A myopathic gait (a.k.a. waddling gait or Trendelenburg gait) occurs due to weakness of the hip abductors resulting in a waddling appearance.
Hip abductor weakness results in an inability to stabilize the pelvis during the stance phase. As a result, the pelvis tilts downwards towards the unsupported side during the swing phase of the gait cycle.
The body compensates to prevent the swinging foot from dragging by:
=> Laterally flexing the torso away from the leg in swing phase; this draws the pelvis and leg up off the floor (causing the characteristic ‘waddling’ appearance)
=> Circumducting the leg.
Associated clinical features
Clinical features which may be associated with a myopathic gait include:
=> Difficulty standing from a seated position without the use of the arms
=> Difficulty standing from a squat or sitting up from a lying position
=> Positive Trendelenburg’s sign; when the patient stands on one leg, the pelvis drops towards the contralateral side.
Causes
Systemic disease:
=> Hyperthyroidism
=> Hypothyroidism
=> Cushing’s syndrome
=> Acromegaly
=> Polymyalgia rheumatica
=> Polymyositis
=> Dermatomyositis
Muscular dystrophies:
=> Duchenne’s muscular dystrophy
=> Becker’s muscular dystrophy
=> Myotonic dystrophy
Choreiform gait
A choreiform gait (a.k.a. hyperkinetic gait) presents with involuntary movements such as:
=> Oro-facial dyskinesia (grimacing or lip-smacking)
=> Choreic movements of the upper and lower limbs (writhing, dance like semi-purposeful movements)
The involuntary movements are usually present at rest, however, walking can accentuate the movements.
Causes
Basal ganglia disease:
=> Huntington’s disease
=> Sydenham’s chorea
=> Cerebral palsy (choreiform type)
=> Wilson’s disease
=> Dopaminergic medications (e.g. Parkinson’s medications)