MYOPATHIC GAIT

Myopathic Gait in Pregnancy

A myopathic gait has several causes, one of which includes pregnancy. For instance, pregnancy causes several physical changes in your body that have an impact on how you walk. In fact, it increases the synthesis of the hormone relaxin as one method of getting ready to give birth. As a result, your pelvic muscles and joints will relax as a result, making it simpler for a baby to pass through. When you are pregnant, you also put on weight. You must slightly incline your back since your center of gravity is altered by the majority of it being in your belly. After giving delivery, your gait should return to how it was before becoming pregnant.

Other Myopathic Gait Patterns

Beyond pregnancy, myopathic or abnormal gait patterns can arise from a variety of causes. Here are some other types you might encounter:

• Antalgic gait: This is when you spend less time bearing weight on one side due to pain, such as from a foot injury or joint inflammation. While often seen in adults, kids can present with this too, sometimes after an unwitnessed bump or fall.
• Circumduction gait (“peg leg”): You might notice someone swinging their leg out to the side in a semicircular motion, often due to stiffness, leg length differences, or spasticity, such as in cerebral palsy.
• Spastic gait: This includes stiff, dragging steps with the foot turned in. It’s commonly seen in neurological conditions like cerebral palsy or after a stroke.
• Ataxic gait: Here, instability is key. The person walks with a base that alternates from narrow to wide, often associated with cerebellar conditions or sensory problems affecting balance.
• Trendelenburg gait: When hip abductor muscles are weak, the pelvis drops on the opposite side during walking. With both hips affected, this can lead to a classic waddling, “rolling sailor” walk—often seen in conditions like developmental dysplasia of the hip, muscle diseases, or neurological disorders.
• Toe-walking (“equinus”) gait: While many toddlers briefly walk on their toes, persistent toe-walking can be a sign of muscle tightness or neurological issues.
• Stepping gait: With weak ankle dorsiflexors (the muscles that lift your foot), the whole leg is lifted higher to clear the ground—called a “foot drop” gait, seen in nerve and muscle disorders.

Myopathic Gait in Muscular Dystrophy

A hereditary disorder called Duchenne muscular dystrophy (DMD) results in progressive muscle weakening. It’s one of four disorders brought on by a change in the dystrophin protein, which keeps muscle cells bound together. By the time they reach school age, children with DMD walk with a waddling stride. A milder kind of DMD called Becker muscular dystrophy (BMD) can also result in a waddling gait. Compared to DMD, it is frequently diagnosed later in life. The progress is typically slower and less predictable. DMD and BMD primarily impact boys. By the time they are 12 years old, most DMD patients need to use a wheelchair. Before that, certain mobility aids can help with walking. These incorporate:

• Supporting ankle and foot braces
• Achilles tendon stretching braces are used at night
• An upright walker
• Wheelchairs with an adjustable height for standing

Myopathic Gait in Spinal Muscular Atrophy

A genetic condition called spinal muscular atrophy (SMA) causes the spinal cord’s nerve cells to die. The peripheral nervous system, the central nervous system, and voluntary muscular movements are all impacted. Mild to severe SMA symptoms are possible. In general, the severity of the ailment increases with the onset of symptoms. Autosomal dominant spinal muscular atrophy, lower extremity-predominant type 2, is one kind of SMA. Early infancy is when signs of this illness first manifest, mostly affecting the thigh muscles. Additional signs include:

• Delayed walking
• Difficulty walking
• Foot deformities
• Loss of some reflexes

Myopathic Gait in Toddlers

Under the age of three, a myopathic gait is typical. When a youngster is first starting to walk, their feet are spread out and pointed out. As they take several quick steps, this aids in maintaining their equilibrium. Ask your child’s physician about it if they are older than 3 and still walk with a myopathic gait.

