Duck gait is detected in congenital and acquired diseases of the hip joint, Kashin-Beck disease, osteomalacia of various origins, myopathies, Lambert-Eaton syndrome. Can be single or double sided. The reason is established on the basis of anamnestic data, the results of a survey, an external examination, a neurological examination, radiography, CT, electrophysiological studies, and other instrumental and laboratory techniques. Treatment is determined by the etiology of the disorder, includes drug therapy, exercise therapy, physiotherapy, and surgical interventions.
The duck gait is a gait "rolling", "rolling over" from one foot to the other. It is a consequence of paresis or weakness of the abductor muscles of the thigh. Can be double sided or single sided. In the first case, a typical "rolling" pattern is revealed, reminiscent of the gait of a duck. In the second, a pronounced asymmetry of walking is observed.
There are two variations of the duck walk. Duchenne's lameness is observed with partial preservation of the function of the abductors. The patient strongly unbends the body in the direction of the supporting leg, this allows you to move the affected leg forward without shifting the pelvis. Trendelenburg's lameness accompanies complete paralysis of the abductor muscles. In this case, the overextension of the body is not enough, the patient is forced to shift the pelvis towards the leg that carries out the movement.
Primary myopathies are hereditary, caused by hereditary metabolic disorders in muscle tissues. Often manifest under the influence of external factors: injuries, acute infections, intoxication, physical overload. Symptoms gradually progress. The duck gait is complemented by a total loss of muscle mass (pseudohypertrophy of the muscles is sometimes possible).
Patients feel weak, move with difficulty, cannot run or jump, use special techniques to get up from a chair and move from a horizontal to a vertical position. Symptoms are detected in the following hereditary progressive muscular dystrophies:
Along with hereditary myopathies, there are pathologies with similar symptoms that have arisen against the background of bacterial, viral and parasitic infectious and inflammatory processes in the muscles. In addition, duck-gait myopathies can develop with dermatomyositis, polymyositis, inclusion myositis, and some metabolic diseases.
It has a secondary autoimmune character. In more than half of the cases, it is provoked by malignant tumors (primarily small cell lung cancer) and is considered as part of the paraneoplastic syndrome, moreover, the manifestations of myasthenia gravis can be several years ahead of the symptoms of an oncological lesion of a particular organ.
Less commonly, the syndrome is observed in autoimmune diseases (SLE, rheumatoid arthritis). Duck gait is a typical sign of Lambert-Eaton pathology. The reason for the change in walking pattern is that muscle weakness is most pronounced in the upper legs. Patients complain of weakness in the lower extremities. Perhaps a combination with myalgia, sensitive and vegetative disorders.
The duck gait is formed with the beginning of walking. Early signs that appear in the first months of life are asymmetry of skin folds, limitation of hip abduction, shortening of the diseased limb, external rotation (turning the foot outward in the supine position). In the absence of treatment of congenital hip dislocation, gait disturbances persist, at the age of 25-3 years, deforming coxarthrosis develops, which aggravates difficulties in movement.
An endemic disease caused by an imbalance of minerals in the water of some regions. Accompanied by multiple deformities of the limbs and impaired joint mobility. Duck gait is determined at the 3rd stage of Urov's disease, occurs against the background of generalization of skeletal changes. Patients are undersized, short-toed. The neck is also shortened, hyperlordosis, pronounced varus or valgus curvature of the limbs, flat feet and visual expansion of the feet are found.
Inflammation of the sacroiliac joint can be aseptic or nonspecific purulent, develop against the background of tuberculosis, syphilis, brucellosis. Duck gait is not a mandatory symptom of pathology, it is determined in individual patients, it often accompanies chronic aseptic sacroiliitis. It is combined with pain in the sacrum, movement restrictions, decreased tolerance to stress on the limb.
It is formed against the background of chronic kidney diseases, due to changes in the structure of bones due to violations of mineral metabolism. The severity of osteodystrophy, the severity of the duck gait, the likelihood of pathological fractures correlate with the degree of renal failure. It can be determined in diseases of the following groups:
Along with kidney diseases, hypovitaminosis D and aluminum intoxication are possible causes of bone structure disorders. Previously, osteomalacia has been reported in people with nutritional malnutrition due to malnutrition. Now in developed countries this problem has lost its relevance. Anorexia is more often the cause of duck gait due to malnutrition.
Depending on the presumed etiology, duck gait is diagnosed by neurologists or orthopedic traumatologists. The collection of complaints and anamnesis provides for the establishment of the time of occurrence and features of the progression of gait disorders, the presence of other manifestations. The doctor evaluates the dynamics of the development of the symptom, finds a connection with others with other diseases.
During a general examination, the specialist reveals external changes characteristic of myopathies (decrease in muscle mass, protruding abdomen, pterygoid shoulder blades), renal edema, bone deformities and other signs indicating a possible genesis of the disease. According to the results of the survey and physical examination, the following are appointed:
Therapeutic tactics is determined by the cause of the pathology that caused the duck gait. With congenital dislocations of the hip, therapy begins from the first days of life. The baby's legs are fixed with a special tire, which in some cases makes it possible to achieve comparison of the acetabulum and the femoral head. In children older than 1 year, the effectiveness of conservative measures is sharply reduced, but sometimes even they manage to do without surgery.
In Urov's disease, non-surgical methods are effective mainly in the initial stages, before the development of duck gait. Drug therapy for pathology includes vitamins, calcium and phosphorus preparations, medicines to stimulate regenerative processes. Patients are referred for exercise therapy, massage, ultrasound, UHF, radon baths.
In the presence of Lambert-Eaton syndrome, the treatment is based on the fight against the tumor process. Radiation therapy, chemotherapy, combined techniques can be used. In the pathology of autoimmune genesis, glucocorticosteroids are used. To improve neuromuscular transmission, patients are prescribed acetylcholinesterase inhibitors. In renal osteodystrophy, the underlying disease is treated.
Pathogenetic therapy of hereditary myopathies has not yet been developed. Carry out symptomatic measures to improve the metabolism of muscle tissue using B vitamins, neostigmine, ATP, anabolic steroids, anticholinesterase agents. Patients are recommended massage, exercise therapy, electrophoresis with neostigmine. It is possible to use special rehabilitation simulators. Some patients require orthopedic appliances. With acquired myopathies, treatment of the underlying disease is necessary.
Patients can undergo the following interventions aimed at eliminating the cause of the disease, correcting the duck gait and other orthopedic consequences: