Lec 5- Pathologic Gait Analysis

Question 1

Clinicians in physical rehabilitation assess gait to…

Answer 1

Discern whether problem is from…
-Skeletal
-Muscular
-Neurologic
-or pain (antalgic gait)

Question 2

Skeletal gait problems

Answer 2

-less likely for PT interventions to adapt or change system
-orthotics, gait adaptation, or assistive devices are necessary
-painful acute and chronic skeletal issues should be referred to orthopedics

Question 3

Skeletal system sets framework for mvmt and gait…

Answer 3

1. supports body weight against pull of gravity
2. supports body when standing
3. works together as lever system

Question 4

How to discern skeletal gait problems?

Answer 4

1. skeletal length in lower limbs
   -leg length discrepancy is common
2. discern whether there is a consistent gait deviation (limbs moving in predictable but abnormal pattern)
3. observe and perform standing alignment, ROM, and various limb alignment assessments

Question 5

Common skeletal gait abnormalities

Answer 5

1. Leg length discrepancy
2. Foot progression angle (hip, knee, and ankle): intoe and outtoe gait

Question 6

How much discrepancy is too much?

Answer 6

> 2cm
-d/t tibia or femur
-previous broken bone, bone infection, juvenile arthritis or arthropathies

Question 7

Skeletal Limb Discrepancy Presentation

Answer 7

Contralateral shoulder drop and ipsilateral pelvis elevation (to clear longer limb during swing)

Question 8

Assessing Leg Length

Answer 8

1. Standing posture assessment- scoliosis or pelvis/shoulder height
2. Supine leg length- tape measure, hooklying
3. Pain assessment- LBP, hip or knee pain

Question 9

Foot progression angle definition

Answer 9

angle between direction of gait and direction of foot (internal, neutral, external), seen most in swing phase, estimated in stance phase
Normal FPA: 13-15 degrees (ER)

Question 10

E. FPA: Out toe gait

Answer 10

Caused by skeletal issues:
1. Pronation
2. External tibial torsion
3. Hip Internal Rotation

Question 11

I. FPA: In toe gait

Answer 11

common in children up to 4y, children will “grow out of this posture”, there are pathologies in children and adults
1. Tibial torsion
2. Femoral anteversion
3. Posture in foot

Question 12

Femoral Anterversion

Answer 12

Normal hip anteversion of 15 degrees relative to knee
-Excessive rotation of hip (>15 degrees anteversion) in adolescents and adults
-Pt unable to walk with foot forward so attempt to bring hip deeper into socket by in toe gait
-if hip IR is >50 degrees suspect femoral anteversion if over 15yr

Question 13

Tibial torsion

Answer 13

Rotation of tibia relative to femur

Question 14

In toe posture in foot

Answer 14

-front of foot points towards midline, spotted by seeing too much of forefoot to inside of heel
-unusual to have untreated club foot in US
-orthotics (gait plate) can assist

Question 15

Exams to assess FPA

Answer 15

1. Walking assessment
2. Standing assessment with dogs
3. Femoral anteversion: bilateral hip rotation in prone (>50 deg IR)
4. Tibia Torsion: prone thigh-foot angle, sitting tibial torsion, or standing assessment of patellar alignment
5. foot or forefoot intoeing: prone

Question 16

Caveat about rotational abnormalities

Answer 16

-discern whether skeletal, muscular, or neurologic
-typically skeletal, difficult for PT’s to improve
-orthotics may assist but will not fix primary issue

Question 17

Pronation during gait

Answer 17

-calcaneus everted, calcaneus sets up midfoot into pronation
-out toeing occurs in severe pronation
-worsens with walking/running

Question 18

Stance phase mechanics w/ pronation

Answer 18

-Tibia IR
-calcaneus eversion and subtalar joint pronation
-midtarsal joint unlocks (inefficient toe off)
-increased midfoot pliability
-increased forced during stance in medial knee
-plantar pressure distribution must be adjusted for initial pronation (pressure moves medially)

Question 19

Neurologic Gait Deficits

Answer 19

Etiology is brain injury (CVA or stroke)
-synergistic pattern in limbs (hemiplegia)

Question 20

How to describe gait pattern

Answer 20

1. assistive device
2. supervision level
3. involvement (hemiplegia, quadriparesis, diplegia)
4. major gait issues: stance phase and swing phase