There is a temptation for a GP to refer a patient to a neurologist, moment he is told that the patient is having difficulty in walking. I would like to warn the GPs that in elderly patients the following 3 conditions are responsible in 90% of the patients, who have difficulty in walking.

1. Patients having lumbar canal stenosis complain of neurogenic claudication and symptoms of pain and paraesthesias in the buttocks, thighs and legs on walking. Many of these patients will ultimately need surgical treatment, if they want relief and freedom to move around.
2. Vitamin D deficiency - In young and middle-aged women osteomalacic myopathy is extremely common and rampant in India. I would like to draw the attention of the GPs to the fact that Vitamin D deficiency also appears in elderly male and female patients, who are often confined indoors. In these patients, even the aged skin and intestine interfere with the absorption of ultraviolet rays having Vitamin D, and the foods containing calcium, respectively. These people instead of having typical osteomalacic waddling gait, often only complain of difficulty in walking and incoordination and show a remarkable response to administration of Vitamin D and calcium.
3. Very often osteoarthritis of the knees and sometimes associated hips is the cause of weakness especially in patients, who do not complain of too much pain. It does not draw the attention of the doctor to the joint because after years of starting knee pain, patients learn trick movements to avoid pain. But in the meanwhile, they develop severe weakness of quadriceps muscles, thus leading to interference with walking.