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What Causes Difficulty In Walking?
Question: Hallo,
Woman of 84, no diagnosed degenerative diseases e.g. diabetes. 100% healthy, brain function superb.
She cannot walk without assistance as she cannot 'feel' her lower legs and feet. (She shuffles very slowly with a walking ring) This has been a progressive condition for the last 15 years. Local Doctors are unable to diagnose.
What is the possible cause and is there any suggestions to curb this degeneration? OR to improve it?
Thank you. XXXX
Woman of 84, no diagnosed degenerative diseases e.g. diabetes. 100% healthy, brain function superb.
She cannot walk without assistance as she cannot 'feel' her lower legs and feet. (She shuffles very slowly with a walking ring) This has been a progressive condition for the last 15 years. Local Doctors are unable to diagnose.
What is the possible cause and is there any suggestions to curb this degeneration? OR to improve it?
Thank you. XXXX
Brief Answer:
Neuropathy tops the list of probable diagnosis
Detailed Answer:
Good day,
Noted the symptoms. Got the lovely photo too.
She look really good for that age.
Shuffling of gait, inability to walk with out support and reduced sensations in feet can be due to many reasons. Neuropathy ( degeneration of nerves) tops the list. This could be due to vitamin B12 deficiency, Diabetes, alcohol, many drugs and toxins, vertebral diseases, brain disorders etc. Other causes include dementia, Parkinson's disease and brain degenerative disorders
I have noted that she doesn't have diabetes and her brain function is superb. We must look for other treatable causes. It is worth doing a thyroid function test, Vitamin B12 , Folate levels, VDRL test and an MRI of brain.
The treatment is based on the cause.
If it is a degenerative disorder, the treatment is largely supportive. General principles include physiotherapy, good supportive care and nutrition.
Fixing railings in steps and bathrooms to avoid falls, avoid rugs and carpets with loose ends to prevent slips and falls etc are important ( I am sure that occupational health would have done all these things).
It is good to have good lighting in doorways and bathrooms to avoid falls. Probably a little bit of weight reduction also might help.
Does she have any trouble with water works ( any urine incontinence?)
How is her speech? Could you describe little bit about her vertebral neurological problems?
I would appreciate a reply
Regards
Binu
Neuropathy tops the list of probable diagnosis
Detailed Answer:
Good day,
Noted the symptoms. Got the lovely photo too.
She look really good for that age.
Shuffling of gait, inability to walk with out support and reduced sensations in feet can be due to many reasons. Neuropathy ( degeneration of nerves) tops the list. This could be due to vitamin B12 deficiency, Diabetes, alcohol, many drugs and toxins, vertebral diseases, brain disorders etc. Other causes include dementia, Parkinson's disease and brain degenerative disorders
I have noted that she doesn't have diabetes and her brain function is superb. We must look for other treatable causes. It is worth doing a thyroid function test, Vitamin B12 , Folate levels, VDRL test and an MRI of brain.
The treatment is based on the cause.
If it is a degenerative disorder, the treatment is largely supportive. General principles include physiotherapy, good supportive care and nutrition.
Fixing railings in steps and bathrooms to avoid falls, avoid rugs and carpets with loose ends to prevent slips and falls etc are important ( I am sure that occupational health would have done all these things).
It is good to have good lighting in doorways and bathrooms to avoid falls. Probably a little bit of weight reduction also might help.
Does she have any trouble with water works ( any urine incontinence?)
How is her speech? Could you describe little bit about her vertebral neurological problems?
I would appreciate a reply
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer (photo taken in the Kgalagadi Transfontier Park in South XXXXXXX last week - beautiful place!) - herewith more detail.
Nutrition superb - uses Lifegain nutritional shake 4 times a week - see www.nativa.co.za - still cooks for herself and husband of 93 years and has a very good grasp of nutrition as a whole.
She has never used drugs or a lot of medicine and is a teetotaler.
