Gait variability is altered in patients with peripheral arterial disease

J Vasc Surg. 2009 Apr;49(4):924-931.e1. doi: 10.1016/j.jvs.2008.11.020. Epub 2009 Feb 14.


Objective: Claudication is the most common presentation of peripheral arterial disease (PAD), producing significant ambulatory compromise. Claudicating patients, most of whom are elderly, have reduced mobility and poor health outcomes, including an increased risk of falls. The gait of elderly fallers is characterized by increased variability. Increase in the variability of the locomotor system makes the gait more noisy and unstable. The purpose of this study is to investigate gait variability in patients with PAD.

Methods: Nineteen symptomatic PAD patients (age, 63.6 +/- 9.8 years; body mass, 82.1 +/- 18.5 kg; height, 1.71 +/- 0.06 m) walked on a treadmill in the absence of pain or claudication symptoms while joint flexion and extension kinematics were captured. Results were compared with results obtained from 17 matched healthy controls (age, 65.2 +/- 12.5 years; body mass, 82.0 +/- 25.9.5 kg; height, 1.73 +/- 0.08 m). Relative joint angles were calculated for the ankle, knee, and hip flexion/extension, and the stride-to-stride variability of joint flexion and extension was calculated from at least 30 consecutive footfalls. Variability was expressed using the largest Lyapunov exponent, standard deviation, and coefficient of variation. Independent t tests were used to compare gait variability between groups.

Results: Symptomatic PAD patients had significantly higher largest Lyapunov exponent values and coefficient of variation values for all joints, and higher standard deviation values at the ankle and the hip (P < .05).

Conclusion: Symptomatic PAD patients have increased gait variability at the ankle, knee, and hip joints at baseline ambulation in the absence of claudication pain. Our findings indicate significant baseline deterioration in the locomotor system of symptomatic PAD patients. This deterioration results in increased noise and instability of gait and is a potential contributing factor to the falls and mobility problems experienced by symptomatic PAD patients.

MeSH terms

  • Accidental Falls
  • Aged
  • Ankle Joint / physiopathology
  • Biomechanical Phenomena
  • Case-Control Studies
  • Female
  • Gait*
  • Hip Joint / physiopathology
  • Humans
  • Knee Joint / physiopathology
  • Male
  • Middle Aged
  • Mobility Limitation
  • Peripheral Vascular Diseases / physiopathology*
  • Range of Motion, Articular
  • Walking*