It’s important to remember that toddlers often display a variety of leg and foot alignments as part of normal development. For example:

• Habitual toe walking is common in young children up to 3 years old.
• In-toeing can occur due to persistent femoral anteversion, where the child’s knees and feet point inward. This pattern is most noticeable between ages 3 and 8.
• Internal tibial torsion is another cause of in-toeing, where the kneecap points forward but the feet turn inward. This typically resolves on its own by age 3.
• Metatarsus adductus (a flexible, “C-shaped” curve to the side of the foot) is usually seen in infants and often corrects itself by age 6.
• Bow legs (genu varum) are common from birth through toddlerhood, often peaking around a child’s first birthday and usually resolving by 18 months.
• Knock knees (genu valgum) can appear around ages 3 to 7 and often resolve by age 7.
• Flat feet are frequent in young children. Most have a normal arch when standing on tiptoes, and this usually improves by age 6.
• Crooked toes are not unusual and often straighten out as a child grows and becomes more active.

Most of these patterns resolve naturally as your child grows, especially with increased walking and activity.

Understanding Normal Gait Development

In toddlers, walking often looks a bit unsteady: their gait is naturally wide-based for support, and they may appear high-stepped and flat-footed with their arms outstretched for balance. You might notice their legs are externally rotated and slightly bowed, which is normal at this stage. As children grow, their walking pattern evolves—heel strike (landing on the heel first) usually develops around 15 to 18 months, along with reciprocal arm swing. Skills like running and changing direction often emerge after age two.

As children reach school age, their step length gradually increases and the frequency of steps slows, becoming more coordinated. By around age eight, most children have developed an adult-like gait and posture. However, there is a considerable range of what’s normal, and family patterns often play a role in when and how these changes occur.

When to Seek Medical Advice

While a slightly awkward or wide-based walk is expected in toddlers, persisting primitive reflexes or gait abnormalities beyond age three may be a sign of an underlying neurologic or muscular condition. If you notice your child’s walking pattern hasn’t matured as expected, or if they continue to walk with a myopathic gait past age three, consult your pediatrician for further evaluation.

However, there are certain signs that may suggest the gait is more than just a normal developmental phase. Causes for concern arise if these normal variations persist beyond the expected age range, if the gait appears to be getting worse or is noticeably different on one side of the body, or if your child experiences pain, difficulty with movement, or any loss of function. Additionally, if you notice that your child’s growth is below average (for example, if their height is less than the 25th percentile), or if their legs appear unusually bowed or knock-kneed, especially if the alignment is asymmetric, further evaluation may be necessary.

In such cases, your pediatrician might recommend X-rays to check for underlying conditions such as skeletal dysplasias or metabolic disorders like rickets. Always trust your instincts—if something about your child’s gait seems off, don’t hesitate to consult your healthcare provider for guidance and reassurance.

Under the age of three, a myopathic gait is typical.

When a youngster is first starting to walk, their feet are spread out and pointed out. As they take several quick steps, this aids in maintaining their equilibrium.

When Should You Be Concerned?

Ask your child’s physician about it if they are older than 3 and still walk with a myopathic gait. Among the illnesses that might manifest in children older than 3 as having a myopathic gait are:

• Developmental dysplasia of the hip
• A muscle sickness, such as DMD
• Cerebral palsy is an illness that disturbs movement and balance
• Lower back curvature that is noticeably more inward, or lumbar lordosis. In children, this often fades away on its own.

Other Causes and Differential Diagnoses for Myopathic or Abnormal Gait in Children

While myopathic gait is often linked to muscle disorders, there is a range of other conditions, both common and rare, that can present as an unusual or asymmetric walk in children. Evaluating a child with a persistent gait abnormality involves considering several possibilities, including:

• Transient synovitis of the hip (sometimes called “irritable hip”): a temporary inflammation that can cause limping
• Toddler’s fracture: a subtle, non-displaced fracture of the tibia, often with an intact fibula
• Legg-Calve-Perthes disease: a condition affecting the hip joint
• Nonaccidental injury: injuries that may raise concern for child safety
• Osgood-Schlatter disease: inflammation below the kneecap
• Juvenile idiopathic arthritis (JIA)
• Spina bifida or other neurologic conditions
• Appendicitis: may sometimes present as limp due to pain

Less Common Causes Include:

