Gait Deviation

Question 1

List some large umbrella causes of gait deviations

Answer 1

1. Pain
2. Joint and/or muscle ROM limitations
3. Muscular weakness/paralysis
4. Impaired motor control
5. Neurological involvement (UMN or LMN)
6. Impaired balance
7. Leg length discrepancy

Question 2

what are some key questions to ask yourself as you analyze gait?

Answer 2

1. Am I seeing hypo/hyper motion in a joint during gait?
   
   • is that joint hypo/hypermobile independent of gait?
2. Am I seeing a deviation or a compensation for a deviation?
3. Why are they walking like that? What could be contributing? Did I assess that area already?

Question 3

What is antalgic gait?

Answer 3

compensatory pattern to remove/decrease discomfort/pain in the LE, pelvis or lumbar spine

Question 4

what are the characteristic features of antalgic gait?

Answer 4

1. decrease duration of stance phase on affected limb
2. lack of weight shift laterally over the stance limb to keep weight off involved limb
3. decrease in stance phase in affected side = decrease in swing phase of uninvolved side = shortened step length on uninvolved side

Question 5

list some specific gait pattern deviations

Answer 5

1. Waddling gait (Tunk Lean)
2. