Abnormal (Atypical) Gait - Chapter 22

Front 1

Gluteus Maximus Gait

Back 1

The trunk quickly shifts posteriorly at heel strike (initial contact). This will shift the body's center of gravity posteriorly over the gluteus maximus, moving the line of force posterior to the hip joints. With the foot in contact with the floor, this requires less muscle strength to maintain the hip in extension during stance phase. The shifting is sometimes referred to as a rocking horse gait because of the extreme backward-forward movement of the trunk.

Front 2

Gluteus Medius Gait

Back 2

The individual shifts the trunk over the affected side during stance phase. The left gluteus medium, or hip abductor, is weak, causing two things to happen: 1) the body leans over the left leg during that leg's stance phase, and 2) the right side of the pelvis drops when the leg leaves the ground and begins swing phase.

Front 3

Quadriceps

Back 3

By leaning forward at the hip, the center of gravity is shifted forward and the line of force now falls in front of the knee. This will force the knee backward into extension. Another compensatory maneuver is suing the hip extensors and angle plantar flexors in a closed-chain action to pull the knee into extension at heel strike (initial contact). In addition, the person may physically push on the anterior thigh during stance phase,holding the knee in extension.

Front 4

Hamstrings

Back 4

During stance phase, the knee will go into excessive hyperextension, sometimes referred to as Genu Recurvatum gait. Without the hamstring to slow the forward swing of the lower leg during the deceleration (terminal swing) part of swing phase, the knee will snap into extension.

Front 5

Equinus Gait

Back 5

Weak ankle dorsiflexion may not be able to support the body weight after heel strike and will thus move toward foot flat (loading response) as they eccentrically contract. The result is foot lap. With the dorsiflexors not being able to slow the descent of the foot, the foot slaps into plantar flexion as more weight is put on the leg. During swing phase, they may not be able to dorsiflex the ankle. Gravity will cause the foot to fall into plantar flexion when it is off the ground This is called drop foot.

Front 6

Triceps Surae Group

Back 6

(The gastrocnemius And Soleus) is weak, there is no heel rise at push -off (terminal stance), resulting in a shortened step length on the unaffected side. This is sometimes referred to as a sore foot limp. Although this gait is noticeable on level ground, it becomes most pronounced when walking up an incline.

Front 7

Wadding Gait

Back 7

Is commonly seen with muscular and other types of dystrophies, because there is diffuse weakness of many muscles groups. The person stands with the shoulder behind the hips, much like a person with paraplegia would balance resting on the iliofemoral ligament of the hips. There is an increase lumbar lordosis pelvic instability, and Trendelenburg gait. Little or no reciprocal pelvis and trunk rotation occur.

Front 8

Hip Flexion Contracture

Back 8

The involved hip is unable to go into hip extension and hyperextension during the midstance and push-off phase (terminal stance). To compensate, the person will commonly assume the salutation or greeting position in which the hip is flexed and the person's trunk leans forward as if bowing. The involved leg may also simultaneously flex the knee when it normally would be extended.

Front 9

Fused Hip

Back 9

Increased motion of the lumbar spine and pelvis can greatly compensate for the hip motion. A decreased lordosis and posterior pelvic tilt will allow the leg to swing forward, whereas an increased lordosis and anterior pelvic tilt will swing the leg posteriorly. This is sometimes referred to as a bel-clapper gait. A bell swing back and forth, causing the clapper inside to also move back and forth.

Front 10

Knee Flexion Contracture

Back 10

Will result in excessive dorsiflexion during midstance and an early heel rise during push-off (terminal stance) .There is also a shortened step length of the unaffected side. If a knee fusion s present, the lower leg will be a fixed length. That length will depend on the position of the joint. If the knee is in extension, the leg will be unable to shorten during swing phase.

Front 11

Circumducted Gait

Back 11

The leg begins near the midline at push-off (terminal stance), swings out to the side during swing phar, then returns to the midline for heel strike.

Front 12

Abducted Gait

Back 12

It is called like this if the leg remains in an abducted position throughout the gait cycle.

Front 13

Triceps Surae Contracture

Back 13

The knee can be forced into excessive extension during midstance, because there is insufficient length of the plantar flexors to allow dorsiflexion. There will be either limited ankle dorsiflexion to the knee will be pulled into extreme extension. In weight-bearing, body weight may force a certain amount of dorsiflexion, thus forcing a tight gastrocnemius to pull the knee into extension. In addition an early heel rise will occur during rush-off (terminal phase), the knee will be lifted higher during swing phase, and the toes will land first during heel strike (initial contact).

Front 14

Ankle Fusion

Back 14

Is commonly called triple arthrodesis because of fusion of the butter joint and the two articulations making up the transversal joint. This will result in loss of ankle pronation and supination. Plantar flexion and dorsiflexion will remain but will be limited.

Front 15

Hemiplegic Gait

Back 15

Is an extension synergy in the involved lower extremity. The hip goes into extension, adduction, and medial rotation. The knee is in extension, through often unstable. The ankle demonstrates a drop foot with ankle plantar flexion and inversion (equinovarus), which is present during both stance phase and swing phase. The involved upper extremity may typically be in a flexion synergy.

Front 16

Ataxic Gait

Back 16

Lack of coordination leads to jerky uneven movements. Balance tends to be poor, and the person walks with a wide base of support (abducted gait). The person usually has difficulty walking in a straight line and tends to stagger. Reciprocal arm motion also appears to be jerky and uneven. All movements appear exaggerated.

Front 17

Parkisonian Gait

Back 17

In which one has tremors, demonstrates diminished movement. he posture of the lower extremities and trunk tends to be flexed. The elbows are partially flexed, and there is little or no reciprocal arm swing. Stride length is greatly diminished, and the forward heel does not swing beyond the rear foot. The person walks with a shuffling gait, with the feet flat and weight mostly forward on the toes.

Front 18

Festinating Gait

Back 18

The person has difficulty initiating movements. This shuffling gait tends to start slowly and increase in speed, and the person often has difficulty in stopping. It gives the appearance that the person's feet are trying to catch up to the forward-leaning trunk.

Front 19

Scissors Gait

Back 19

Results in spasticity in the hip adductors, this gait is most evident during the swing phase, when the unsupported let swings against or across the stance leg. Needled to say, the walking base is narrowed. The trunk may lean over the state leg as the swing phase leg attempts to swing past it.

Front 20

Crouch Gait

Back 20

Describes the bilateral lower extremity involvement seen in the spastic diplegia associated with cerebral palsy. There is often great variation in the gait from what is considered "typical". There is excessive flexion, adduction, and medial rotation at the hips and flexion at the knees. The ankles are plantar flexed. The pelvis maintains an anterior pelvic tilt, and there is an increased lumbar lordosis. To compensate the reciprocal arm swing and horizontal displacement are exaggerated.

Front 21

Antalgic Gait

Back 21

If the pain is caused by a hip problem, the person will lean over that hip during weight-bearing. This will decrease the torque placed on the joint and the amount of pressure placed on the femoral head.