WADDLING GAIT
Waddling gait appears as a different kind of walking. It occurs by muscular weakness in the pelvic girdle, which consists of a network of bones and muscles.
At Medical City Children’s Orthopedics and Spine Specialists, our expert waddling gait Doctors are dedicated to diagnosing and treating spinal problems in children and ensuring comprehensive care tailored to each patient’s needs. With advanced techniques and a compassionate approach, our team is here to diagnose, treat, and care for children suffering from Waddling Gait.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Waddling Gait
To parents, waddling gait appears as a different kind of walking. It is brought on by muscular weakness in the pelvic girdle, a network of bones and muscles that links your torso to your hips and legs and aids in your ability to balance. It’s more difficult to maintain balance when walking if your pelvic girdle is weak. Your body, therefore, sways from side to side to prevent falling. As you walk, your hips could also bend to one side.
This type of walking often results from weakness in the hip girdle and upper thigh muscles, such as what occurs in certain myopathies. When these muscles, especially those that help extend the hip joint, are affected, the posture at the hip may become more flexed.
Then the lower back may arch more than usual (a condition known as lumbar lordosis). Children or adults with this kind of muscle weakness often have trouble rising from a seated position.
A key muscle involved is the gluteus medius. If it’s weak, the hip on the side of the swinging leg tends to drop with each step—a sign known as the Trendelenburg sign. To compensate, people may lean their trunk toward the side that’s bearing weight (sometimes called the Duchenne sign). All these adjustments contribute to the distinctive side-to-side, “waddling” motion seen in this gait.
Other Causes for Waddling Gait
The age of young kids, particularly toddlers, don’t walk as adults do. Their mechanics of balance and walking require practice. Short steps and a waddling stride are typical in youngsters under the age of two. However, a waddling gait that persists above the age of three may indicate a deeper problem, particularly if it’s accompanied by:
- Tiptoeing, often known as walking on the balls of your feet
- A protruding stomach
- Falling, or stumbling
- Low endurance
A waddling gait in a kid older than three years old might indicate:
- Muscular dystrophy
- Cerebral palsy
- Congenital hip dysplasia
- Lumbar lordosis
Some of these issues, such as lumbar lordosis, frequently resolve on their own. It’s advisable to consult with your child’s physician to identify the underlying problem because certain symptoms call for therapy. Your youngster might occasionally just need to work with a physical therapist.
Infant hip dysplasia can significantly impact a child’s ability to walk normally, often leading to a characteristic waddling gait. This condition arises when the hip joint is either improperly formed or too loose, contributing to instability during movement. As a result, infants with hip dysplasia may exhibit an uneven walking style as they compensate for this instability.
QUESTIONS AND ANSWERS
What causes my child's waddling gait, and is it normal?
A waddling gait in a child can have various underlying causes. Some common reasons include:
- Developmental Factors: In toddlers and young children who are still developing motor skills, a waddling gait might be a normal part of the developmental process. It often resolves as the child’s muscles and coordination improve.
- Muscle Weakness or Imbalance: Weakness or imbalance in the muscles supporting the hips and thighs can contribute to a waddling gait. Conditions such as hip dysplasia or muscle disorders may be factors.
- Orthopedic Issues: Structural problems in the bones or joints, such as those associated with certain genetic conditions or developmental disorders, can affect the gait.
How is a waddling gait diagnosed, and what tests are needed?
Diagnosis involves a thorough evaluation by a healthcare professional, often a pediatrician or a pediatric orthopedic specialist. The doctor will typically conduct a physical examination, observe the child’s gait, and inquire about the child’s medical history and any additional symptoms.
In some cases, imaging studies such as X-rays or MRI may be ordered to assess the structure of the bones and joints. Blood tests may also be performed to rule out certain metabolic or genetic conditions.
What are the treatment options for a waddling gait, and can it be corrected?
The treatment of a waddling gait depends on the underlying cause. Common approaches may include:
- Physical Therapy: Exercises and physical therapy can help strengthen muscles, improve coordination, and address muscle imbalances contributing to the waddling gait.
- Orthopedic Interventions: In some cases, orthopedic interventions such as braces, splints, or orthotic devices may be recommended to provide support and encourage proper alignment during walking.
- Surgical Options: For certain structural issues or severe cases, surgical intervention may be considered to correct abnormalities in the bones or joints.
