Abnormal gait

Question 1

What are the 3 causes of abnormal gait?

Answer 1

1. Pain
2. Central nervous system disorders
3. Musculoskeletal impairments

Question 2

Stance due to: Generalized ligamentus laxity, weak quads, plantarflexor contracture, extensor spasticity

Answer 2

Genu recurvatum

Question 3

The excessive elevation of the iliac crest on the side of swing limb; Gait deviation due to: Weak hip flexors. Weak knee flexors, hamstrings. Limited knee flexion ROM. Painful knee. Extensor spasticity.

Answer 3

Hip hiking

- muscles involved = abductors of stance limb, quad lumborum and possible abdominals and extensors of swing limb side

Question 4

Gate deviation due to: Weak PF, pain in forefoot. Limited ROM at hip, knee or ankle

Answer 4

Inadequate push- off (stance)(shuffling)

Question 5

due to Painful knee, weak quads

Answer 5

knee wobbling or buckling (stance)

Question 6

Excessive hip and knee flexion; Weak Dorsiflexion. Plantarflexion Spasticity.

Answer 6

Steppage gait

Question 7

IC with ground made by forefoot followed by heel region; due to severely weak DF, PF contracture, Knee flexion contracture, PF spasticity, Painful heel, LE too short

Answer 7

Toes first at initial contact

Question 8

toe drag (swing phase); Weak DF, Plantarflexion spasiticity, can also see lowering of pelvis due to weakness of gluteus medics on stance side

Answer 8

Foot drop

- usually compensated by excessive hip and knee flexion (steppage gait)

Question 9

Rapid ankle plantar flexion occurs after heel contact; due to weak DF

Answer 9

foot slap

Question 10

weak quads, hip flexion contracture, knee flex contracture

Answer 10

forward trunk lean

Question 11

What are the causes of too much PF/ not enough DF

Answer 11

1. Spasticity (gastroc)
2. Weakness (DF)
3. Contracture (gastroc, posterior tib)
4. Too Much Knee Extension (can’t have PF without ext in closed chain)

Question 12

Irregular, jerky and weaving
2 types:
- Cerebellar-broad base, poor balance, lurches and staggers
- Sensory-broad base-slaps floor as can’t feel feet and looks down

Answer 12

Ataxic gait

Question 13

With too much plantar flexion, one limb is too long. How do you compensate in gait?

Answer 13

1. Steppage gait
2. Circumduction
3. Vaulting
4. Hip hiking
5. Contralateral lean
6. Forward trunk lean
7. Knee hyperextension

Question 14

What do weak dorsiflexor gait deviations result in?

Answer 14

1. Foot slap in initial contact/loading response

2. Toe drag in initial and mid swing

Question 15

What causes too much DF or not enough PF?

Answer 15

1. AFO or ankle fusion (Blocks ankle PF)
2. Soleus Weakness
3. Too much knee flexion

Question 16

What two patterns are seen with decreased PF and what is their cause?

Answer 16

1. Sudden DF at LR and then maintained until TSt; AFO or ankle fusion- Lose ankle rocker
2. Progressive increase in DF from MSt to TSt -Too much DF caused by weak soleus

Question 17

What gait deviations are seen with too much DF/ decreased PF?

Answer 17

Seen during IC through LR:
- Increased heel rocker and forward progression
- Increased demand on quads
Destabilizing effect on knee during MSt & TSt
- Decreased step length on contralateral limb

• biggest problem is demand placed on quads

Question 18

What are non contractile causes of too much DF?

Answer 18

1. Talipes Calcaneus
2. Joint Contracture
3. Knee flexion contracture
4. AFO

Question 19

What are AFO gait deviations?

Answer 19

1. Obstruction of heel rocker
2. Quick foot flats leads to increased knee flexion which increases quad demand and a destabilized knee
3. MSt - knee stays in flexion instead of extending
4. Forefoot rocker - gone
5. TSt - load is greater on plantar flexors

Question 20

What are causes of too much pronation or supination?

Answer 20

1. Spasticity (usually of PFs and inverters; excessive supination)
2. Weakness of inverters (too much pronation; pes planus)
3. Foot deformity

Question 21

What are the causes of too much knee extension and not enough knee flexion

Answer 21

1. Quadriceps Weakness (#1, Changes the BV)
2. Knee Pain
3. Quadriceps Spasticity or Extensor Synergy
4. Plantar flexion contracture or spasticity
5. Extension Contractures

Question 22

What 3 phases are most affected by too much knee extension

Answer 22

1. LR - large amount of force driven up the chain
2. Pre swing
3. Initial swing - causes dragging foot on the ground

Question 23

What are the causes of too much knee flexion and not enough knee extension

Answer 23

1. Spasticity
2. Knee Flexion Contracture
3. Soleus Weakness (too much ankle DF)
4. If it is in swing-could be too much plantar flexion

Question 24

What phases of gait are affected with knee flexion greater than 30 degrees (contracture)?

Answer 24

All phases of gait, with exception of initial swing

• with less thank 10* contracture, there are no deviations in gait
• above 10, under 30 = due to quads IC/LR, due to motion at terminal stance and terminal swing

Question 25

What causes too much hip flexion/ not enough hip extension?

Answer 25

1. Hip Flexion Contracture 2. Hip Flexor spasticity 3. IT band contracture 4. Excess knee flexion and ankle DF 5. Pain 6. Arthrodesis or ankylosis 7. Ankle plantar flexion contracture (in mid swing)

Question 26

What are potential gait deviations with reduced hip extension?

Answer 26

1. Shortened stride 2. Decreased step length 3. Increased pelvic rotation

Question 27

What are postural compensations seen with too much hip flexion?

Answer 27

1. Forward trunk lean (elderly) 2. Ant. Pelvic tilt increases relative ROM – can only account for 15* hip flexion; Can use lumbar lordosis to reduce force demands of hip ext. 3. Flexion knee

Question 28

What causes too much hip extension/ not enough hip flexion?

Answer 28

1. Hip flexor weakness 2. Hip extensor weakness - Keeping BV back and use Y ligament for stability 3. Arthrodesis (rare)

Question 29

What are potential gait deviations with not enough hip flexion?

Answer 29

1. Use of abdominal muscles to advance thigh (post tilt) 2. Circumduction 3. Contralateral vaulting 4. Lateral lean to the opposite side 5. Hip hiking 6. Substituting the Abductors or the Adductors 7. T4T5 paraplegic walking

Question 30

What are causes of excessive adduction? abduction?

Answer 30

``` Adduction: 1. Ipsilateral Abductor weakness 2. Ipsilateral Adductor tightness 3. Contralateral Abductor tightness Abduction: 1. Ipsilateral Abduction contracture 2. Ipsilateral Short leg ```

Question 31

What are causes of excessive lateral rotation? medial?

Answer 31

``` Lateral: 1. Too much plantar flexion 2. Use of adductors as hip flexors Medial: 1. Spasticity in medial hamstrings 2. Abductors as hip flexors 3. Quad weakness - resting on LCL for stability ```

Question 32

Decreased weight on same side, Decreased step length on opposite side; Pain in LE, protecting painful leg with

Answer 32

Antalgic gait

Question 33

Backward trunk Lean (stance), lurch back; Weak hip extensors

Answer 33

Glut max gait

Question 34

Swings leg in an arc away from the body; Weak hip flexors, Weak knee flexors, Limited hip or knee flexion ROM. Painful knee. Knee extensor spasticity.

Answer 34

Circumduction

Question 35

Flexed neck, trunk and knees. Shuffling gait, reduced arm swing; Festination-lean forward with progressively faster gait

Answer 35

Parkinson's gait

Question 36

Arm across the trunk adducted at the shoulder with flexion of elbow, wrist and MCP joints; Leg extended at hip and knee with either circumduction or pushing leg ahead. (from weak hip flexors, using adductors - very little activehip flexion and DF - ER and PF toes

Answer 36

Hemiplegic gait

Question 37

Ipsilateral trunk bending during stance/ Contralateral hip drop; Compensated = lat flex on affected side; Weak gluteus medius, abductors or Painful hip.

Answer 37

Glut medius gait (compensated)/ trendelenberg gait (uncompensated)

Question 38

What gait deviations are seen with too much PF/ decreased DF?

Answer 38

1. Shortened step (ipsilateral) - Lose rockers, so momentum is lost 2. Foot flat contact 3. Absent or decreased heel and ankle rocker 4. Early heel rise in MSt 5. ER of stance leg to utilize pronation range 6. Toe Drag 7. Forward trunk lean 8. Excessive hip and knee flexion with possible lateral trunk lean to clear the toes in swing 9. Excessive plantarflexion in TSw

Question 39

What are contractile causes of too much DF

Answer 39

1. Soleus Weakness-disuse, paralysis, or poor surgical outcome with Achilles tendon lengthening surgery 2. Primitive flexion patterns – neurological lesions esp seen during swing phase

Question 40

Calcaneus is rotated inward and associated with pronation

Answer 40

Calcaneovalgus

Question 41

Rigid supinated foot; starts with Achilles tendon tightening; pushes weight forward and laterally; causes too much rigidity in the foot; shock absorption is limited so risks stress fxs up the chain (especially 4th and 5th MT)

Answer 41

equinovarus AKA club foot | - contact with ground made with lateral border of the forefoot; WB on lateral border of foot during stance

Question 42

What muscle is overworked in a supinated, flexible foot?

Answer 42

fibularis longus

Question 43

What are the causes of too much hip extension/not enough flexion?

Answer 43

1. Hip flexor weakness 2. Hip extensor weakness - Keeping BV back and use Y ligament for stability 3. Arthrodesis (rare)

Question 44

What are causes of excessive adduction?

Answer 44

1. Ipsilateral Abductor weakness 2. Ipsilateral Adductor tightness 3. Contralateral Abductor tightness

Question 45

What are causes of excessive abduction?

Answer 45

1. Ipsilateral Abduction contracture | 2. Ipsilateral Short leg

Question 46

What are causes of too much lateral rotation?

Answer 46

1. Too much plantar flexion | 2. Use of adductors as hip flexors

Question 47

What are causes of too much medial rotation?

Answer 47

1. Spasticity in medial hamstrings 2. Abductors as hip flexors 3. Quad weakness - resting on LCL for stability

Question 48

What are causes of ipsilateral pelvic hike?

Answer 48

1. Too much plantar flexion, knee extension -Weakness of DF | 2. Long limb

Question 49

What are causes of contralateral pelvic hike?

Answer 49

Weak abductors or tight adductors

Question 50

What are causes of ipsilateral pelvic drop?

Answer 50

1. Tight abductors | 2. Short limb (excessive DF or knee flexion)

Question 51

What are causes of excessive forward rotation?

Answer 51

Weak hip flexors

Question 52

What are causes of excessive backward rotation?

Answer 52

Lack of heel rise on reference limb

Question 53

What are causes of lack of pelvic rotation?

Answer 53

1. Back pain, lack of hip extension | 2. Wide base of support - Excessive soft tissue in thighs

Question 54

Entire plantar aspect of the foot touches the ground at initial contact, followed by normal passive ankle dorsiflexion during the rest of stance; due to marked weakness of dorsiflexors

Answer 54

foot flat

Question 55

congenital structural deformity; Supinated foot positioning WB on lateral aspect of the foot during stance; high ML arch is noted with reduced mid foot mobility throughout swing and stance

Answer 55

Pes cavus deformity

Question 56

Compensatory mechanism demonstrated by exaggerated ankle plantar flexion during Mst; ends to excessive vertical body movements; due to contralateral limb having not enough DF, not enough knee flexion, or not enough hip flexion during swing

Answer 56

Vaulting

Question 57

What is the result of retroversion of the neck of the femur or tight hip external rotators?

Answer 57

toeing out

Question 58

What is the result of excessive femoral ante version or spasticity of the hip adductors and/or hip internal rotators?

Answer 58

toeing in

Question 59

What compensations are often seen with a PF contracture?

Answer 59

1. IC made with forefoot region 2. Knee hyperextension in Mst 3. forward trunk lean in Tst to maintain forward propulsion