Gait is evaluated by having the patient walk across the room under observation. Gross gait abnormalities should be noted. Next ask the patient to walk heel to toe across the room, then on their toes only, and finally on their heels only. Normally, these maneuvers possible without too much difficulty.
Be certain to note the amount of arm swinging because a slight decrease in arm swinging is a highly sensitive indicator of upper extremity weakness.
Also, hopping in place on each foot should be performed.
Walking on heels is the most sensitive way to test for foot dorsiflexion weakness, while walking on toes is the best way to test early foot plantar flexion weakness.
Abnormalities in heel to toe walking (tandem gait) may be due to ethanol intoxication, weakness, poor position sense, vertigo and leg tremors. These causes must be excluded before the unbalance can be attributed to a cerebellar lesion. Most elderly patients have difficulty with tandem gait purportedly due to general neuronal loss impairing a combination of position sense, strength and coordination. Heel to toe walking is highly useful in testing for ethanol inebriation and is often used by police officers in examining potential "drunk drivers"."
Walking on your tiptoes or on your heels is a test of balance and coordination, which we don’t always have. The neurologist will test things like that to establish baselines. If you don’t walk as well the next time, perhaps that’s a sign of progression that calls for a modification of treatment.
Another test is a heel-to-toe walk, which I usually fail miserably. Thankfully I never have to do that for a field sobriety test. Otherwise, if MS means I can’t do that particularl walk, than I can live with MS.
I suspect you could go to physical therapy to regain the ability to walk on your tiptoes, but that might not be worth the time and money. Just take care of yourself and the balance and coordination might not get any worse!
Its definitely worth the time to watch and read about all these seemingly silly little neuro tests we're made to do, they do actually indicate where the damage is located, clinical findings of lesions etc.
I am havibg a difficult time walking in my heels. I can walk on my toes just fine, however, walking on my heels is next to impossible. I've tried walking a distance going from heel to toe and toe to heel without any difficulty. Everything I've found online says ms. Could it be anything else?
mtLouie: Um sorry if i'm missunderstanding, but if your thinking you might have MS because you can't walk on your heels, then relax, there is a heck of a lot more to MS than heel and toe walking, seriously even perfectly normal disorder/disease free people can have issues with these type of balance tests. lol I walk like a string puppet but i can still walk a straight line of heel to toe walking better than DS or DH, they both wobble or need to put there foot out to balance.
Sometimes it really doesn't mean anything is abnormal, lol i was a gymnast and have been very sports orientated through out my entire life. DS and DH dont have an athletic bone in their body, even at my worst, i'd still expect I could out balance them, now falling over whilst standing still is another story entirely. If walking on your heels is something you've never been able to do, then it could simply be developementally normal.
vamanos: :o) your welcome! oh i suggest you practise walking heel to toe, brain plasticity, the more you do something the easier it is and the more likely your laying down new muscle memory and generating alternate neuro pathways. Things may never be what they were but i strongly believe in brain plasticity, i've seen it too many times to ever give up!
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