Why Do I Walk This Way?

I was born with very severe bilateral congenital hip dysplasia. The twelve hip surgeries I had before the age of 5 allowed me to walk, but my gait has always been abnormal.

My five childhood osteotomies and use of a position brace allowed me to learn to walk. Until my tendon lengthening surgeries at age 4, I was a toe-walker and unable to flatten my foot to include my heels in my step, but that particular surgery (and subsequent physical therapy) fixed that issue. Since then, my walking pattern is a mixture of three identifiable gaits — Waddling gait, Trendelenburg gait, and Antalgic gait.

Waddling gait means that when walking the part of the pelvis of the leg moving forward moves outward and the part of the leg which is normally placed moves inward. The reason for a Waddling gait abnormality is weakness of the proximal muscles of the pelvic girdle which causes weakness of the gluteus muscles. It is often referred to as “walking like a duck” and indeed, during my entire childhood, I was teased that I walked like a duck.

The second is Trendelenburg gait, which is caused by hip abductor weakness — the pelvis tilts downwards instead of upwards on the non-weight bearing extremity. In an attempt to lessen this effect, the person compensates by a lateral tilt of the trunk away from the affected hip, thus center of gravity is mostly on the stance limb causing a reduction of the pelvic drop. This condition makes it difficult to support the body’s weight on the affected side. Trendelenburg gait is very typical of people with congenital hip dysplasia. My Trendelenburg gait is especially noticeable on the right side.

The last is Antalgic gait. An Antalgic gait is a gait that develops as a way to avoid pain while walking. It is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It is totally a response to constant hip pain, and is a reactive stance gait. In my case, this is a response to several things — my weak abductors, my limited adduction, my leg length discrepancy, and my hip height discrepancy.

You may ask, how do I know that my strange way of walking is a mix of these three gaits? I did not know the names of these gaits until I was in college. The head of the physical therapy department saw me walking one day, and approached me to ask if I had hip dysplasia. I told him that I did, and he asked me to “help him out.”

For the duration of my college experience, I was a gait model for the physical therapy department. Young physical therapy students were asked to observe my gait and determine my gait pattern(s). Once they determined this, the department head would have them develop a PT plan for this, and when they all had, he would demonstrate how to work with a patient with weak hip abductors, limited adduction, and weak medial glutes.

It made me feel good to help in this way. By identifying gaits, physical therapists can help a patient strengthen weak muscles and improve their walking ability, balance, and strength. While physical therapy can’t eliminate these gaits if the underlying causes have not or cannot be repaired, it can help each patient to lead a more independent life, and avoid falls by increasing balance and mobility.

Even now, after a total of 19 hip surgeries, including two total hip replacements in my early 30s, I still have these distinctive gait patterns. Hip replacements could not undo the prior thirty-some years of muscle development (and atrophy,) or fix my skeletal abnormalities. Even with hip replacements, my pelvis is still mis-shaped, as are the angles of my artificial hips. My skeletal abnormalities will never permit full abduction and adduction range-of-motion, which leaves my hip abductors, hip flexors, and gluteal muscles forever weakened and unable to fully function.

The severe unsteadiness that remains because of this leaves me balance-impaired. However, assistive devices, such as my rollator, dual canes, or forearm crutches, help me maintain my balance while walking or standing, and helps me prevent falls. On-going physical therapy helps me to maintain as much balance and mobility as possible.