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Gait deviations

Terms in this set (39)

Foot slap
rapid ankle plantar flexion occurs after heel contact
- mild weakness of ankle dorsiflexors
foot flat
entire plantar aspect of the foot touches the ground at initial contact followed by normal passive ankle dorsiflexion
-marked weakness of ankle dorsiflexors
initial contact made by forefoot followed by heel region
-severe weakness of dorsiflexors
- likely requires excessive knee and hip flexion during swing
initial contact made with forefoot, but heel never makes contact
heel pain, plantar flexion contracture (pes equinus deformity) or spasticity of plantar flexors
- purposeful strategy to avoid WB on heel
- knee and hip are kept in flexion throughout stance leading to crouched gait
initial contact made with forefoot and heel is brought to ground by posterior displacement of tibia at midstance
plantar flexion contracture, pes equinus, or spasticity of plantar flexors
- knee hyperextension during stance since the tibia cannot translate forward
- hip flexion and excessive forward trunk lean during terminal stance to shit weight over foot
premature elevation of the heel in mid or terminal stance
lack of ankle dorsiflexion
- congenital or acquired plantar flexor tightness
-bouncing gait pattern
heel remains in contact with the ground in terminal stance
weakness or flaccid paralysis of plantar flexors with or without a fixed dorsiflexed position
- excessive dorsiflexion results in prolonged heel contact, reduced push off and shorter step length
supinated foot position and weight bearing on the lateral aspect of the foot during stance
pes cavus deformity
- high longitudinal arch is noted with midfoot mobility throughout swing and stance
excessive foot pronation occurs during stance with failure of the foot to supinate in midstance (normal arch during swing)
-rearfoot varus and or forefoot varus
- may be accompanied by internal rotation of the lower extremity during stance
excessive foot pronation with WB on medial portion of foot during stance (arch remains absent during swing)
- weakness of invertors
- pes planus deformity
- excessive internal rotation of lower extremity during stance is possible
excessive inversion and plantar flexion of foot and ankle during swing and initial contact
pes equinovarus deformity
- contact made with the ground is made with lateral border of the forefoot. WB on the lateral border during stance
drop foot
ankle remains plantar flexed during swing and can be associated with dragging of the toes
- weakness of dorsiflexors and or pes equinius deformity
- hip hiking, circumduction or excessive hip and knee flexion of the swing lower extremity or vaulting of the stance limb
vaulting
compensatory mechanism demonstrated by exaggerated ankle plantar flexion during midstance phase leads to excessive vertical movement of the body
- any impairment of the contralateral lower extremity that reduces hip flexion, knee flexion, or ankle dorsiflexion during swing
- strategy used to allow the foot of a functionally long contralateral lower extremity clear the ground during swing
toeing-out
excessive foot angle during stance
- retroversion of the neck of the femur or tight ER
- foot is in excessive toeing-out because of excessive external rotation of LE
reduction of the normal foot angle during stance is called toeing-in
excessive femoral anteversion of spasticity of hip adductors and or hip IR
- general IR of the lower extremity
rapid extension of the knee (knee extensor thrust) after initial contact
- spasticity of the quads
- may occur without hyperextension of the knees
knee remains extended during loading response but there is no extensor thrust
- likely impairment weak quads or knee pain
- an associated anterior trunk lean in the early part of stance moves the line of gravity slightly anterior of the axis of the knee - keep the knee extended without action of the knee extensors, may lead to excessive stretched posterior capsule and eventual knee hyperextension (genu recurvatum)
- knee is kept in extension to reduce the need for quads activity and associate compressive forces- reduced stance time and shorter step length
genu recurvatum during stance
-knee extensor weakness
-secondary to progressive stretching of the posterior capsule of the knee
varus thrust during stance
laxity of the posterior and lateral capsules
- rapid varus of the knee during midstance typically accompanied by hyperextension
