Pk: Gait 2

Front 1

Influence of Impairment and Pathology on Step Length (4)

Back 1

1. Normal gait
- Equal long steps for both legs
2. Painful hip gait
- Longer step with impaired limb
- Shorter step with sound limb (stance is on impaired limb)
- Strong limp with short steps
3. Hemiparesis gait
- Longer step with paretic limb
- Shorter step with sound limb (stance is on paretic limb)
- Subtle limp with shorter steps
4. Parkinson's gait
- mostly equal step length (may be slightly longer on one side)
- short staggering steps

Front 2

Weak hip abductors and gait

Back 2

1. Gluteus medius lurch: Antalgic gait
- to compensate for weak hip abductors
2. Trendelenberg Gait: test/marker for weak abductors

Front 3

Weak Hip Extensor Gait

Back 3

Extension Lurch (also Known as Gluteus Maximus Lurch) to Compensate for Weak Hip Extensors

Front 4

Ankle Plantar Flexion Contracture Gait

Back 4

Knee Hyperextension and Forward Trunk Lean to Compensate
- Pushing foot down through knee extensor torque

Front 5

Weak or Paralyzed Dorsiflexors Gait

Back 5

Drop Foot During The Swing Phase of Gait

Front 6

Steppage Gait

Back 6

Excessive Hip And Knee Flexion To Compensate For Foot Drop

Front 7

Vaulting (Rising up on Toes) during Gait

Back 7

On the Unaffected Side To Compensate for a Lack of Hip Flexion, Knee Flexion, or Ankle Dorsiflexion on the Affected Side (Increasing Ground Clearance During the Swing Phase)

Front 8

Hip Circumduction During Swing

Back 8

Due to Inadequate Hip and Knee Flexion

Front 9

Excessive Anterior Trunk Bending during Gait

Back 9

Excessive Anterior Trunk Bending To Compensatory for Weak Quadriceps
- GRF is posterior to knee causing a flexor torque that the quadraceps are too weak to counteract
- Bending supports quadraceps actions

Front 10

Knee Flexor Contracture Gait

Back 10

Causes A Crouched Gait Of The Stance Leg

Front 11

Observed Gait deviation at the ankle/foot-
Foot slap: rapid ankle PF occurs following heel contact
(Know for testing)

Back 11

1. Impairment
- mild weakness of ankle DF
2. Pathologic Precursors
- common fibular nerve palsy
3. Mechanical rationale and/or associated compensations
- Ankle dorsiflexors have sufficient strength to dorsiflex the ankle during swing but not enough to control ankle plantar flexion after heel contact

Front 12

Observed Gait deviation at the ankle/foot-
Entire Plantar aspect touches ground at initial contact followed by normal, passive, ankle DF, during the rest of the stance
(Know for testing)

Back 12

1. Impairment
- marked weakness of ankle DF
2. Pathologic Precursors
- common fibular nerve palsy
3. Mechanical rationale and/or associated compensations
- sufficient strength of the dorsiflexors to partially, but not completely, dorsiflex the ankle during swing
- normal dorsiflexion occurs during stance as long the ankle has normal ROM

Front 13

Observed Gait deviation at the ankle/foot-
Initial contact with the ground is made by the forefoot followed by the heel region. Normal passive ankle DF occurs during stance

Back 13

1. Impairment
- severe weakness of ankle dorsiflexors
2. Pathologic Precursors
- common fibular nerve palsy
3. Mechanical rationale and/or associated compensations
- no active ankle dorsiflexion is possible during swing
- normal dorsiflexion occurs during stance as long as the ankle has normal range of motion

Front 14

Observed Gait deviation at the ankle/foot-
Initial contact is made with the forefoot but the heel never makes it to the ground during stance
(Know for testing)

Back 14

1. Impairment
-(a) heel pain
- (b) plantar flexion contracture (pes equinas) or spasticity
2. Pathologic Precursors
- (a) calcaneal fracture, plantar fascitis
- (b) upper motor neuron lesion (cerebral palsy, CVA)
3. Mechanical rationale and/or associated compensations
- (a) purposeful strategy to avoid weight bearing on the heel
- (b) to maintain the weight over the foot, the knee and hip are kept in flexion throughout stance, leading to a "crouched gait"

Front 15

Observed Gait deviation at the ankle/foot-
Initial contact is made with forefoot and the heel is brought to the ground by a posterior displacement of the tibia
(know for testing)

Back 15

1. Impairment
- plantarflexion contracture or spasticity
2. Pathologic Precursors
- upper motor neuron lesion (cerebral palsy, CVA)
- ankle fusion in a plantar flexed position
3. Mechanical rationale and/or associated compensations
- knee hyperextension occurs during stance owing the the inability of the tibia to move over the foot
- hip flexion and excessive forward trunk lean during terminal stance occur to shift the weight of the body over the foot

Front 16

Observed Gait deviation at the ankle/foot-
Premature elevation of the heel in midstance
(know for testing)

Back 16

1. Impairment
- lack of ankle dorsiflexion
2. Pathologic Precursors
- Tightness of ankle plantarflexors (congenital or acquired)
3. Mechanical rationale and/or associated compensations
- characteristic bouncing gait pattern

Front 17

Observed Gait deviation at the ankle/foot-
Heel remains in contact with ground late in terminal stance
(know for testing)

Back 17

1. Impairment
- weakness/paralysis of plantarflexors with or without fixed DF (pes calcaneus)
2. Pathologic Precursors
- PNS/CNS nervous system disorder
- Excessive surgical lengthening of achilles tendon
3. Mechanical rationale and/or associated compensations
- excessive ankle dorsiflexion results in prolonged heel contact, reduced push off, and a shorter step length

Front 18

Observed Gait deviation at the ankle/foot-
Supinated foot position and weight bearing on the lateral aspect of the foot during stance
(know for testing)

Back 18

1. Impairment
- pes cavus deformity
2. Pathologic Precursors
- congenital structural deformity
3. Mechanical rationale and/or associated compensations
- a high medial longitudinal arch is noted with reduced midfoot mobility throughout swing and stance

Front 19

Observed Gait deviation at the ankle/foot-
Excessive foot pronation occurs during stance with failure of the foot to supinate in midstance. Normal longitudinal arch noted during swing

Back 19

1. Impairment
- rearfoot varus and/or forefoot varus
2. Pathologic Precursors
- congenital or acquired structural deformity
3. Mechanical rationale and/or associated compensations
- excessive foot pronation and associated flattening of the medial longitudinal arch may be accompanied by a general internal rotation of the lower extremity during stance

Front 20

Observed Gait deviation at the ankle/foot-
Excessive foot pronation with weight bearing on the medial portion of the foot during stance. The medial longitudinal arch remains absent during swing
(know for testing)

Back 20

1. Impairment
- (a) weakness (paralysis) of ankle invertors
- (b) pes planus deformity
2. Pathologic Precursors
- (a)upper motor neuron lesion
- (b) congenital structural deformity
3. Mechanical rationale and/or associated compensations
- an overall excessive internal rotation of the lower extremity during stance is possible

Front 21

Observed Gait deviation at the ankle/foot-
Excessive inversion and plantarflexion of the foot and ankle occur during swing and at initial contact

Back 21

1. Impairment
- pes equinovarus deformity due to spasticity of the plantarflexors and invertors
2. Pathologic Precursors
- upper motor neuron lesion (cerebral palsy, CVA)
3. Mechanical rationale and/or associated compensations
- contact with the ground is made with the lateral border of the forefoot
- weight bearing on the lateral border of the foot during stance

Front 22

Observed Gait deviation at the ankle/foot-
Ankle remains plantarflexed during swing and can be associated with dragging the toes, typically called drop foot
(know for testing)

Back 22

1. Impairment
- weakness of dorsiflexors and/or pes equinas deformity
2. Pathologic Precursors
- common fibular nerve palsy
3. Mechanical rationale and/or associated compensations
- hip hiking, hip circumduction, or excessive hip and knee flexion of the swing leg or vaulting of the stance leg may be noted to lift the toes off the ground and prevent the toes from dragging down during swing

Front 23

Observed Gait deviation at the ankle/foot-
Vaulting: compensatory mechanism demonstrated by exaggerated ankle plantar flexion during mid stance: leads to excessive vertical movement of the body
(know for testing)

Back 23

1. Impairment: any impairment of the contralateral lower extremity that reduces:
- hip flexion
- knee flexion
- ankle dorsiflexion
2. Mechanical rationale
- strategy used to allow the foot of a functionally long, contralateral LE to clear the ground during swing

Front 24

Observed Gait deviation at the ankle/foot-
Excessive foot angle during stance that is called toeing-out

Back 24

1. Impairment
- retroversion of the neck of the femur or tight hip external rotators
2. Mechanical Rationale
- Foot is in excessive toeing-out due to excessive external rotation of the lower extremity

Front 25

Observed Gait deviation at the ankle/foot-
Reduction of the normal foot angle during stance that is called toeing

Back 25

1. Impairment
- excessive femoral anteversion or spasticity of the hip adductors and/or hip internal rotators
2. Mechanical Rationale
- general internal rotation of the lower extremity

Front 26

Observed Gait deviation at the knee -
Rapid extension of the knee (knee extensor thrust) immediately after the initial contact

Back 26

1. Impairment
- spasticity of the quadraceps
2. Pathologic Precursors
- upper motor neuron lesion
3. Mechanical Rationale and/or Associated Compensations
- may occur with or without knee hyperextension

Front 27

Observed Gait deviation at the knee -
Knee remains extended during the loading response, but there is no extensor thrust

