Some people have gait problems without any changes in their balance. But if a person has trouble with balance, it usually affects their gait and may make it unsteady.
Gait refers to the pattern of limb movements when a person walks. Balance is the ability of the body to maintain its center of gravity while staying upright.
Both gait and balance rely on a complex interplay between the brain, nervous system, sensory organs, and musculoskeletal system. A problem in any of these areas can cause difficulties with gait and balance and may increase the risk of falling.
This article describes the symptoms of gait and balance problems in adults and children and provides information about diagnosing and treating the underlying causes. It also offers strategies and techniques for increasing mobility and preventing falls.
A healthy gait and typical balance require a complex interplay between:
- the neurological system, which includes the brain and nervous system
- the musculoskeletal system, which includes the muscles, bones, and connective tissues
- multiple sensory inputs
These sensory inputs include the person’s perception of where their body parts are in space. This is called “proprioception.” Vision and the vestibular system, which is mainly located in the inner ear, are also involved.
A person with a gait problem, a balance problem, or both might experience:
- unsteadiness or swaying while walking or standing
- difficulty rising from a seated position
- difficulty walking
- a slowed walking pace
Depending on the underlying cause, a person may also experience:
Gait and balance problems can have multiple causes. Some examples include:
- musculoskeletal injuries, such as:
- problems with the feet, such as corns and calluses
- degenerative bone diseases, such as arthritis
- vision problems
- problems with the inner ear
- neurological disorders, such as:
- cerebellar disorders, which affect the area of the brain that controls balance and coordination
- irregular development in the bones or muscles of the feet or legs
Gait and balance problems are not common among children. A child who does experience these issues may appear clumsy, and their movements may seem uncoordinated.
Most gait and balance problems in children result from developmental issues that typically resolve with age. Examples include:
- Flat feet: This involves fallen arches, causing the entire sole of each foot to press flat against the ground.
- Tibial torsion: This involves the shinbones twisting, causing the legs and feet to turn inward or outward.
- Metatarsus adductus: This causes the front half of the foot to curve toward the body.
- Bowing of the legs: This causes the legs to curve outward at the knees when the feet are touching.
Another common cause of gait issues in children is injury to the bones or soft tissues of the legs and feet.
Other causes may include:
- inner ear problems
- damage to the brain, spinal cord, or motor nerves
- sensory ataxia, which is a loss of coordination due to nerve damage and an associated lack of proprioception
- neurological or muscular diseases
To diagnose the cause of gait or balance problems, a doctor will likely:
- Ask about the symptoms.
- Take a full personal and family medical history.
- Perform a physical examination, which may include asking the person to stand or walk.
- Perform a neurological examination to check nerve function.
The doctor may also request:
- MRI or CT scans, to check the brain, spinal cord, and soft tissues, such as muscles, ligaments, and tendons
- X-rays, to determine whether a health issue is affecting the bones
- an electromyogram, to evaluate muscle and nerve problems
- blood tests, to check for infection, inflammation, or disease
- tests of the inner ear
- hearing tests
- vision tests
The treatment for gait and balance problems depends on the underlying cause. Physical therapy is
Physical therapists test to determine the source of balance and gait problems before developing a personalized treatment plan. These tests may be different for adults and children.
Physical therapy, also called rehabilitation therapy, might involve:
- balance exercises
- strength training
- movement and gait training
- work that targets the soft tissues
- assistive devices
- changes to the home and workplace to improve convenience and safety
- techniques for preventing falls
Another treatment approach involves medication, which can help manage underlying diseases, such as Parkinson’s disease and MS.
In addition, if the cause of gait or balance problems is neurological or musculoskeletal, doctors may recommend surgery.
A physical therapist may recommend gait training or rehabilitation — sets of exercises that can help improve standing, walking, and movement in general.
They may also recommend vestibular exercises. These involve inducing loss of balance for short periods so that a person can learn what to expect and how to cope. These exercises might include distorting or taking away visual input and practicing specific head or eye movements.
In addition, the following strategies can help prevent falling:
- being vigilant about environments and avoiding dangers, such as uneven or wet floors
- wearing safe, high-grip, low-heeled shoes
- enhancing the safety of home and work spaces by:
- keeping walkways clear
- tacking down or removing loose carpets
- applying no-slip strips to slippery surfaces
- keeping electrical cords tied up or tucked away
The Centers for Disease Control and Prevention (CDC) have developed an
Gait refers to a person’s pattern of limb movement while walking, and balance refers to a person’s ability to maintain their center of gravity while staying upright.
Gait and balance issues can cause unsteadiness and difficulty standing and walking. Depending on the cause, a person may also experience vertigo, dizziness, and motion sickness, for example.
In children, gait and balance problems typically stem from developmental issues that can result in flat feet and bowing of the legs.
The treatment depends on the underlying cause. Some options include medications or surgery to manage underlying conditions and physical therapy to reduce the risk of falls, improve mobility, and enhance the quality of life.