NO speech impediment - sounds over the phone like in her 40-50's.
Brain functions optimally i.t.o. intellect and intellectual functions - as has always been the case.
Bladder does not work during the day - only when she goes to bed at night and has laid down, after a few hours - she tends to have a lot of fluid retention, mainly in her legs and feet, for which she uses a duireticum once a week or once every 10 days. (Preferably 40mg Furosamide but sometimes Moduretic - an amiloride and hydrochlortriazide combination)
She had a lot of problems with bladder infections earlier in her life - but that has subsided the last 10 years.
Her version of her legs is: 'My feet is stupid - they do not get the messages from my brain to move' - I help her a lot with shopping, getting in and out of the car, etc. and get the distinct idea that she uses her legs from the knee downwards as 'stumps' or like you would use prosthetics.
She cannot in any circumstances climb a stair, even if it is only 3 inches high - we put a chair in front of her, and then she uses both hands on the chair to pull her feet up the step, one by one.
Her hips are flexible and she can pull her leg up as a whole from a lying position.
Her weight is stable and has been as it is now for literally decades.
The situation with her mobility is definitely getting worse as time goes by.
I will request the tests as you suggested.
Nutrition superb - uses Lifegain nutritional shake 4 times a week - see www.nativa.co.za - still cooks for herself and husband of 93 years and has a very good grasp of nutrition as a whole.
She has never used drugs or a lot of medicine and is a teetotaler.
NO speech impediment - sounds over the phone like in her 40-50's.
Brain functions optimally i.t.o. intellect and intellectual functions - as has always been the case.
Bladder does not work during the day - only when she goes to bed at night and has laid down, after a few hours - she tends to have a lot of fluid retention, mainly in her legs and feet, for which she uses a duireticum once a week or once every 10 days. (Preferably 40mg Furosamide but sometimes Moduretic - an amiloride and hydrochlortriazide combination)
She had a lot of problems with bladder infections earlier in her life - but that has subsided the last 10 years.
Her version of her legs is: 'My feet is stupid - they do not get the messages from my brain to move' - I help her a lot with shopping, getting in and out of the car, etc. and get the distinct idea that she uses her legs from the knee downwards as 'stumps' or like you would use prosthetics.
She cannot in any circumstances climb a stair, even if it is only 3 inches high - we put a chair in front of her, and then she uses both hands on the chair to pull her feet up the step, one by one.
Her hips are flexible and she can pull her leg up as a whole from a lying position.
Her weight is stable and has been as it is now for literally decades.
The situation with her mobility is definitely getting worse as time goes by.
I will request the tests as you suggested.
Brief Answer:
ANy Neurology consultation yet?
Detailed Answer:
Thank you very much for the reply. Noted the points.
I shall wait for the reports.
Hope some treatable cause will be found in the tests. In that case, we could restore her leg functions and mobility at least partially.
I was wondering if she was seen by a neurologist ( or a geriatrician with interest in neurology) any time? If not, that would be a fantastic idea. In fact, I would recommend it even before any tests. Because, a through physical examination will often give enough clues and will guide the doctor towards the right direction.
Besides, it is very important to talk to a physiotherapist and occupational health team, so that supportive care can be placed at home to avoid falls etc.
I wish her good health
Regards
Binu
ANy Neurology consultation yet?
Detailed Answer:
Thank you very much for the reply. Noted the points.
I shall wait for the reports.
Hope some treatable cause will be found in the tests. In that case, we could restore her leg functions and mobility at least partially.
I was wondering if she was seen by a neurologist ( or a geriatrician with interest in neurology) any time? If not, that would be a fantastic idea. In fact, I would recommend it even before any tests. Because, a through physical examination will often give enough clues and will guide the doctor towards the right direction.
Besides, it is very important to talk to a physiotherapist and occupational health team, so that supportive care can be placed at home to avoid falls etc.
I wish her good health
Regards
Binu
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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