What is Trendelenburg Gait?
Trendelenburg gait is an unusual way of walking that occurs due to a problem with your hip muscles that help move your leg away from the center of your body. This primarily involves a group of muscles in your buttocks, like the gluteus medius and minimus. When these muscles are weak, it results in a sort of droop of your pelvis on the side opposite to where the weakness is, while walking. Other reasons for this can include any type of damage or disease in the hip region that leads to difficulty in moving your leg away from the body and results in the droop on the opposite hip while walking. This way of walking was named after a German doctor named Friedrich Trendelenburg. He reported a test associated with it back in 1895. The test he described is used to identify weakness in the hip muscles or any problems in patients suffering from developmental issues with their hips.
What Causes Trendelenburg Gait?
The hip joint functions much like a seesaw, with various forces acting to keep it balanced. Any issues affecting these forces can result in a positive Trendelenburg sign and a distinctive walk, or gait.
A problem with the hip joint itself, acting like the seesaw’s pivot point, or fulcrum, can occur in various conditions, such as:
- Osteonecrosis of hip – a condition that occurs when there is not enough blood reaching the hip, causing the bone to die
- Legg-Calvé-Perthes disease – a childhood condition in which blood supply to the ball part of the hip joint is interrupted
- Developmental dysplasia of the hip – a disorder seen in babies and children where the socket in the hip does not fully cover the ball of the thigh bone
- Dislocated hips due to an accident or injury
- Dislocated hips due to infections like tuberculosis of the hip
Issues with the “lever” or the bones involved in the hip joint can come from conditions like:
- Greater trochanteric avulsion – a tear or rupture of any of the muscles that attach to the bump on the side of the hip
- Non-healing of the neck of the thigh bone
- Coxa vara – a condition in which the angle between the ball and the shaft of the thigh bone is reduced
Weakness of the muscles that move the hip (the “effort”) can be caused by:
- Poliomyelitis – a disease that can cause paralysis and muscle weakness
- L5 radiculopathy – an issue with one of the spinal nerve roots which can lead to pain or weakness in the hips and legs
- Damage to the superior gluteal nerve, the nerve supplying the buttock muscles
- Tendonitis of the gluteus medius and minimus, the muscles at the side of the hip
- An abscess (collection of pus) in the gluteus medius and minimus muscles
- After a total hip replacement
Risk Factors and Frequency for Trendelenburg Gait
A Trendelenburg gait is a walking issue often seen in patients who have weakness or paralysis in the muscles that pull the leg away from the body (hip abductors), or problems with the hip joint itself. This leads to difficulties in moving the leg outward.
Signs and Symptoms of Trendelenburg Gait
A Trendelenburg gait is a type of limp that can be seen in patients due to different health conditions. Some people might feel pain with this limp, while others might not. It becomes severe in some cases, causing the person to lean to one side, this type of limp is called a lurching gait. A notable characteristic of a Trendelenburg gait is that the person’s healthy hip drops during the standing phase of walking. This gait pattern can give clues about possible underlying conditions like an unhealed bone in the thigh or a developmental disorder of the hip. When muscle weakness in the hip is causing this gait, often in muscle diseases, the pathology usually affects both sides causing a waddling walk.
When examining a patient’s gait, doctors look at how the person walks, their arm swings, and observe the standing and swing phases of walking. They may also have the person walk on their toes, heels, and do a heel-toe walk. The doctor would also check if the person can stand from a squatting position and at the same check the Romberg sign, which tests their balance. If the patient exhibits a lurching or waddling walk, the doctor will examine the hip’s abductor mechanism closely.
It can be challenging to notice a mild Trendelenburg gait when the patient is fully clothed. In such cases, a Trendelenburg test is performed. To do this test, the examiner stands behind the patient, who is asked to lift each foot off the ground alternatively for at least thirty seconds. In healthy individuals, the unsupported side of the pelvis slightly rises; however, if the abductor mechanism is weak, then the pelvis drops towards the unsupported side. If this drop is noted in the standing position, it indicates a positive Trendelenburg test.
It’s important to note that this test should be performed only if the person doesn’t have painful hip pathology and doesn’t have any deformity in moving their hip inwards or outwards. Certain limitations of the Trendelenburg test include that in some athletes and asymptomatic patients with hip problems, the pelvis drop does not correspond to hip abductor weakness. Also, in early stages of a condition called osteonecrosis, despite having a weak abductor mechanism, the Trendelenburg sign and gait may not be apparent. Also, certain healthy individuals may have their pelvis drop even if their abductor mechanism is normal.
