L5 Pathologic gait

Question 1

What can we do after performing an observational gait analysis for patient if issue is skeletal?

Answer 1

Peds can change skeletal development up to 6-7, by 16 W 19 M skeletal development done and can only change muscles around skeleton
orthotics
refer to orthopedics for painful acute or chronic skeletal issue

Question 2

discern skeletal gait abnormality

Answer 2

1. skeletal length of LE
2. limbs move predictable but abnormal pattern, consistent deviation
3. standing alignment, ROM, limb alignment

Question 3

skeletal gait abnormalities

Answer 3

leg length discrepancy
foot progression angle: intoe or outtoe due to hip, knee, or ankle difference

Question 4

observe skeletal limb discrepancy

Answer 4

from frontal plane
look for shoulders sloping, pelvic asymmetry

Question 5

How much leg length discrepancy is significant?

Answer 5

2 cm difference in tibias or femurs

Question 6

measure leg length

Answer 6

1. standing: posture assessment - look for scoliosis and pelvis/shoulder height
2. supine leg length with tape measure (ASIS and medial malleoli) and hook lying (compare tibial tuberosities)
3. pain assessment - LBP, hip, or knee pain

Question 7

normal foot progression angle in adults

Answer 7

13-15 degrees

Question 8

issues causing out toe gait

Answer 8

tibial torsion, pronation, hip IR passively

Question 9

issues causing in toe gait

Answer 9

common in children 0-4
1. femoral anteversion (excess rotation of hip due to femoral head)
2. tibial torsion (IR)
3. club foot (unusual in US)

Question 10

test for femoral anterversion

Answer 10

prone, BL hip internal rotation
assymetry or hip IR greater than 50

Question 11

pronation mechanism in stance phase

Answer 11

tibia internally rotates, calcaneus everts, subtalar pronation
this unlocks the midtarsal joints making the midfoot more flexible
creates flattening of the foot in midstance

Question 12

disadvantage to over pronation

Answer 12

creates more stress on the medial knee in stance, increasing chance of medial OA
reduces efficiency of toe off

Question 13

common features of neurologic gait deviations

Answer 13

brain injury etiology from CVA/stroke
hemiplegia/synergistic limb patterns
clonus

Question 14

four details to include in gait description

Answer 14

1. assistive device
2. supervision level
3. involvement like hemiplegia
4. major gait issue and phase