Gait Deviations Flashcards
1
Q
Progression of gait over the supporting foot requires what?
A
Rockers
2
Q
What is the first rocker?
A
First – motion of foot from dorsiflexed to plantarflexed position during LR to achieve foot flat
3
Q
What is the Second rocker?
A
Second - Closed chain advancement of the tibia into a dorsiflexed position over a fixed foot during MSt
4
Q
What is the Third rocker?
A
Third - Begins when center of pressure is over the mets and heel lift occurs in TSt/PSw
5
Q
What is the critical event of initial contact?
A
Heel first contact
6
Q
What stance is the opposite limb in during initial contact?
A
TSt/PSw
7
Q
What position is the hip during IC? What major muscles?
A
20 flexion
Extensors
8
Q
What position is the knee during IC? What major muscles?
A
0-5 flexion
Quads
9
Q
What position is the ankle during IC? What major muscles?
A
0
Pretibials
10
Q
What is/are the critical event of LR?
A
Hip stability, controlled knee flexion, and ankle PF
11
Q
What stance is the opposite limb in during LR?
A
PSw
12
Q
What position is the hip during LR? What major muscles?
A
20 flexion
Extensors, abductors
13
Q
What position is the knee during LR? What major muscles?
A
15 flexion
Quads
14
Q
What position is the ankle during LR? What major muscles?
A
5 PF
Pretibials
15
Q
What is/are the critical event of MSt?
A
Controlled tibial advancement
16
Q
What stance is the opposite limb in during MSt?
A
ISw-MSw
17
Q
What position is the hip during MSt? What major muscles?
A
0
Abductors
18
Q
What position is the knee during MSt? What major muscles?
A
5 flexion
Quads are quiet
19
Q
What position is the ankle during MSt? What major muscles?
A
5 DF
Gastroc-soleous
20
Q
What is/are the critical event of TSt?
A
Controlled ankle DF with heel rise
21
Q
What stance is the opposite limb in during TSt?
A
TSw
22
Q
What position is the hip during TSt? What major muscles?
A
20 ext
None
23
Q
What position is the knee during TSt? What major muscles?
A
5 flexion
None
24
Q
What position is the ankle during TSt? What major muscles?
A
10 DF
Gastroc-soleus
25
What is/are the critical event of PSw?
Passive knee flexion to 40, ankle PF, 60 MTP ext
26
What stance is the opposite limb in during PSw?
IC - LR
27
What position is the hip during PSw? What major muscles?
10 Ext
| Adductors
28
What position is the knee during PSw? What major muscles?
40 flexion
| None
29
What position is the ankle during PSw? What major muscles?
15 PF
| None (Tib Ant)
30
What is/are the critical event of ISw?
Hip flexion, knee flexion
31
What stance is the opposite limb in during ISw?
LR - MSt
32
What position is the hip during ISw? What major muscles?
15 flexion
| Flexors
33
What position is the knee during ISw? What major muscles?
60 flexion
| Flexors
34
What position is the ankle during ISw? What major muscles?
5 PF
| Pretibials
35
What is/are the critical event of MSw?
Continued hip flexion, foot clearance
36
What stance is the opposite limb in during MSw?
MSt
37
What position is the hip during MSw? What major muscles?
25 flexion
| Flexors
38
What position is the knee during MSw? What major muscles?
25 flexion
| Flexors
39
What position is the ankle during MSw? What major muscles?
0 DF
| Pretibials
40
What is/are the critical event of TSw?
Knee extension
41
What stance is the opposite limb in during TSw?
TSt
42
What position is the hip during TSw? What major muscles?
20 flexion
| Flexors
43
What position is the knee during TSw? What major muscles?
5 flexion
| Quads
44
What position is the ankle during TSw? What major muscles?
0 DF
| Pretibials
45
Why do we analyze gait?
- Identify deviations to address with intervention
- Determine functional ambulation capability across variety of environments
- Assess balance, safety, endurance energy expenditure
- Need for AD/orthotics
- Describe how interventions impacted gait
46
Abnormality in gait may be caused by what?
- Pain
- Joint and/or muscle ROM limitation
- Muscular weakness/paralysis
- Impaired motor control
- Neurological involvement (UMN or LMN)
- Impaired balance
- Leg length discrepancy
47
T/F Deviations are often compensations attempting to make gait more efficient
True
48
When analyzing gait, how can you be systematic?