• Slipped capital femoral epiphysis
• Developmental hip dysplasia (beyond infancy)
• Tarsal coalition
• Sever’s disease (heel pain)
• Spondylolysis (spinal stress fracture)
• Juvenile dermatomyositis
• Systemic lupus erythematosus (SLE)
• Septic arthritis or osteomyelitis (bone or joint infections)
• Muscular dystrophies
• Hemophilia or other bleeding disorders
• Sickle cell disease
• Leukemia and other malignancies
• Benign or malignant bone tumors (such as osteosarcoma or Ewing sarcoma)
• Rickets (vitamin D deficiency)
• Lysosomal storage disorders
• Complex regional pain syndrome

A careful review of your child’s history and a thorough physical exam—sometimes including imaging or lab tests—may be needed to pinpoint the cause. If you notice your child has a persistent limp or myopathic gait beyond age 3, or if they develop new symptoms like pain, weakness, or swelling, consult with your child’s healthcare provider for a comprehensive evaluation.

Because so many different conditions can cause a myopathic gait in children older than three, it’s important to seek evaluation by a healthcare professional for a thorough assessment. This ensures appropriate diagnosis and management tailored to your child’s specific needs. It’s essential to distinguish habitual or developmental patterns from persistent abnormal gaits that may signify underlying conditions.

Myopathic Gait Causes

The weakening of the hip girdle muscles, which is most frequently caused by myopathy and is most distinctively caused by muscular dystrophy, results in a myopathic gait. When walking, the pelvis needs to be stabilized by the hip abductor muscles, particularly the gluteus Medius. Sometimes this walking style is referred to as a gluteus Medius gait. Because the hip abductors on the opposite side are weak,

Trendelenburg’s sign causes an irregular pelvic drop on the side of the swing leg. As the stance leg adducts, the hip on the afflicted side juts laterally rather than remaining in a stable posture. In contrast to the hip on the swing side, which sags downward, the stance side hip moves laterally.

When there is bilateral weakness, the hip on the side of the swing leg droops, causing an accentuated pelvic swing with every stride and a “waddling” gait. Exaggerated pelvic swings are frequently referred to as “sexy” gaits because they mimic runway models’ strides. This walking pattern can take on odd shapes, especially with FSH dystrophy. The patient’s shoulders are flung back, and his or her pelvis is shoved forward as they walk. This gait style is particularly prevalent in people with facioscapulohumeral muscular dystrophy. Also, take note of whether there is a protruding belly, lumbar hyperlordosis, or forward-facing shoulders.

To prevent the patient from falling forward due to weak back and hip extensors, this posture shifts the center of gravity behind the hips. Recognizing the differences between myopathic gait and other abnormal gait patterns—like antalgic, spastic, ataxic, or “clumsy” gaits—helps guide the search for underlying causes and the best approach to care.

How Is Myopathic Gait Diagnosed?

Your doctor will examine you physically and discuss your symptoms with you. They could also verify:

• Muscle power, tone, and synchronization
• Check your spine and neck for abnormalities
• Determine your risk of falling
• Your heart rate while sitting, standing, and lying down
• Your vision
• In the case of neurological conditions like muscular dystrophy
• Arthritis

To ensure an accurate diagnosis, your doctor will also want to understand both normal and abnormal gait patterns, as well as identify any potential “red flags” that might indicate a more serious underlying condition. The assessment may differ depending on whether your symptoms appeared suddenly or have developed gradually over time. For instance, a sudden limp might suggest trauma or injury, while a chronic, slowly developing gait change could point to a muscle or nerve disorder.

Because children (or even adults) might not always be able to accurately describe what happened, especially if the incident occurred away from home, a careful and thorough history is important. This often involves talking to caregivers, teachers, or anyone who witnessed the onset of symptoms.

During the evaluation, your doctor will:

• Examine all major joints (hips, knees, ankles, feet) to look for swelling, tenderness, or restricted movement
• Perform a general physical assessment, including abdominal, neurologic, and developmental checks to rule out other possible causes.
• Investigate for signs of infection, inflammation, or systemic illness if appropriate.

Your doctor may recommend additional testing or imaging procedures based on the results. These may include blood tests, X-rays, MRI scans, or muscle biopsies to further clarify the cause of your symptoms and help guide the best treatment approach.