Last but not least, it’s important to distinguish between a Trendelenburg gait and an antalgic gait. Both types of gait result in a limp. An antalgic gait, however, is a limp caused by pain when weight bearing on the affected side. It’s observed when the affected lower extremity has a shortened weight-bearing phase. In contrast, the Trendelenburg is caused by weakness in the hip abductor mechanism.
Testing for Trendelenburg Gait
When a doctor notices you’re walking in a strange or unusual way, which is called an abnormal gait, they’ll carry out a detailed physical examination. This means they will be carefully checking out your hip joint, the top part of your thigh bone (which is called the upper femur), and the muscles around your hip, particularly those called the abductors. These muscles help you move your leg away from the middle of your body.
Your doctor may also use a variety of imaging tests to help figure out what might be causing your abnormal gait. This might include x-rays, a type of ultrasound (which uses sound waves to create images of the inside of your body), CT scans (which use a computer to create detailed images from different angles), and MRI (which uses a large magnet and radio waves to make detailed images of organs and tissues).
Blood tests might also be performed. These can provide additional information and help to confirm the results from the imaging tests.
Treatment Options for Trendelenburg Gait
Output: When someone has Trendelenburg gait, a type of walking abnormality where the hip drops on the side of the swinging leg, it’s crucial to understand what’s causing it to provide proper treatment. This walking issue can speed up the wearing out of the hip joint so it’s important to treat it right away.
The main method of treatment is physical therapy. This type of therapy includes exercises to strengthen the gluteus medius and minimus muscles – the muscles in your buttocks that are crucial for walking. These exercises could involve lying on the side that’s not affected and lifting the leg that’s affected upwards, kind of like it’s reaching for the ceiling. To make the exercise more challenging, a rubber exercise band, also known as a theraband, can be used on the lower part of the leg. Other exercises that can help are lateral side stepping (stepping sideways) and balance exercises.
For patients who still have weakness in these muscles after hip surgery, there are specific exercises that can help. These include exercises where you stand while moving your leg out to the side (known as standing abduction) that can be done with or without putting weight on the leg, lying on your side and lifting your leg (side-lying abduction), and exercises that require stepping sideways against resistance.
Research shows that exercises involving weight-bearing (putting weight on the leg) can help patients recover better compared to non-weight-bearing exercises. Gait training, a type of physical therapy that helps improve the way you walk, can be beneficial too since it can make up for the weakness in the hip muscles.
Studies suggest that surgery might be required for patients who have a tear in their gluteus medius muscle (one of the main muscles in the buttocks) and weakness in hip abduction (moving the leg away from the middle of the body), particularly if the muscle strength is significantly reduced and there’s disturbance in the way they walk.
What else can Trendelenburg Gait be?
When trying to identify Trendelenburg gait, it’s essential to rule out other walking styles that may look similar. These could include:
- Functional gait disorder: which is common yet difficult to diagnose
- Short limb gait
- Antalgic gait
- Extension lurch gait
- High stepping gait
- Stamping gait
To correctly identify the type of gait, a detailed patient history and physical examination are crucial.
What to expect with Trendelenburg Gait
Trendelenburg gait, a condition that affects how a person walks, can be effectively treated no matter the cause. It’s key that any changes in a person’s walk are noticed quickly, as a fast diagnosis and appropriate treatment of the main condition contributing to this change can greatly improve the chance of a good recovery.
Possible Complications When Diagnosed with Trendelenburg Gait
If a Trendelenburg gait, or an abnormal walking pattern, is left untreated for a long time, it might cause further health problems in the knees or ankles. This condition speeds up the process of wear and tear, especially in the hip joint. The areas of the hip that are not usually used in normal walking are the most affected, particularly in athletes.
Ignoring a Trendelenburg gait can also result in a condition called dynamic lower extremity valgus. Here’s how it happens: the pelvis on the good side lifts up, leading to the body leaning towards the affected side. This steers the force coming from the ground towards the outer side of the knee joint. Over time, this can result in a valgus knee, or a knee that bends outwards on the affected side, causing knee pain.
This information can be summarized into the following points:
- Chronic untreated abnormal Trendelenburg gait can cause secondary issues in the knees and ankles.
- The condition speeds up wear and tear in the hip joint.
- The parts of the hip not usually used during normal walking are most affected, especially in athletes.
- Untreated Trendelenburg gait can lead to dynamic lower extremity valgus.
- The force from the ground is directed towards the outer knee joint, leading to an outward bent knee.
- This can cause knee pain over time.
Preventing Trendelenburg Gait
People should know about conditions like Trendelenburg gait and other unusual walking patterns. It’s important to get medical help quickly if you notice these patterns, as this can stop any permanent harm from happening to your hip joint. Trendelenburg gait is a condition characterized by the hip dropping on the side of the raised foot during walking.
