✅Myopathic gait
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)