- Management of Underlying Conditions: If the waddling gait is associated with an underlying medical condition, such as a muscle disorder or hip dysplasia, addressing that condition is an essential part of the treatment plan.
It’s crucial for parents to seek prompt medical attention when they notice a persistent or concerning waddling gait in their child. Early intervention and a comprehensive evaluation by healthcare professionals can help determine the cause and develop an appropriate treatment strategy.
Walking differently can be a medical indication that something is wrong. Make an appointment with one of our pediatric orthopedists to ensure everything is fine.
Diagnosing Waddling Gait
Doctors can find the source of a waddling gait in a number of ways. Your doctor may use any of the following methods following a physical exam to look for any new symptoms:
- Doctors search for particular illness signs through genetic testing.
- Doctors identify Muscle problems with a biopsy.
- Doctors identify MD via an enzyme blood test for high creatine kinase levels..
- Doctors identify Hip dysplasia using ultrasonography.
It’s natural to walk with a waddling gait when pregnant, but this usually goes away upon the baby’s birth. However, for some, it may take several months to dissipate completely. Additionally frequent in children under 2, it frequently goes away on its own. If it doesn’t, it can indicate a more serious illness, such as MD or baby hip dysplasia.
For children under 2, a waddling gait is common and often resolves without intervention.
Issues That Can Cause Waddling Gait
Our doctors understand why parents become concerned when their child walks with a waddling gait. We want parents to bring their children to us to seek guidance. However, We advise parents that a waddling gait does not indicate a serious issue. It’s common for toddlers and young children who are still developing their motor skills to exhibit a waddling gait. As children grow and their muscles strengthen, their gait may naturally improve. In such cases, observation and monitoring under the guidance of our specialists may be sufficient. Here are some considerations:
Duration and Persistence:
If a child’s waddling gait persists beyond the typical age of refinement (usually by the age of 2 to 3), or if it worsens over time, it may warrant closer attention. Persistent waddling, especially in older children, could be a sign of an underlying issue that requires evaluation by a healthcare professional.
The Role of the Trendelenburg Sign in Waddling Gait
When it comes to understanding waddling gait, the Trendelenburg sign is a key clue for parents and doctors alike. This sign is seen when the muscles around the hip—especially the gluteus medius—aren’t strong enough to keep the pelvis level during walking. If these muscles are weak, the hip on the opposite side of the swinging leg dips down with each step.
This dropping of the hip is what gives rise to that familiar waddling motion. Alongside this, kids might also appear to arch their lower back more than usual and can often have trouble getting up from a seated position, since the same muscle weakness can make standing a bit of a challenge. So, if your child’s step seems especially side-to-side, noticing the Trendelenburg sign can help point to the underlying muscle weakness causing the gait pattern.
Changes Over Time:
Parents should be attentive to any changes in their child’s gait pattern over time. If there is a sudden onset of a waddling gait or if it worsens, it may signal an acute issue that requires timely attention.
It’s important for parents to communicate openly with their child’s pediatrician and share any concerns about their child’s gait. The pediatrician can conduct a thorough examination, assess the child’s overall development, and determine whether further evaluation or intervention is necessary. In many cases, early intervention and targeted therapies, such as physical therapy, can address the underlying causes of a waddling gait and contribute to improved mobility and function.
If the waddling gait doesn’t improve after the expected time, it may be a symptom of an underlying condition. Understanding these potential causes can help guide when to seek medical advice. If concerns persist, consulting a healthcare professional is recommended to rule out any serious issues.
Infant Hip Dysplasia
Recognizing the signs early is crucial for effective management. Common symptoms include:
- Leg Length Discrepancies: Legs may appear to be different lengths, affecting balance and gait.
- Altered Mobility: You may notice reduced flexibility or mobility in one leg, which can lead to uneven walking patterns.
- Skin Folds: Uneven skin folds on the thighs may be visible, indicating asymmetry in hip alignment.
- Limping or Tiptoeing: As the child begins to walk, they might limp or walk on tiptoes on one side.
Muscular Dystrophy (MD)
A series of uncommon disorders collectively referred to as muscular dystrophy (MD) weaken and eventually destroy muscles. Waddling is a sign of several forms of MD, including:
Duchenne MD
This condition affects the arms, legs, and pelvis and is virtually exclusively seen in boys. A primary indicator is having trouble crawling or standing up off the floor. As the disorder progresses, weakness of the hip girdle and upper thigh muscles leads to instability of the pelvis, especially noticeable when standing or walking. Children may adopt a flexed posture at the hip joints, and an exaggerated curve in the lower back (lumbar lordosis) often develops as a way to compensate. These muscle weaknesses make movements that require rising from a seated position particularly challenging.
