Shuffling gait vs Festinating gait – Are you dragging your feet?

Shuffling gait means a walking pattern, in which a person drags his/her feet while walking. Shuffling gait is defined as a walking pattern in which the foot is still moving when it hits the ground.

Some people call it “Festinating gait“. But, shuffling gait and Festinating gait are different.

Festinating gait is a walking pattern with rapid, small steps as if the person is going to fall over.

You can see a video of shuffling gait, and a video of festinating gait below.

The most common cause of both is Parkinson’s disease. But there are also other causes of shuffling gait such as hydrocephalus.

The treatment of shuffling gait depends on its cause.

Please read the simple explanations below:

What is the meaning of Shuffling gait?

Let us think about a fictional person, Sue. Sue has a normal gait.

Sue starts walking.

Sue first lifts one foot up. Then he moves that foot forward. After the foot is adequately in front, Sue stops moving it forward. She then places the foot down on the ground.

Sue can do this very rapidly, and walk very fast.

 

WalkingFast

 

Usually, we walk like Sue. We do not shuffle.

==

Shuffling gait means a peculiar way of walking, in which the foot is still moving when it hits the ground.

Let us look at another person, Mary.

Mary does not lift the foot high off the ground. She moves it forward slowly. Even before he/she moves it forward adequately, it is time to put the foot down! And so she does so.

This causes Mary to shuffle while walking. This is the meaning of a “shuffling gait”.

See this sample video of bradykinesia posted by a Russian doctor on youtube:

Festinating gait verus Shuffling gait

Festinating gait and shuffling gait are slightly different terms.

Festinating gait happens when the person bends forwards while walking. Let us look at a third person – Michael.

Michael bends forwards at all times – sitting, standing & even while walking.

Now, Michael starts to walk. But he immediately feels like he will fall forwards on his face. He takes a quick short step forward to avoid falling. Saved!

But again, immediately, he again feels like he will fall forwards. So he takes another quick, short step. And so on…

This is called a Festinating gait.

Note that these movements are rapid. It is different than the slow shuffling gait seen in Parkinson’s disease.

You can see an example of Festinating gait in the video below (youtube – Ms. Kosutzka):

Thus, Festinating gait happens when the patient bends forward while walking. He/she then takes rapid, small steps while walking to avoid falling forwards.

Further reading:

  1. Gait festination in parkinsonism: introduction of two phenotypes – Jorik Nonnekes, Journal of Neurology 2019; 266(2): 426–430.
    It is not essential to read this paper. This paper talks about the controversies regarding these two terms. It is fascinating, but is difficult to read for a non-medical audience.

Shuffling gait causes

The most common cause of shuffling gait is Parkinson’s disease.

In Parkinson’s disease, the patient becomes slow. So, the gait is a slow shuffling gait. Treatment can dramatically improve this slow shuffling.

Some other conditions can mimic shuffling gait.

If someone has very painful knee arthritis they cannot lift their feet high off the ground. Their gait may be mistaken for a shuffling gait.

5 causes of Shuffling gait that are not Parkinson’s disease
  1. Alzheimer’s disease – the person might “forget how to walk”. This is called “Gait Apraxia”.
  2. Hydrocephalus – Excessive water inside the head
  3. Vascular disease – obstructions to blood flow to the brain, causing small strokes.
  4. Severe unsteadiness – due to problems with the balance system of the body. The person feels like he is going to fall all the time. Hence, he takes small, shuffling steps instead of boldly stepping forward (“Cautious gait”).
  5. Parkinson’s Plus syndromes [Click here for reading more]

Sometimes, the gait seen in these diseases is extremely difficult if not impossible to differentiate from the shuffling gait of Parkinson’s disease.

For example, here is a video posted by the hydrocephalus association of America.

This patient has Normal Pressure Hydrocephalus (NPH), and NOT Parkinson’s disease. As you can see, the gait looks very similar to Parkinson’s disease.

Thus, NPH can mimic Parkinson’s disease.

So, it is critical to look for other features of the “Parkinsonian gait” before making a diagnosis. For example, watch the video above again. Notice how there is no slowness of the upper part of the body.

Other features of the gait in Parkinson’s disease are described below.

What is Parkinson’s gait?

The term GAIT in medicine includes all body movements while walking.

In Parkinson’s changes in the movements of other body parts are also seen.

Gait changes seen in Parkinson’s disease
  1. Head is bent forward
  2. Body is bent forward
  3. The person may take some time to start walking (“Freezing”).

Once he or she starts walking:

  1. The normal swinging of arms while walking is reduced.
  2. The chest and stomach appear “stiff” while walking
  3. Walking becomes slow
  4. Shuffling gait and/or festinating gait may be seen
  5. There might be unsteadiness while walking
  6. The person might “Freeze” when he/she has to turn. This also happens when walking through doorways or around obstacles.

