Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia.

BACKGROUND

We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC).

METHODS

Two groups of PAD-IC patients: unilateral (Unilat-IC; n = 15), bilateral (Bilat-IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain-free, onset of pain and maximum pain in PAD-IC patients.

FINDINGS

Single leg stance in the asymptomatic leg of Unilat-IC increases and becomes higher than the symptomatic leg and the Bilat-IC legs at maximum pain. Step time is higher and cadence is lower in PAC-IC than in controls. Tibialis anterior activation peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat-IC during maximum pain. Tibialis anterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemius medialis activation peak in Bilat-IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat-IC presents a significant decrease between pain-free and maximum pain phases.

INTERPRETATION

Ischemia impacts gait in PAD-IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat-IC induces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a 'double' Unilat-IC when evaluating gait.