Having arthritis in your hips, knees, ankles, or feet can making walking harder — a side effect that can have consequences for your daily well-being and quality of life. “I found myself limping to avoid pain,” arthritis patient Lisa H. told us on Facebook. “It got to the point where my daughter would imitate my walk, which made me realize I needed some help.”
Managing the underlying disease, physical therapy to help correct your movements, and possibly using assistive devices or shoes can help you minimize changes to your gait and retain your independence and mobility.
What Is a ‘Gait’ and How Does Arthritis Affect It?
Arthritis in the lower part of your body, whether osteoarthritis or inflammatory arthritis, can change your gait, or how you walk.
To understand how arthritis affects gait, first let’s look at the body mechanics involved in walking. “There are two phases of gait: the stance phase, where your foot is on the ground; and the swing phase, where the foot is off the ground,” says Kathleen Hogan, MD, an orthopedic surgeon at New Hampshire Orthopaedic Center in Nashua, New Hampshire who specializes in hip and knee arthritis. “Arthritis in your hips and knees affect your gait because of three factors: pain, stiffness, and weakness.”
The same goes for arthritis in the feet. “If you have arthritis in one of the foot joints, your gait will change or compensate to allow you to try and move more freely,” says Alan Bass, DPM, a board-certified podiatrist practicing in Manalapan, New Jersey, and a spokesman for the American Podiatric Medical Association (APMA).
Although there are many types of abnormal gaits, Dr. Hogan highlights a couple that are common among people with arthritis. “When it hurts to put weight on your hip or knee [or foot], you will often unconsciously spend less time during the gait cycle bearing weight on that extremity, shortening the stance phase, which is usually 60 percent of gait. This is called an antalgic gait,” she says, more commonly known as a limp.
In addition, “weakness in the muscles around the hip and knee often occur in patients with arthritis,” Dr. Hogan says. “For example, it is quite common that patients will have poor balance and are unable to stand only on one leg. Since single limb support occurs during gait, this poor balance will then affect your gait, often resulting in a waddling pattern called a Trendelenberg gait.” With this muscle weakness, the pelvis drops on one side when lifting the opposite leg.
The loss of flexibility, or stiffness, of arthritic joints can also change the normal way you move, Dr. Hogan says. Arthritis patients have a tendency to walk slower because of all these additional challenges.
How Different Types of Arthritis Affect Your Gait
Osteoarthritis (OA), which results from wear and tear on a joint, is much more common in the knee, while rheumatoid arthritis and gout tend to affect the many small joints of the foot and ankle. “While osteoarthritis and rheumatoid arthritis have different origins [causes], they can affect the foot joints similarly and cause the patient to change or alter their gait to try and walk and function with less pain,” Dr. Bass says.
In addition, OA often occurs on only one side of the body, while RA is often symmetrical. But symmetry isn’t necessarily a good thing because it means more joints are involved. “Most patients with osteoarthritis have arthritis that is isolated to one or two major joints; with rheumatoid arthritis, swelling and inflammation can occur in many joints simultaneously,” Dr. Hogan says. “The multiple joint involvement, especially the involvement of the ankle joints, may increase gait abnormalities in patients with these systemic forms of arthritis. The more joints that are stiff and painful, the more difficult it is for your body to compensate and maintain a normal-appearing gait.”
“I have to walk based on what joint hurts the least and that changes your gait on a continuous basis, which is not healthy, of course,” Ranay C. told us on Facebook.
The effects on gait by other forms of inflammatory arthritis, such as gout, which occurs when there’s of a buildup of uric acid in the foot or ankle, are likely similar, although unfortunately they haven’t been studied as well.
“Gout most commonly affects the big toe joint, which can also affect the way a patient walks,” Dr. Bass says. The extreme pain of gout often prevents patients from walking at all; and during a gout flare rest and elevation of the foot, along with these other gout home remedies, is often advised.
The Effects of Gait Changes on Your Body and Disease
The negative effects of gait changes are often obvious: You find it more challenging, uncomfortable, and awkward to walk. But gait changes may have additional long-term consequences.
Arthritis in Other Joints
“With changes in gait, other joints will begin to compensate and may begin to undergo arthritic changes,” Dr. Bass says. For example, with arthritis in the foot, “this sometimes leads to problems elsewhere such as in the ankle, knee, or hip.”
Other Muscle or Joint Injuries
In addition, other injuries to the body can occur. “Walking with a limp can place additional stresses on the muscles around the back, hip, and knee,” Dr. Hogan says. “Trochanteric bursitis, for example, which is an inflammation of the tissues around the side of the hip, is often triggered by poor balance and abnormal gait patterns.”