You can notice these changes in the videos below. In the early stages of Parkinson’s, these changes may be very subtle. That is why it is so easy to miss the diagnosis of Parkinson’s disease.

Here is an excellent video demonstrating these symptoms. This video has been made by Lancet, a leading medical journal.

Treatment of shuffling gait of Parkinson’s

The treatment of shuffling gait depends on its cause.

The most common cause is Parkinson’s disease. In Parkinson’s disease, the brain has a deficiency of the chemical called Dopamine.

Levodopa is an oral medication. Once it goes to the brain, it gets converted into dopamine! This can result in rapid improvement in shuffling gait.

Treatment also improves slow shuffling gait, festination & other symptoms of Parkinson’s disease.

Shuffling gait and festinating gait is usually easy to treat. But “Freezing”  may need extra treatment such as physiotherapy, visual cues and brain stimulants. These therapies are described in another article.

Treatment of other causes

Other reasons of shuffling gait respond also respond to treatment.

For example, the following therapies are effective:

DiseaseTreatment
1. HydrocephalusDiverting water into the stomach using a pipe (called “Shunting”)
2. Alzheimer’sPossibly: Donepezil, brain stimulants and other medications
3. Vascular diseasesame as Alzheimer’s
4. UnsteadinessTreating the cause of unsteadiness. For example – low vitamin B12 levels
5. Parkinson’s plus syndromesDescribed in another article [Click here]

Further reading:

  1. Normal Pressure Hydrocephalus – Meaning and treatment
    This article is quite important. A variety of hydrocephalus (called Normal Pressure Hydrocephalus or NPH) can also produce a shuffling gait. Misdiagnosis is possible. NPH may be mistaken for Parkinsons disease. The treatment of NPH is shunt surgery, rather than medications.

Treatment of Festinating gait

Festinating gait is treated in the same way as shuffling gait of Parkinson’s disease.

The most important thing

Do not neglect a slow shuffling gait. Do not neglect a festinating gait.

And finally, do not neglect other conditions which may cause similar walking problems.

These conditions have effective treatments.

Do not be afraid. See a doctor early.

 

 

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, SV Road, LIC Colony, Vile Parle

4.5 77 reviews

  • Avatar Paras Prabhu ★★★★★ a month ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Sanjay Pradhan ★★★★★ 2 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar Pinakin Shah ★★★★★ in the last week
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Manish Ranjan ★★★★★ 3 months ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar aman ul hauq Khan ★★★★ 2 months ago
    Dr Kharkar gives you all the time you need to hear you out in complete detail. He probes in depth to ensure he has managed to gain all data points to find … More the best way forward medically for you. He is an authority on the subject. After 4 years of suffering I have found my go to doctor
  • Avatar N N ★★★★★ 2 months ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Lawrence Castellino ★★★★★ 2 months ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ 4 months ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you
  • Avatar Anil Chinchulkar ★★★★★ 4 months ago
    We have visited the hospital and meet the Dr. S. Kharkar. And my personal experience is very much better and exilent. My father is very well recover as … More we thought. Thanks to Nanavati Hospital and Dr. S. Kharkar.
  • Avatar MAMTA YADAV ★★★★★ 4 months ago
    The services that I received from doctor Siddharth kharkar is excellent ,and the other doctor is also very good who had taken initial discussion with me … More ...and the staff are friendly and ensure that I am properly informed about my health and care and would highly recommend to anyone..
  • Avatar Khushi Valia ★★★★★ 4 months ago
    Had very Severe migraine attacks for years and suddenly my migraine had triggered for continuous 5 days thats when I contact Dr Siddharth and was fortunate … More to have a effective medication which help me reduced my triggers and headaches..Lucky in few months I have very less days of headache in a month and can do my Daily life with much ease.
  • Avatar JAIKUMAR MANI ★★★★★ 9 months ago
    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
  • Avatar Rohit shetye ★★★★★ 10 months ago
    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
  • Avatar Ashish Patil ★★★★★ 10 months ago
    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
  • Avatar Bianca D'silva ★★★★★ 9 months ago
    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
  • Avatar Neelam Satghare ★★★★★ 10 months ago
    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
  • Avatar Nitin Ghotge ★★★★★ 10 months ago
    Dr.Sidharth Kharkar is one of the best neurologist i came across ....He is really genuine and focused .....We really satisfied after consultancy...
  • Avatar Krishna kumari Radhakrishnan ★★★★★ 11 months ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
  • Avatar a kumar ★★★★★ 10 months ago
    Dr kharkar is very nice doctor, sir explained each and every thing very nicely, and i am thankful for Dr kharkar for his treatment .
  • Avatar Nidhi Sonawane ★★★★★ a year ago
    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ 10 months ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ a year ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
  • Avatar Govind Patel ★★★★★ 11 months ago
    Doctor explained very Good nice person give length time to check body
  • Avatar Sharmila Kumawat ★★★★★ a year ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

Leave a Comment

India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai