Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia
Résumé
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 tibialisanterior and gastrocnemiusmedialis were re-corded. 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 be-comes 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. Tibialisanterior activa-tion peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat- IC during maximum pain. Tibialisanterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemiusmedialis activation peak in Bilat-IC decreases with pain. Gastrocnemiusmedialis 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 in-duces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a ‘double’ Unilat-IC when evaluating gait.