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Limping

WHEN TO SEE YOUR DOCTOR

* You have a limp from an injury or a pain in your body that does not go away after five days.

* Any unexplained limp, especially in children, should be seen by a doctor.

* See your doctor immediately if the limp comes on suddenly and is accompanied by muscle weakness on one side of the body, numbness, fever or radiating pain.

What Your Symptom Is Telling You

A limp is okay if you're Gabby Hayes or Walter Brennan—they made careers out of hobbling and wobbling across the silver screen. Unfortunately, Hollywood doesn't have much of a demand for comical cowboys these days. Besides, most of us would probably prefer to carry ourselves with the grace of Fred Astaire or Ginger Rogers.

Maintaining a smooth, even gait is much more complex than putting one foot in front of the other. It requires a variety of systems and body parts exerting forces and moving in precise harmony. "Any kind of neural, muscular or skeletal abnormality can disrupt this harmony and produce an imbalance in the way we walk," says Howard Hillstrom, Ph.D., director of the Gait Study Center at the Pennsylvania College of Podiatric Medicine in Philadelphia.

A commonly seen abnormality is a difference in the lengths of one's legs. "A limp will frequently develop because one leg is measurably shorter than the other," says Howard Dananberg, D.P.M., podiatrist and director of The Walking Clinic in Bedford, New Hampshire. But in some people, there is only an apparent discrepancy in limb length. This can happen if you experience contraction or spasms of the muscles that run on one side of your body from your shoulder to your pelvis. "Although the legs are really the same length, one side is so tight, the leg functions as if it were shorter," says Dr. Dananberg.

Legs that are too big because of excess weight can also produce problems. Being overweight can produce collapsed arches, turned-in knees, poor posture and can worsen any underlying imbalance. Large thighs can also force you to adopt unusual walking patterns.

Now, suppose that all your body parts are the right size—only they're not quite in the right place. "Any part of your body that's out of alignment can produce an imbalance, just like a bad tire can do to your car," says Peter Francis, Ph.D., professor of physical education at San Diego State University. One such alignment problem is excessive pronation—inward rolling of the foot—usually from fallen arches. Another cause of imbalance might be a kneecap that "derails" from its normal track of movement.

Sometimes all your parts are where they should be, only they're not doing what they should do. An example of this is functional hallux limitus—a locking of the big toe. This locking can block your ability to extend your thigh, causing you to drag your leg and flex your waist awkwardly. Stiffness in the joints of the leg or a muscle weakness that affects the motion of one or more joints might also cause a leg to drag.

If any of the bones, muscles or nerves in a leg or foot are injured, you may limp to minimize the pain. You may even be in pain and not even be aware of it! Suppose you're a frequent jogger, a "weekend warrior" or a former high school football star. The wear and tear of overuse, aging joints or old injuries that did not heal properly may start producing a little pain. Before you even notice it, your body starts limping as a defense mechanism.

Sciatica, a pinching of the sciatic nerve, which runs from the spine through the leg, can also bring on some horrendous hobbling.

Some limps are created purely by habit. For instance, carrying books, a briefcase or a heavy pocketbook on the same side everyday can throw your body off kilter. If you do a great deal of standing on the job, you may tend to unconsciously shift your weight to one leg, even when walking.

The worst-case scenario is that a limp could be the first sign of a bacterial infection in the leg or foot. It can be the initial sign of multiple sclerosis. A limp can even indicate a neurological problem such as nerve damage, neuromuscular disease, a lesion on the spine or a brain tumor. Fortunately such problems are rare.

Symptom Relief

Correcting a limp can be tricky business. Most people don't have the patience or the awareness of their movements to re-train their gaits on their own, says Dr. Hillstrom. If you try to treat the effect and not the cause, the problem can get worse. And with so many possible causes, it really requires a physical therapist, podiatrist, orthopedist or walking specialist to find the right one. In the meantime any of the following tips can help put that spring back into your step.

Get a lift. You can easily correct leg length discrepancies, toe lock, fallen arches, pronation and other problems with the use of a prescription, custom-fitted heel lift or arch support, says Dr. Dananberg. "A store-bought device can provide some short-term relief for a minor limp, but it could be detrimental for the limp that has been getting progressively worse." Try an over-the-counter product for two weeks. If it doesn't produce results, see a specialist.

Shift your load. If you overuse one half of your body, start using the other half of your body more, says Dr. Francis. Get in the habit of carrying things on the other arm or try a backpack. If you stand a lot, shift your weight to your other leg or try to place your weight evenly on both legs.

Trade in your chair. Sitting all day in an uncomfortable or unbalanced chair can produce stiffness of joints, numbness of legs and pain from the neck down. Dr. Hillstrom recommends using a chair that has good back support, adjustable height to prevent neck arching or foot dangling and a soft but sturdy cushion on the seat.

Check your shoe size. "Most people don't realize that their foot size can change with time," says Dr. Dananberg. Cramming your tootsies into a tight or poorly fitted shoe can lead to limping, so make sure that you have the proper fit. Also look for flexibility of the soles across the balls of the feet, a raised arch and a slightly raised heel.

Lose a few pounds. Getting rid of excess weight can help ease up many conditions that lead to limping, says Dr. Francis.

Walk on flat surfaces. Walking is an excellent exercise for improving posture . . . as long as you're level. If you limp, you should try to avoid hills, inclines and uneven terrain that can make you lean to the side or cause foot pronation, says Dr. Dananberg.

Swing your arms. A natural, healthy walk involves legs and arms. When your right leg is forward, your left arm swings forward; when your left leg is forward, so swings your right arm. If you have difficulty doing this, it may be a sign of stiffness or weakness in the shoulders, says Dr. Francis. This should be checked by a physician who will recommend appropriate strengthening and flexibility exercises.

Pedal with one foot. If you have an obvious imbalance in leg strength or lack flexibility in a joint, you may benefit by focusing strength-building or range-of-motion exercises on that body part, says Dr. Francis. An excellent strength-builder is to pedal on a stationary bike with one leg. Devote more riding time to the weaker leg until it becomes equal in strength to the other. Stop if you feel pain or if the limp worsens.