Your doctor will examine you physically and discuss your symptoms with you. They could also verify:

• Muscle power, tone, and synchronization
• Check your spine and neck for abnormalities
• Determine your risk of falling
• Your heart rate while sitting, standing, and lying down
• Your vision
• In the case of neurological conditions like muscular dystrophy
• Arthritis

Your doctor may recommend additional testing or imaging procedures based on the results.

What are the warning signs that a limping child needs urgent evaluation?

While many walking differences in children are harmless and resolve with time, there are certain signs that should prompt immediate medical attention. Red flags include:

• Limping that persists beyond the typical age range for normal walking variations
• A limp that is getting worse over time or appears suddenly
• Any walking pattern that is noticeably different on one side compared to the other (asymmetry)
• Accompanying pain, especially if it interferes with everyday activities
• Signs of muscle weakness or loss of function
• Evidence of nerve problems, such as tingling, numbness, or changes in reflexes

If your child shows any of these signs, contact your pediatrician promptly for a thorough assessment. Early intervention can make a significant difference in diagnosis and treatment outcomes.

Evaluating a Limp: Acute vs. Chronic Presentations

When a child presents with a limp, your doctor will approach the evaluation differently depending on whether the symptoms appeared suddenly (acute) or have developed more gradually over time (chronic).

For acute limps, the focus is on rapidly identifying serious conditions that may pose immediate risks, such as infections (like septic arthritis or osteomyelitis), trauma, or, less commonly, tumors. The history will include any recent injuries, fever, or signs of illness. The physical exam quickly assesses joint warmth, swelling, tenderness, and range of motion. If red flags are present—such as inability to bear weight, severe pain, or systemic symptoms—urgent imaging (like X-rays) and laboratory tests (blood counts, inflammatory markers) may be ordered to guide immediate intervention.

In contrast, a chronic limp often develops subtly, with the child sometimes adapting their walking pattern over weeks or months. Here, the evaluation is geared toward identifying underlying causes such as developmental disorders, neuromuscular diseases (including muscular dystrophies), or musculoskeletal conditions like juvenile idiopathic arthritis. Your doctor will look for asymmetry in limb length, evidence of muscle weakness, changes in joint mobility, and alterations in balance. Imaging studies and further specialized testing may be needed, but the urgency is usually less than with acute limps—unless new severe symptoms develop.

Regardless of whether the limp is acute or chronic, recognizing abnormal gait patterns, noticing warning signs, and understanding the broad potential causes enables a thorough and safe assessment.

When to Worry: What Triggers Further Investigation?

While certain gait variations are common, your physician will pay special attention if these changes are persistent (lasting beyond the expected age), progressively worsening, notably asymmetric, or accompanied by pain, functional limitations, or signs of neurological involvement. In children, if gait abnormalities are paired with additional red flags such as short stature (height below the 25th percentile), marked bow legs (genu varum), knock knees (genu valgum), or asymmetry between limbs, further evaluation may be recommended. This can include X-rays to rule out underlying conditions like rickets or skeletal dysplasias.

Depending on the findings from the physical exam, your doctor might order blood tests, nerve conduction studies, or advanced imaging (such as MRI or CT scans) to better pinpoint the cause of the gait disturbance and guide an appropriate treatment plan.

How Is Myopathic Gait Treated?

The etiology of a waddling gait will determine the course of treatment. Some illnesses could get better on their own. Other medical possible aids include:

• Balance aids like canes and walkers
• Physical therapy helps improve flexibility, balance, and strength
• Physical therapy to prevent falls
• Leg braces or splints to aid in proper foot alignment.
• Medicine
• Surgery
• prosthetics

Choosing Medical City Children’s Orthopedics and Spine Specialists

Always consult with your doctor if your child begins to walk differently.  If you come to one of our Medical City Children’s Orthopedics & Spine Specialists offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, our pediatric orthopedic doctors will examine your child and recommend the best treatment options available.

As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists will examine your child.  By doing so, they will determine and understand the reasons for the unusual gait.  At that point, the doctor will prepare an individualized treatment plan for your child if he finds the cause of the unusual gait.  Finally, the doctor will devise and formulate a plan and strategy — using the latest technology and treatments — to provide the very best methods to assist the child’s mobility.

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Footnote:

Performance Health Academy: How to identify gait abnormalities