Becker MD
This disorder, a lesser variation of Duchenne MD, is similarly more prevalent in boys. It has an impact on the shoulders, pelvis, hips, and thigh muscles. Often diagnosed in late childhood or early adolescence, Becker MD presents symptoms that are milder than those of Duchenne MD, allowing for a more gradual progression.
Genetic Links to Waddling Gait
Certain genetic variations can play a key role in the development of a waddling gait, especially in children exhibiting muscle weakness or structural challenges. Research has identified several genes that are commonly associated with this distinctive walking pattern:
- ACBD5: Variations in this gene have been linked to muscle issues that may manifest as a waddling gait.
- BGN: Mutations here are sometimes seen in individuals with connective tissue abnormalities, which can contribute to walking difficulties.
- BICD2: Changes in this gene are known to disrupt nerve and muscle function, potentially leading to a waddling walk.
- COL10A1 and COL2A1: These genes are crucial for the normal development of cartilage and connective tissue, and mutations are often associated with structural bone and joint problems, frequently resulting in abnormal gait patterns.
Understanding the genetic factors involved can help guide early diagnosis and targeted therapies, offering families a clearer path forward when addressing symptoms like a waddling gait.
Spinal Muscular Atrophy
Spinal muscular atrophy (SMA) is a hereditary neurological condition that runs in families. This disorder causes the motor neurons in your spinal cord to deteriorate, leading to muscle weakness and other symptoms. One specific form of SMA, known as autosomal dominant spinal muscular atrophy with lower extremity predominance, primarily affects the thighs, resulting in muscle weakening and tissue loss. This unusual variant of SMA often manifests in early childhood, highlighting the importance of early diagnosis and intervention.
Treatment of Waddling Gait in Children
The treatment of a waddling gait in babies and children depends on the underlying cause of the gait abnormality. Here are some common approaches that healthcare professionals may consider:
In very young children, especially toddlers who are still developing their motor skills, a waddling gait might appear as a normal part of the developmental process. In such cases, healthcare professionals may recommend observation and regular monitoring to see if the gait improves as the child’s muscles and coordination develop naturally.
Physical Therapy:
Physical therapy is a common and effective intervention for addressing a waddling gait. The physical therapists can work with the child to improve muscle strength, flexibility, and overall coordination. They may prescribe specific exercises and activities designed to target the muscles supporting the hips and thighs.
Orthopedic Interventions:
For structural issues or conditions affecting the bones and joints, orthopedic interventions may be recommended. This can include the use of braces, splints, or orthotic devices to provide support and encourage proper alignment during walking. These devices may assist in stabilizing the hip and knee joints.
Surgical Options:
In certain cases, especially when there are structural abnormalities or severe conditions, doctors may recommend surgery. Orthopedic surgeries can address issues such as hip dysplasia, muscle lengthening, or corrections to bone alignment. However, surgery is typically reserved for cases where conservative measures have not been effective, and the waddling gait is significantly impacting the child’s mobility and function.
Management of Underlying Conditions:
If the waddling gait is a symptom of an underlying medical condition, such as a muscle disorder or hip dysplasia, the primary focus will be on managing and treating that condition. This may involve medication, specialized therapies, or other targeted interventions.
It’s important to note that the treatment plan will be individualized based on the specific needs and characteristics of the child. Early intervention is crucial for a favorable outcome, and parents should consult with healthcare professionals, such as pediatricians or pediatric orthopedic specialists, to determine the appropriate course of action. Regular follow-up appointments are typically recommended to assess progress, make adjustments to the treatment plan as needed, and ensure optimal development.
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, Texas, our pediatric orthopedic doctors will examine your child and recommend the best treatment option to repair the problem and get your child back playing.
As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists, will examine your child and understand the reasons for a waddling gait. At that point, the doctor will prepare an individualized treatment plan for your child if he finds the cause of the unusual gait. After correcting the problem, your child will resume his or her favorite activities. For athletes, it may take up to a year before they may resume their sport.
____________________
Call 214-556-0590 to make an appointment.