- Analyze from bottom up (toes to head) or top to bottom (head to toes)
- Work in segments
- Identify a reference limb
- Select a plane to start in (for example, sagittal plane first, then frontal plane), but look from all planes
- Work in phases; this will require the patient to walk back and forth several times
49
What is antalgic gait? How does it affect stance phase on affected side? Step length of uninvolved side? Lateral shift?
- Compensatory gait adopted to remove or decrease the discomfort caused by pain in the lower leg, pelvis, or lumbar spine
- Decrease in stance phase in affected side will result in decrease in swing phase of uninvolved limb and thus shortened step length on uninvolved side
- Lack of weight shift laterally over the stance limb to keep weight off the involved limb
50
What are the causes of the hip deviation forward trunk lean?
- Result of weak quadriceps (decreases flexor movement of knee)
- Hip flexor contractures
- Weak lumbar or hip extensors
- Hypomobile joint capsule
51
What are the causes of the hip deviation decreased hip extension?
- Tight hip flexors
- Decreased joint mobility (posterior roll/anterior glide tightness)
- Weak glutes
52
What is glute max role during initial contact of gait?
Contracts at initial contact, slowing forward motion of trunk by resisting flexion of the hip and initiating extension
53
If glute max is weak how will my body compensate?
- Gluteus Maximus Gait/backward trunk lean (“rocking horse gait”)
- Trunk will quickly shift posteriorly during initial contact to try and offset forward momentum, this requires less muscle strength to maintain the hip in extension during stance phase
54
What might you see with weak gluteus medius?
Hip drop contralateral side
55
How would we compensate with weak glute medius?
Trunk lean
| Hip hike
56
What is the name for knee hyperextension during gait?
Genu recurvatum gait
57
What are the possible causes of knee hyperextension during gait?
- Quadriceps weakness
- Hamstring weakness
- Increased tone of quadriceps
- Compensation for plantarflexion contracture or spasticity (tight gastroc)
1. When stretch gastric – knee straight and foot dorsi flexed (essentially Midstance)
2. Tibia progresses forward -> spastic wants to get out so tibia hyperextends to decrease dorsiflexion and decrease stretch on gastroc
58
What are possible causes of decreased knee extension?
- Quadriceps weakness (unable to straighten knee)
- Knee joint hypomobility
- Hamstring contracture or stiffness
- Strategy to avoid heel rocker (to stop advancement of knee)
59
With decreased knee extension, we will see difficulty doing what on stairs?
Going down stairs
60
What is excessive genu valgum?
Knock knee gait
| Both knees face each other widening base of support (BOS)
61
What are potential impairments/sources of genu valgum?
- Boney deformity
- Pain
- Excessive foot pronation
- Glute med weakness
- Excessive femoral adduction
- Ipsilateral trunk lean
62
What is excessive genu varum?
Bow leg gait
| Both knees face outwards
63
What are potential impairments/sources of genu varum?
Degenerative changes
Pain
Boney deformity
64
What is equinus gait? What point of body will land at initial contact?
Excessive PF during gait
| Toes
65
What might be the causes of equinus gait?
- Tib ant weakness
- Plantarflexion contracture
- Hypomobility of talocrural joint (posterior glide hypomobility)
- Compensation for short leg/short stride length (essentially making leg longer)
- Painful heel/avoiding heel rocker
66
What might equinus gait make it difficult to do?
Walk and run without tripping
67
What is calcaneal gait?
Increased DF
68
What might cause calcaneal gait?
- Contracture tib anterior
- weakness gastric
- hypomobility talocrural joint (anterior glide hypomobility)
69
What deviations would you expect with calcaneal gait?
Walking on heel
70
What is equinovarus gait?
- Club foot
- Ankle PF and subtalar inversion
- Walk on outside of foot
71
Equinovarus gait is more often seen in what age group?
Seen more often in children
72
What is foot drop (foot slap gait) often due to?
dorsiflexor weakness caused by paralysis of common peroneal nerve
73
What might foot drop (foot slap gait) look like?
Won’t be normal heel strike, instead foot comes in contact with ground as a whole with slapping sound
74
What muscles would you manual muscle test for foot drop (foot slap gait)?
Tib anterior
75
What muscle do you worry about becoming too tight for foot drop gait?
PF (difficulty getting into DF)
76
How might someone compensate for foot drop gait?
Steppage gait (bigger step to clear foot)
Circumduction
Vaulting
77
What is foot flat gait and what might cause it?
