing forwards, remain stiff and spastic, and refuse to bend. The gait may remain wide-based and unstable. Faulty motor coordination due to neurological causes may produce an inordinately clumsy child who has frequent falls.

About 35 per cent of senior citizens have difficulty in walking half a kilometre or climbing one flight of stairs. The gait changes gradually in 60 per cent people; this is obvious in those 80 years or older. There is a reduction in speed of motion, the width and the length of the stride. A greater length of time tends to be spent with both feet on the ground. There is a tendency to remain bent with eyes fixed on the ground. This makes the gait appear cautious and shuffling. Weak hip muscles may make the gait "waddling."

This deterioration is not necessarily a natural consequence of aging, even though physically inactive people lose five per cent of muscle mass every decade. The change in gait may be due to weakness, but medication, diabetes, liver disease, the pain of arthritis, peripheral neuritis can also play a part. An unstable gait can lead to falls, injuries and fractures.

Any medical conditions causing gait problems should be targeted and treated. Physical therapy is helpful. During exercise, concentrate on the correct gait sequence: heel strike, flat foot, toe off. You should practise walking in a straight line, toe to heel walking, balance exercises, yoga, and pelvic and leg muscle strengthening. These interventions are effective if they are performed regularly four to five times a week.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in