Excessive plantarflexion can result in which abnormalities at initial contact?
1- Low heel strike (loss of heel rocker)
2- Toe touch/forefoot contact (they don’t heel strike–they forefoot strike but this is bad in walking)
What gait abnormalities does excessive plantarflexion cause during loading response?
If heel cord flexibility, toe touch-heel down possible. If not, forefoot contact persists as it did in forefoot strike, or knee hyperextends (recurvatum)
What abnormalities occur in midstance due to excessive plantarflexion?
- Premature heel rise
- Genu recurvatum due to lack of DF
- substitution of forward lean, due to CoG being restrained backwards (lack of tibial advancement)
What abnormalities does excessive plantarflexion cause during midswing?
- toe drag
- substitution by hip and knee flexion = STEPPAGE GAIT
What happens to the knee with an excessive heel rocker?
-Increased knee flexion–> patient has the sense of falling forward
What abnormalities does excessive dorsiflexion cause in gait?
- prolonged heel contact
- excessive knee flexion
- sustained heel contact in preswing
How are the quads affected by excessive dorsiflexion?
They are ineffective in changing knee angle– due to lack of stability from soleus and resultant knee flexion
How are IC and LR affected by inadequate knee flexion?
Reduced shock absorption
-excessive dorsiflexion and prolonged heel contact
How does inadequate knee flexion impact initial swing?
Results in toe drag
How does extensor thrust/ recurvatum (excessive knee extension) impact gait?
- premature plantarflexion
- retraction of tibia (soleus) or femur (glut max) can produce this
What is the substitution for a weak quadriceps?
- Avoidance of loading with flexed knee, using soleus to retract tibia and/or glut max to retract femur
- Knee hyperextension to move vector a nterior to knee joint (passively extends the knee)
- Over activity of quads can also lead to hyperextension
What are the results of inadequate knee extension?
- excessive dorsiflexion, inability to advance body, secondary to lack of thigh movement
- In terminal swing,, loss of reach with limb results in shorter step.
How does inadequate hip extension affect gait?
1- lumbar lordosis compensation
2- flex knee to get CoG over feet, so they’re a knee flexor person
How does inadequate hip extension affect gait?
In terminal stance, inability of limb to trail for push off. Limb advances earlier, resulting in shorter step.
How does a contralateral pelvic drop affect gait?
- uncompensated: weak gluteus medius = contralateral pelvic drop during gait
- compensated: trunk lean to ipsilateral weak side (due to weak glut med)
What affects does backwards trunk lean have?
- Substitution for weak glut max (brings vector behind hip)
- Lordosis with backwards lan to compensate for hip flexion contracture
- along with a posterior pelvic tilt to advance thigh–kicks femur forward
Effects of forward trunk lean?
- Lumbar lordosis to compensate for hip flexor tightness or ankle PF tightness
- Compensation for quad weakness
- Compensation for hip flexion contracture
Ipsilateral trunk lean
Compensation for weak glut med – brings CoG close to stance limb to decrease strength demand (this is a compensated trendelenberg)
- compensation for tight adductor muscles, causes pelvic drop
- also hip abductor/TFL tightness
