A Trendelenburg gait is characterized by a certain walking style. It causes you to appear like you're swaying from side to side when you're walking. It may look as though you're missing steps or perhaps limping. This type of gait is caused by weakened muscles and can lead to chronic pain and long-term issues in your knees and ankles if not treated properly.
What Is Trendelenburg Gait?
Trendelenburg gait occurs when your hip abductor muscles are very weak. This muscle group includes the gluteus medius and gluteus minimus muscles, located in the area of your butt. When these muscles are not strong enough, your pelvis will droop on the opposite side of the body from the affected muscles.
This type of walking pattern is named after German surgeon Friedrich Trendelenburg. He first reported this gait in 1895 after developing a physical exam that identified weakness in the hip abductor muscles.
What Are Trendelenburg Gait Causes?
A person's gait consists of two phases. When your leg moves forward in the swing phase (off the ground), your other leg balances you in the stance phase (on the ground). Due to weak hip abductor muscles, the pelvis tilts down instead of up with a Trendelenburg gait.
To balance themselves, a person will tilt their body away from the affected hip, moving the body’s center of gravity to reduce the pelvic drop.
Many times, the muscle weakness that causes the Trendelenburg gait starts with damage to the superior gluteal nerve, which originates in the pelvis and ends in the gluteus minimus muscle. When this nerve is damaged, it's hard for the affected side to support the weight of the body.
Nerve damage or muscle weakness can be caused by many different things, including:
- Osteoarthritis (caused by aging joints, injury, or obesity)
- Trauma to the hip, including surgery
- Neurological conditions, like cerebral palsy, stroke, etc.
- Developmental disorders of the hip
How Is Trendelenburg Gait Diagnosed?
A physical examination and overview of your medical history are necessary to accurately diagnose Trendelenburg gait and rule out other gait disorders caused by weak hip muscles. Those might include:
- Antalgic gait
- High stepping gait
- Extension lurch gait
- Stamping gait
A simple test can determine if you have Trendelenburg gait. During this physical examination, you'll stand on one leg. If the pelvis of the lifted leg tilts upward, you'll end up with a negative result. If the pelvis of the lifted leg tilts downward — or the hip drops — this indicates a positive Trendelenburg sign.
Alongside this test, an X-ray may also be done to diagnose Trendelenburg gait.
What Is the Treatment for Trendelenburg Gait?
There are several ways to treat Trendelenburg gait:
Physical therapy. Physical therapy can reduce the effects of the weakened hip muscles and help improve your gait.
Therapy focuses on moving your leg in different directions to help your joints get used to proper directional motions. This increases muscle resistance and strength.
Medication. Anti-inflammatories, such as acetaminophen and ibuprofen, can be used to help ease discomfort caused by this gait. Continued pain can be treated with steroid injections.
Surgery. Surgeries may include an osteotomy and arthroplasty. An osteotomy is the cutting and/or removal of bone, while arthroplasty involves the surgical reconstruction of a joint.
Osteotomies in the pelvis result in substantial improvement in walking tolerance, posture, and overall gait pattern.
What Are the Long-Term Effects of Untreated Trendelenburg Gait?
Chronic untreated Trendelenburg gait can lead to long-term complications in your knees and ankles. It also speeds up the effects of degenerative arthritis. The “wear and tear” appears at the hip joint in areas that aren't usually affected by a normal gait.
Left untreated, Trendelenburg gait can lead to extreme elevating of the pelvis on the unaffected side. This ultimately causes outward bowing of the knee joint, leading to knee pain over time. Other potential complications of chronic untreated Trendelenburg gait include pinched nerves, hip grinding, the need for a walker or wheelchair, or death of bone tissue.
