There are a lot of reasons someone may not be walking normally. Some common examples are neurological disorders (like stroke and cerebral palsy), muscular disorders (like muscular dystrophy and myositis ossificans), disorders of bone, (such as club foot, vertical talus and tarsal coalitions), and diseases of joints, (such as arthritis and chronic infection).
As the topic is too broad to be discussed in a forum with limited space such as this, so we'll review some of the more common mechanical causes.
Leg length discrepancy
A very common, yet very commonly-overlooked, disorder is that of leg length discrepancy. Simply put, this is a condition where one leg is either structurally or functionally longer than the other.
This condition can occur at several possible levels. A short tibia (leg bone) or femur (thigh bone) are good examples of structural leg length difference. An arthritic or abnormally-functioning hip, knee, ankle or foot are good examples of a functional leg length discrepancy.
Leg length discrepancies may be caused by a birth defect, prematurely closed growth plate, infection or illness, trauma and other causes. Each possibility has to be assessed before treatment can begin.
This condition can be best assessed upon physical examination and special type of X-rays designed specifically to measure this condition. These films are best done with the patient standing.
Limb length discrepancies may be treated in a variety of ways. A simple heel lift or special accommodations to the shoe are adequate for many simple structurally-caused leg length discrepancies, but functional orthoses may be required, especially in functional discrepancies, or in discrepancies caused by a combination of factors.
Excessively Pronated Foot Type
The excessively pronated foot, or a foot that flattens more than it should, is a very common problem, and a big topic with multiple possible causes (forefoot varus, calcaneal valgus, generalized ligamentous laxity, etc.).
The pronated foot is associated with a host of other conditions, such as arch and heel pain, bunions, hallux limitus, tailor's bunions, neuromas, hammertoes and arthritis. Each of these conditions has its own webpage that can be visited by clicking directly on the condition.
Excessively Supinated Foot Type
The opposite of the excessively pronated foot mentioned above, is an excessively supinated foot. This is a condition where the foot is excessively rigid, and adapts poorly to the ground in gait. Generally (but not always), an excessively supinated foot is associated with an abnormally high arch (a condition known as pes cavus).
The excessively supinate foot is a rarer condition that the excessively pronated foot, but the effects can be more severe. As the foot is an excessively rigid, poor adaptor to the ground, the foot is more likely to develop fractures of bone, twisted ankles and other acute injuries. In contrast the excessively pronated foot tends to develop more chronic aching types of injuries.
An excessively supinated foot type can be caused by several factors, including tarsal coalitions (where certain joints never formed correctly and the corresponding bones forming the joint are abnormally attached to each other), neurological disorders (like the often-overlooked Charcot-Marie-Tooth disease), arthritis and infection and genetic factors.
Treatment depends upon the cause of the problem. Surgery is indicated for some conditions (like tarsal coalitions, some arthritic and infectious causes), and accommodative or functional orthoses can be used for other causes. A good podiatric examination is necessary to differentiate between these possibilities.
Arthritis, or joint disease, of the joints in the foot, knee, hip or back is another very common cause of gait abnormalities. This is another topic common enough and large enough to warrant its own webpage on arthritis.
Other structural problems can also cause an individual to walk abnormally. Some of the possible causes are:
Simply put, the above names describe structural problems of the hip, knee or leg respectively where the bones are misaligned relative to each other.
When mild to moderate, these conditions are usually treated with specialized shoes, braces, orthoses or other appliances. When severe, surgery may be indicated.
The In-toed Patient
The in-toed individual, commonly described as being "pigeon toed", is an individual with the condition where the patient walks with their toes pointed in.
This condition can be cause at the level of the foot, the hip, or somewhere within the leg.
This is usually first seen as a child, and often the patient is treated at that time. Treatment for the intoed child is covered in more detail on the Pediatric Foot Problems webpage.
But the condition can persist into adulthood. The adult is too old for leg braces, serial casting and some of the other techniques used for children. So treatment of the adult usually consists of trying to allow the individual to function well with the deformity, with orthoses, special shoes or other appliances, or by surgical means, with the procedure chosen on the basis of where the deformity is located.
The Out-toed Patient
The out-toed individual, commonly described as walking like a duck, is the condition where the patient walks with their toes pointed outwards. Like the in-toed condition, this can be caused by problems at the foot, the hip, the leg, or from arthritis and obesity.
Treatment for the out-toed child is covered in more detail on the Pediatric Foot Problems webpage.
But the condition can persist into adulthood. The out-toeing adult generally has fewer functional problems than the intoed individual. But the condition can cause arch and heel pain, bunions, hallux limitus, tailor's bunions, neuromas, hammertoes and arthritis.
Treatment of out-toeing adult usually consists of trying to allow the individual to function well with the deformity by addressing the patient's symptoms. This can be done with orthoses, special shoes or other appliances, or by surgical means, with the procedure chosen on the basis of where the primary complaint is located.