Back 27

1. Impairment
- weak quadraceps
2. Pathologic Precursors
- femoral nerve palsy (L3-4), compression neuropathy
3. Mechanical Rationale and/or Associated Compensations
- knee remains fully extended throughout stance
- anterior trunk lean in the early part of stance moves the line of gravity of the trunk, slightly anterior to the axis of rotation of the knee, keeping the knee extended
- leads to excessive stretching of the posterior capsule of the knee and eventual knee hyperextension (genu recurvatum) during stance

Front 28

Observed Gait deviation at the knee -
Genu recurvatum

Back 28

1. Impairment
- knee pain
2. Pathologic Precursors
- arthritis
3. Mechanical Rationale and/or Associated Compensations
- knee is kept in extension to reduce the need for quadriceps activity and associated compressive forces
- may be accompanied by an antalgic gait pattern characterized by a reduced stance time and shorter step length

Front 29

Observed Gait deviation at the knee -
Flexed position of the knee during stance and lack of knee extension in terminal swing

Back 29

1. Impairment
- (a) knee flexion contracture > 10 degrees (genu flexum)
- (a) hamstring overactivity (spasticity)
- (b) knee pain and joint effusion
2. Pathologic Precursors
- (a) upper motor neuron lesion
- (b) trauma or arthritis
3. Mechanical Rationale and/or Associated Compensations
- (a) associated increase in hip flexion and ankle dorsiflexion during stance
- (b) knee is kept in flexion since this is the position of lowest intraarticular pressure

Front 30

Observed Gait deviation at the knee -
- Reduced or absent knee flexion during swing

Back 30

1. Impairment
- (a) spasticity of knee extensors
- (b) knee extension contracture
2. Pathologic Precursors
- (a) upper motor neuron lesion
- (b) immobilization or surgical fusion
3. Mechanical Rationale and/or Associated Compensations
- compensatory hip hiking and/or hip circumduction could be noted

Front 31

Observed Gait Deviation at the Hip/Pelvis/Trunk:
Backward trunk lean during loading response

Back 31

1. Impairment
- weak hip extensors
2. Pathologic Precursors
- paralysis
- poliomyelitis
3. Mechanical Rationale and/or Associated Compensations
- This action moves the line of gravity of the trunk behind the hip and reduces the need for hip extension torque

Front 32

Observed Gait Deviation at the Hip/Pelvis/Trunk
- Lateral trunk lean toward the stance leg; since this movement compensates for a weakness, it is often called "compensated" Trendelenberg gait and is referred to as a waddling gait if bilateral

Back 32

1. Impairment
- (a) marked weakness of the hip abductors
- (b) hip pain
2. Pathologic Precursors
- (a) Guillain-Barre or poliomyelitis
- (b) arthritis
3. Mechanical Rationale and/or Associated Compensations
- (a) shifting the trunk over the supporting limb reduces the demand on the hip abductors
- (b) shifting the trunk over the supporting lower extremity reduces compressive joint forces associated with the action of hip abductors

Front 33

Observed Gait Deviation at the Hip/Pelvis/Trunk
- Excessive downward drop of the contralateral pelvis during stance. Referred to as positive Trendelenburg sign if present during single-limb standing

Back 33

1. Impairment
- mild weakness of the gluteus medius of the stance leg
2. Pathologic Precursors
- Guillain-Barre or poliomyelitis
3. Mechanical Rationale and/or Associated Compensations
- While the Trendelenburg sign may be seen in single-limb standing, a compensated Trendelenburg gait is often seen in severe weakness of the hip abductors

Front 34

Observed Gait Deviation at the Hip/Pelvis/Trunk
- Forward bending of the trunk during mid and terminal stance, as the hip is moved over the foot

Back 34

1. Impairment
- (a) hip flexion contracture
- (b) hip pain
2. Pathologic Precursors
- (a) (b) hip osteoarthritis
3. Mechanical Rationale and/or Associated Compensations
- (a) forward trunk lean is used to compensate for lack of hip extension. An alternative adaptation could be excessive lubar lordosis
- (b) keeping the hip at 30 degrees flexion minimizes intraarticular pressure

Front 35

Observed Gait Deviation at the Hip/Pelvis/Trunk
- Excessive lumbar lordosis in terminal stance

Back 35

1. Impairment
- hip flexion contracture
2. Pathologic Precursors
- arthritis
3. Mechanical Rationale and/or Associated Compensations
- lack of hip extension is terminal stance is compensated for by increased lordosis

Front 36

Observed Gait Deviation at the Hip/Pelvis/Trunk
- Hip circumduction; semicircle movement of the hip during swing - combining hip flexion, hip abduction, and forward rotation of the pelvis

Back 36

1. Impairment
- Hip flexor weakness
2. Pathologic Precursors
- L2/L3 nerve compression
3. Mechanical Rationale and/or Associated Compensations
- hip abductors are used as flexors