flexed position of the knee during stance and lack of knee extension in terminal swing
genu flexum, hamstring overactivity, knee pain and joint effusion
-associated increase in hip flexion and ankle dorsiflexion during stance
- knee is kept in flexion because this is the position of lowest interarticular pressure
reduced or absent knee flexion during swing
spasticity of knee extensors, knee extension contracture
- compensatory hip hiking and or hip circumduction
knee is kept in flexion during stance despite knee having normal ROM
- impairments at the ankle or hip including pes calcaneus deformity, plantar flexor weakness, and hip flexion contracture
- exaggerated ankle dorsiflexion or hip flexion during stance forces the knee in a flexed position
contralateral swing limb hows exaggerated hip and knee flexion to clear the toes
hyperextension of the knee from initial contact to preswing
ankle plantar flexion contracture or spasticity of ankle plantar flexors
- knee must hyperextend to compensate for the lack of forward displacement of the tibia
antalgic gait
paintful stance of the lower extremity
- characterized by shorter step length and stance time on the side of the painful of LE
may be accompanied by ipsilateral trunk lean with hip pain or contralateral trunk lean with knee and foot pain
excessive knee flexion in swing
lack of ankle dorsiflexion of swing limb of a short stance limb
- strategy to increase toe clearance of swing limb is typically accomplished by increased hip flexion
backward trunk lean during loading response
weak hip extensors
- moves the line of gravity of the trunk behind the hip and reduces the need for an extension torque
lateral trunk lean toward the stance LE because this movement compensate for a weakness (trendelenburg)
hip pain
- shifting trunk over the supporting LE reduces compressive joint forces association with the action of hip abductors
excessive downward drop of the contralateral pelvis during stance (positive trendelenburg)
mild weakness of the glut med of stance leg
- weakness of hip abductors
forward bend of the trunk during mid and terminal stance as the hip is moved forward and over the foot
hip flexion contracture
- forward trunk lean is used to compensate for lack of hip extension
- excessive lumbar lordosis
** keeping the hip @30 flexion minimizes intraarticular pressure
excessive lumbar lordosis in terminal stance
hip flexor contracture
- lack of hip extension in terminal stance is compensated for by increased lordosis
trunk lurches backward and toward the unaffected stance limb from heel off to midswing
hip flexor weakness
- hip flexion is passively generated by a backward movement of the trunk
posterior tilt of the pelvis during initial swing
hip flexor weakness
- abdominals are used during initial swing to advance the swing LE
hip circumduction: semicircle movement of the hip during swing
hip flexor weakness
- combining hip flexion, abduction and forward rotation of the pelvis
forward bending of the trunk during loading response
weak quads
- trunk is brought forward to move the line of gravity anterior to the axis of rotation of the knee reducing the need for knee extensors
forward bending of the trunk during mid and terminal stance
pes equinius deformity
- lack of ankle dorsiflexion during stance results in knee hyperextension at mid stance and forward trunk lean during terminal stance to move the weight of the body over the stance foot
excessive hip and knee flexion during swing
often caused by a lack of dorsiflexion of the swing limb, may also be caused by a functionally or anatomically short contralateral stance LE
- used to clear toes of the swing limb
hip circumduction during swing
lack of shortening of the swing limb secondary to reduced hip flexion, reduced knee flexion and or lack of ankle dorsiflexion
- used to lift foot of the swing limp off the ground and provide toe clearnance
hip hiking (elevation of ipsilateral pelvis during swing)
lack of shortening of the swing limb secondary to reduced hip flexion, knee flexion and or ankle dorsiflexion, functionally or anatomically short stance limb-
- used to lift foot of the swing limb off the ground and provide toe clearance
excessive backward horizontal rotation of the pelvis on the side of the stance LE in terminal stance
ankle plantar flexor weakness
-leads to prolonged heel contact and lack of push off
-increased pelvic horizontal rotation is used to lengthen limb and maintain adequate step length
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