Foot Care Flashcards
(27 cards)
Antalgic Gait
An antalgic gait is a gait that develops as a way to avoid pain while walking (antalgic = anti- + alge, “against pain”).
painful (antalgic) gait may occur if patient is protecting an injury to the foot, ankle, knee hips or pelvis
usually the STANCE phase on the affected leg is shorter in duration because the patient attempts to remove affected leg from weight bearing – therefore- note and compare stance phase of the two legs
decreased walking velocity = decreased steps per minute (normal is 90-120 steps/minute)
observe if the hand is supporting the painful area
Ataxic Gait
Abnormal gait due to poor sensation or lack of muscle coordination
Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that includes gait abnormality. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum.
may be due to drinking alcohol
patient’s gait / walk lacks balance, may appear irregular, jerky, weaving and staggering
Arthrogenic gait
stiff hip or knee or ankle due to stiffness, laxity or deformity
joint related pathologies (examples of joint pathologies are osteoarthritis, hip joint problems such as avascular necrosis of the femoral head, rheumatoid arthritis, etc…)
Trendelenberg’s Gait
This abnormal gait is due to gluteus medius weakness or paralysis.
trendelenburg’s sign ( hip popping out on the weight bearing side) may be seen
Lurching Gait
due to paralysis or weakness of the gluteus maximus
hand drops down, thorax moves posteriorly on the affected arm – patient walks lurching forward
Parkinsonian Gait
short steps
wide base of support (unstable when walking)
shuffling steps
Parkinsonian gait (or festinating gait, from Latin festinare [to hurry]) is the type of gait exhibited by patients suffering from Parkinson’s disease. This disorder is caused by a deficiency of dopamine in the basal ganglia circuit leading to motor deficits. Gait is one of the most affected motor characteristics of this disorder
Psoatic Limp Gait
due to psoas muscle spasm, and/ or edematous and/ or inflamed psoas bursa
limitation of movement due to pain & produce a atypical gait.
causes flexion, adduction and lateral (external) rotation of the leg or hip, also knee in slight flexion (positions seem to relieve tension of the muscle & hence relieve the inflamed and tight structures)
Scirssors Gait
one leg crosses in front of the other – like walking on the catwalk
due to spasticity in the thigh adductors
short/ tight adductors
Scissor gait is a form of gait abnormality primarily associated with spastic cerebral palsy. That condition and others like it are associated with an upper motor neuron lesion.
Steppage Gait
anterior compartment of the lower leg (dorsiflexors) are weak or paralyzed
elevation of the hip on the affected side for toe to clear the ground
Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking.
Hemiplegic Gait
due to cerebrovascular disease / hemiplegia
partial (unilateral) weakness or paralysis
on the affected side you would see:
internal rotation of the shoulders
flexion of the elbow and wrist
flexion and adduction of the hip
flexion of the knee
arm flexed, adducted and internally rotated
leg on same side is in extension with plantar flexion of the foot and toes
Contracture
Contractures in the lower limb. Nerve or joint pathology and deformities can cause contractures (eg. polio, gastrocnemius contracture, fixed knee flexion deformity, osteophyte formation in the knee, contractures from scars, burns etc.)
prolonged immobilization can also cause muscle contractures that affect walking
example of contractures from prolonged immobilizations are lack of activity and prolonged sitting or wheelchair ambulation after surgery. Contractures may be prevented by avoiding over tightening of the muscles and appropriate postoperative positioning maintained.
exercises to strengthen the muscles controlling the joint may also help along with passive stretching
Number of bones, ligaments, and muscles in the foot
28 bones, 214 ligaments, 38 muscles
Sagittal Plane
in half from side to side: dorsi and plantar flexion
frontal plane
divide front to back: inversion and eversion
transverse plane
divide top and bottom: abduction and adduction
supination
dorsiflexion, adduction, and inversion
what portion of gait cycle is stance phase?
60% - this is the weight bearing portion
swing phase
40% of gait cycle - non-weight bearing
Diabetic Charcot Neuropathy
chronic and progressive disease that occurs as a result of loss of protective sensation which leads to the destruction of foot and ankle joints and surrounding bony structures.
Diagnosis can be made clinically with a warm and erythematous foot with erythema that decreases with foot elevation. Radiographs often reveal obliteration of joint space and fragmentation of both articular surfaces of a joint leading to subluxation or dislocation.
Symptoms of Charcot neuropathy
swollen foot and ankle
pain in 50%, painless in 50%
loss of function
Eichenholtz Classification
Stage 0
Joint edema
Radiographs are negative
Bone scan may be positive in all stages
Stage 1
Fragmentation
Joint edema
Radiographs show osseous fragmentation with joint dislocation
Stage 2
Coalescence
Decreased local edema
Radiographs show coalescence of fragments and absorption of fine bone debris
Stage 3
Reconstruction
No local edema
Radiographs show consolidation and remodeling of fracture fragments
acute charcot neuropathy
inspection
swollen
warm
average of 3.3 degrees C warmer than contralateral side
erythema
often confused with infection
erythema will decrease with elevation in Charcot arthropathy, but is unchanged in infection
chronic Charcot neuropathy
inspection
structurally deformed foot
bony prominences
rocker bottom deformity
collapse of medial arch
motion
may be ligamentously unstable
neurovascular
Semmes-Weinstein monofilament (5.07) testing
sensitivity of 40-95% in diagnosing neuropathy
onychia
inflammation of the nail bed resulting in loss of the nail
