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ULY CLINIC

10 Septemba 2025, 11:32:35

Gait, Waddling [Ducklike gait]

Waddling gait is a characteristic, ducklike walk caused by weakness of the pelvic girdle muscles, including the gluteus medius, hip flexors, and extensors. The weakness destabilizes the weight-bearing hip during ambulation, causing the trunk to lean toward the stance side and exaggerating lumbar lordosis, abdominal protrusion, and, in severe cases, leg and foot contractures. It is commonly associated with muscular dystrophies, spinal muscle atrophies, and congenital hip disorders.

Pathophysiology

Waddling gait develops due to weakness of the pelvic girdle muscles, particularly the gluteus medius and minimus, which normally stabilize the pelvis during single-leg stance in gait. Weakness leads to a lateral tilt of the pelvis toward the unsupported side, causing compensatory trunk lean toward the stance leg and exaggerated lumbar lordosis. In muscular dystrophies, progressive degeneration and wasting of proximal muscles exacerbate instability, resulting in increased fall risk, abnormal posture, and functional limitations. Secondary contractures and foot deformities may further alter gait mechanics.

History and Physical Examination

History: Assess onset, progression, and associated functional limitations (e.g., difficulty rising from a chair, climbing stairs, frequent falls). Obtain family history for muscular or congenital disorders.
Physical Examination: Inspect leg muscle bulk, tone, and symmetry. Check for Gowers’ sign (indicative of pelvic muscle weakness). Evaluate motor strength in upper and lower limbs, assess posture, lumbar lordosis, and presence of abdominal protrusion.

Medical causes and clinical features

Cause	Typical Age/Onset	Key Signs & Symptoms	Clinical Clues/Distinguishing Features
Congenital hip dysplasia	Birth or early walking	Bilateral hip dislocation, waddling gait, pain, lumbar lordosis	Pain with hip movement, limited hip abduction
Duchenne muscular dystrophy	3–5 years	Progressive waddling gait, positive Gowers’ sign, lordosis, calf hypertrophy, eventual wheelchair dependence	Early delayed walking, frequent falls, pseudohypertrophy of calves
Becker muscular dystrophy	Late adolescence	Slowly progressive waddling gait, lordosis, abdominal protrusion, positive Gowers’ sign	Milder, slower progression than Duchenne; pelvic and upper arm muscle weakness
Facioscapulohumeral dystrophy	Late childhood/adolescence	Waddling gait after facial and shoulder weakness spreads to pelvis and legs	Early facial and shoulder muscle involvement; slight lordosis
Kugelberg-Welander syndrome (spinal muscle atrophy type III)	>2 years	Slowly progressive waddling gait, leg/pelvic weakness, positive Gowers’ sign, tongue fasciculations	Gradual loss of ambulation over years; ophthalmoplegia may occur
Werdnig-Hoffmann disease (spinal muscle atrophy type I/II)	Learning to walk	Early waddling gait, absent reflexes, hip/thigh weakness, lumbar lordosis	Rapid progression; severe functional impairment, complete loss of ambulation in adolescence

Special considerations

Encourage daily walking (≥3 hours/day if possible) and active/passive stretching to maintain muscle strength and reduce contractures.
Supervise ambulation, especially on uneven ground, and consider assistive devices.
Provide nutritional guidance to prevent obesity and optimize energy levels.
Offer psychological and family support due to the progressive nature of the condition.
Consider referral for genetic counseling and local muscular dystrophy support groups.

Patient counseling

Warn against prolonged bed rest to prevent accelerated muscle deterioration.
Teach safe ambulation techniques and the use of orthoses.
Discuss disease prognosis, potential complications, and family planning options.

References:

Huang, Y., Meijer, O. G., Lin, J., Bruijn, S. M., Wu, W., Lin, X., … van Dieën, J. H. (2010). The effects of stride length and stride frequency on trunk coordination in human walking. Gait & Posture, 31(3), 444–449.
Hurt, C. P., Rosenblatt, N., Crenshaw, J. R., & Grabiner, M. D. (2010). Variation in trunk kinematics influences variation in step width during treadmill walking by older and younger adults. Gait & Posture, 31(4), 461–464.