Changes to your posture itself are a bit of a chicken-or-egg scenario when it comes to gait. “Poor posture, which is frequently caused by stiffness and arthritis, is often a cause of gait abnormalities and not an effect of it,” Dr. Hogan says.
Higher Risk of Falls
One of the biggest problems with gait changes is the increase in your risk of falls. “The awkwardness in my gait is pronounced and I often lose my balance,” Laurie D. told us on Facebook. “In Arizona there are lots of rocks, bricks, and flagstone used in entry ways to businesses so I have to be careful about falling.”
Taking a spill can lead to more problems. “Limping and poor balance can contribute to falls and therefore to fractures,” Dr. Hogan says. Broken bones can mean more limited mobility and possibly post-traumatic arthritis later on. Having arthritis can also increase your risk of osteoporosis, or fragile bones, which makes fractures more likely if you experience a fall.
How to Prevent Arthritis Gait Changes
Unfortunately, “it is impossible to prevent arthritis, but you can control your reaction to it,” Dr. Hogan says. “Strengthening the muscles around the hip and knee and improving balance are key to prevent arthritis-related gait changes.”
With your doctor’s OK, she recommends an exercise program that focuses on core strength and balance, such as tai chi, yoga, barre, or Pilates.
Although exercise in general is a great treatment for all kinds of arthritis, “walking more will not make someone walk better; strengthening the muscles involved in the gait cycle is necessary to improve gait,” Dr. Hogan says.
Therefore, she also recommends physical therapy to improve flexibility and increase strength. Although some arthritis patients we heard from said PT made their symptoms worse, it’s still worth trying with your doctor’s approval.
A physical therapist can help identify the cause of the abnormality, and then “retrain” you how to walk. “Focusing on walking correctly is often helpful, especially once the underlying abnormalities have been corrected,” she says. “Unfortunately if you have been limping for a long time, this new gait pattern can become ‘normal.’” After hip replacement surgery, Lisa told us she had this issue. “I had to relearn how to walk with a PT, because even without the pain, I reverted to the limping,” she says. Dr. Hogan suggests looking at your reflection in shop windows to remind you how you look when you walk.
Sticking with your prescribed medication regimen and treating your underlying disease to keep joint damage in check can slow the progression of any gait changes. In addition, “decreasing pain and swelling in the joints may also improve gait, so anti-inflammatory medications and [steroid] injections can therefore be helpful in some cases,” she says.
Patients with foot arthritis may benefit from seeing a podiatrist, a foot specialist who can treat you medically as well as help you find proper-fitting shoes or fit you for custom ones. “Many times seeing a podiatrist early on can help prevent more serious joint damage,” Dr. Bass says.
“Depending on the activity and the patient, the right shoes may help with proper walking or running. A shoe that has a deep heel cup and stiff sole could help; shoes that are too flexible will not provide the proper support needed. A shoe should only ‘bend’ in the area associated with the ball of the foot, so a soft, cushiony sneaker is not always the best,” he says.
Although arthritis patient Debra R. prefers lightweight shoes, “the foot and ankle doctor recommended shoes with hard soles and better arches,” she told us on Facebook. Because of the intricacies involved in choosing the right pair, patients should be fitted by an expert in arthritic conditions.
Here’s more advice for picking the right shoes when you have arthritis.
If you’re already dealing with gait changes, correcting them might require the help of a cane or walker. “Their use prevents limping from becoming a habit, and if pain is the root cause of the limp, a walker or cane may decrease that pain,” Dr. Hogan says.
A cane should be used in the opposite hand as to the injury — no matter which is your dominant hand — to improve balance and stability. “This shifts the joint reactive forces toward the side holding the cane, effectively unloading the joint,” she says. Crutches that keep the pressure on your forearms can help avoid hand and wrist pain that some users told us can occur with traditional canes.
Although you might be hesitant to use one of these devices, they can help you maintain your independence and mobility.
Surgery as a Last Resort for Gait Changes
Dr. Hogan says when you stop participating in activities that you used to like because of your arthritis, it may be time to think about surgery.
“When arthritis pain keeps you from doing activities you enjoy, prevents you from doing household tasks, and limits you at work, it is time to consider surgery,” she says. This might not mean total joint replacement at first. “Whether it is cleaning up the joint, realigning the joint or even replacing the joint, podiatrists [and other surgeons] can provide many options,” he says.
You’ll want to exhaust other more conservative treatment measures first. “Although joint replacement is a very successful procedure, there is always a risk of complications,” Dr. Hogan says. “Patients should have tried non-operative treatments such as anti-inflammatory medications, acetaminophen, physical therapy, weight loss, and injections prior to deciding to go forward with surgery.”