Thinking with Your Feet – How Changes in Your Brain are Reflected in Your Walking Pattern!

The extreme heat plaguing Ohio lately has everyone feeling as though walking outside is more difficult than usual and that slow is the only acceptable pace. Changes in the way you walk develop not only based on external conditions, but can also reflect internal changes in your body. Recent studies presented at the Alzheimer’s Association International Conference this month have suggested that gait changes in the elderly parallel losses in cognitive function. These studies contribute to the long list of medical conditions affecting all parts of the body in which the feet can serve as a window to disease.

The way an individual walks is a function of many different factors. Foot and leg muscles, nerves, bones, arteries and veins are all imperative to foot health and maintaining the normal sequence of walking. In diabetes, both the nerves and vasculature in the foot supply become diseased. When the nerves in the lower extremity are damaged it is called a peripheral neuropathy, because these nerves are not included as part of the central nervous system, which is primarily the brain and spinal cord. Peripheral neuropathies can cause major changes in gait. When the nerves controlling the muscles that lift your foot off the ground stop working a “steppage” gait develops. This style of walking is characterized by lifting the leg high up during the swing of each step to avoid the toes dragging on the ground. When the heel lands back on the ground a loud “foot slap” also occurs. The muscles and nerves that lift your toes up to clear the ground are also responsible for a slow and smooth landing, which when lost, results in the toes “slapping” to the ground. The one advantage of this slap noise is that in those with a peripheral neuropathy who cannot feel their feet land, they can at least hear the landing. This type of gait occurs not only in individuals with diabetes, but also in individuals with sciatica, stroke, multiple sclerosis and spinal stenosis.

When certain parts of the central nervous system are damaged, gait will become slower and less organized. Normal muscle control of the lower extremity is disturbed, resulting in an unsteady, unbalanced walk in which the feet are wide apart. Feet set widely apart provide a large base of gait to help maintain balance. These gait changes are those that have been found to parallel losses in mental function in Alzheimer’s and other forms of dementia that typically affect the elderly. While these changes may indicate disease processes in the brain, it is important to differentiate a gait of disease from that of normal aging. It is normal to see some decrease in speed and symmetry of stride with increased age.

Changes in gait at any age can be a sign of problems that should be evaluated by your podiatrist. By addressing these changes, not only may the underlying disease process be appropriately treated, but falls resulting from an unsteady gait may be prevented by utilizing custom orthotics, bracing or custom shoes.

Please visit for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Worthington.

By Dr. Animesh (Andy) Bhatia