- Entire foot contacts ground (no heel strike)
- Weak dorsiflexors
- limited ROM
- hypomobility (posterior joint capsule)
- normal immature gait pattern (neonatal)
78
In excessive supination gait, what part of foot would they likely land on?
Excessive lateral contact of foot during stance with varus position of foot (land and stay in supination)
79
What might cause excessive supination gait?
- Hypomobility of subtalar and/or midtarsal joints
- spastic invertors or intrinsic foot muscles
- weak evertors
- genu varum (bow legged)
80
In excessive pronation gait, what part of foot would they likely land on?
Excessive medial contact of foot during stance with valgus position of foot
81
What might cause excessive pronation gait?q
- Foot intrinsic muscle weakness (helps support arch)
- Posterior tibialis weakness (helps support arch)
- Hip abductor weakness (collapse inward at hip)
- Hypomobility of subtalar and/or midtarsal joints
82
What might cause Inadequate push-off (during terminal stance/pre swing)?
- Result of weak plantar flexors
- Tight/spastic dorsiflexors
- Hypomobile talocrural joint
- Pain in forefoot (won’t want to bear weight so limit push off)
83
What is normal degree of anterior pelvic tilt during gait?
10-30 to facilitate leg to ground
84
Excess anterior pelvic tilt can lead to what two things?
Lumbar lordosis
| Low back pain
85
What are potential causes of excessive anterior pelvic tilt?
- Weak hip extensors
- Hip flexion contracture
- Abdominal muscle weakness
- Limited hip extension ROM
86
Excessive posterior pelvic tilt is caused by what?
- Tight hamstrings
| - Hip flexor weakness (posterior tilt acts as a substitution to create relative hip flexion)
87
Excessive posterior pelvic tilt limits what and can cause what?
Limited lumbar extension
| Low back pain
88
What is an anatomical leg length discrepancy (LLD)?
legs are actually different lengths as confirmed with x ray or tape measurements
89
What is a functional leg length discrepancy (LLD)?
on x-ray the leg lengths are equal, but for some reason they appear longer could be due to tightness, weakness, compensation, etc. (glute med weakness)
90
What are 4 compensations for LLD?
- Circumduction
- Hip hiking
- Steppage gait
- Vaulting
91
What is circumduction?
During swing phase
| Clears leg by swinging out in circular pattern
92
What is hip hiking?
activating lateral trunk musculature
93
What is steppage gait?
exaggerated hip and knee flexion to compensate for excess plantar flexion at the ankle
94
What is vaulting?
Patient will rise up on stance phase toe to clear contralateral leg for swing phase
95
What is waddling gait? What are the potential causes?
- Someone trying to regain their balance
- Tight IT band
- Contralateral hip abductor weakness
- Limited hip or knee flexion- leans to contralateral side to compensate to clear foot
- Commonly seen with pain in hip related to arthritis
96
What are the clinical correlations of widened BOS? Commonly seen in what population?
- More lateral movements of trunk (less efficient)
- May indicate imbalance or fear of falling
- Observed with decreased proprioception, cerebellar ataxia, etc (balance concerns)
97
What are the clinical correlations with narrow BOS? Commonly seen in what population?
- Adduction deformity of the hip
- Varus deformity of knee
- Increased hip adduction (increased tone, muscle tightness) during swing causing swing limb to cross over stance limb for contact
- Commonly observed in those with Cerebral Palsy
98
If narrow BOS is severe enough, what will it be referred to?
Scissoring gait
99
Describe the spastic pattern of hemiplegic leg?
- Hip into extension, adduction, and medial rotation
- Knee in extension
- Ankle in drop foot with plantar flexion and inversion, present during both stance and swing phases
- Spastic muscles won’t allow hip and knee to flex to clear the floor
100
How does hemiplegic leg affect gait?
- Patient often performs circumduction
- Usually with no reciprocal arm swing
- Step length tends to be lengthened on involved side and shortened on uninvolved side
101
What is sensory ataxic gait? Often seen in patients with what disorder?
- presence of abnormal and uncoordinated movements
- Referred as ataxic because walking is uncoordinated and appears to be “not ordered”
- Often seen in individuals with cerebellar disorders
102
What is festinating gait (describe CoG and BoS)? Seen in patients with what disorder?
- Displacement of CoG anteriorly
- In order to keep CoG within BoS, patient will shuffle their steps and will walk faster in an attempt to avoid losing their balance
- Because of rigidity all joints will want to flex forward
- Most often seen in Parkinson’s Disease, but can be seen in other basal ganglia diseases
