Lec 4- Gait Deviations

Question 1

Definition of “gait abnormality or deviation”

Answer 1

any variation from the standard gait phases that involves the arms, trunk, pelvis, hip, knee, or ankle

Question 2

Etiology of gait abnormality may be

Answer 2

1. Normal aging
2. Pharmaceutical
3. Disease
4. Injury

Question 3

Why does gait deviation occur?

Answer 3

-Biomechanical (joint, skeleton), muscular, and neuromuscular (cortex, brain, cerebellum, and peripheral nerve) pathologies

Question 4

Singular disease or several different systems (muscular and skeletal)

Answer 4

may cause a gait deviation (foot drop)

Question 5

Before performing a gait analysis…

Answer 5

be sure to have a diagnosis or a condition to assist in analysis. Diagnosis will assist you in knowing if the problem stems from a muscular, skeletal, or nervous system problem.

Question 6

Clinical Assessment of Gait Deviations

Answer 6

1. observational gait analysis is always performed with a clinical assessment
2. Note the deviations using a form or note
3. Additional outcome measures: gait velocity & specific gait measures

Question 7

Trunk Gait Deviation Terminology

Answer 7

-Lateral lean (left/right)
-Lateral lean (back/forward)
-Lateral rotation (left/right)

Question 8

Pelvic Gait Deviations- Rotation

Answer 8

Normal Pelvic Rotation: reference limb forward accompanied by ipsilateral pelvis protraction, movement into swing phase accompanied by pelvic retraction

Excessive pelvic rotation: hip flexor weakness during swing phase accompanied by excessive pelvic rotation, hip fusion will not allow normal pelvic anterior rotation on contralateral side

Question 9

Pelvic Gait Deviations- Elevation

Answer 9

elevating pelvis during swing phase (initial swing/mid swing) used to clear foot during swing limb advancement

Question 10

Gluteus medius and pelvic/trunk deviations

Answer 10

1. Abductor lurch or gluteus medius gait: trunk lateral lean toward involved side during stance phase- to balance body weight over femoral head (eliminating need for muscle contraction and decreased torque)
2. Trendelenburg gait: contralateral limb during swing phase drops below horizontal
3. Pelvic drop: ipsilateral pelvic drop d/t leg length discrepancy
4. Waddling Gait: bilateral pelvic drop

Question 11

Hip Gait Deviations

Answer 11

1. Gluteus maximus gait/Extensor lurch: weakness in glute max during stance phase leads to thrusting trunk posteriorly (trying to maintain hip extension)
2. Hip hike and circumduction: pt w/ drop foot or stiff knee flexion hike ipsilateral pelvis to clear floor

Question 12

Knee Gait Deviations

Answer 12

1. Knee hyperextension/recurvatum (SLS): weakness of quad may develop back knee gait in midstance- to lock knee and prevent knee from buckling and going into excessive flexion
2. Knee flexion (SLS): knee flexion during midstance
3. Knee varus: normal slight varus in midstance to increase pressure at proximal medial knee, excessive varus result of prosthetic

Question 13

Ankle Gait Deviations

Answer 13

1. Foot drop or high steppage gait: swing phase abnormality d/t weakness/paralysis of ankle DF- compensation by flexing hip and knee of ipsilateral limb to avoid toe drag
2. Flat foot gait or calcaneal gait: inability to push off d/t rigidity or pain in forefoot. rather than pushing off toes, whole foot brought up from ground (weakness of calf muscles)
3. Vaulting: pronounced plantar flexion of ankle to elevate COM to assist in clearance of prosthetic limb in swing phase (prosthesis may be too long)

Question 14

Ankle Gait Deviations continued…

Answer 14

Foot slap gait: rapid plantar flexion immediately after IC, insufficient PF resistance in prosthetic

Heel off gait: heel not in contact with ground during LR or midstance

Question 15

Ankle most common deviation

Answer 15

Foot drop: observed throughout gait cycle, esp during swing phase
Various etiologies: peripheral nerve injury and neuromuscular diseases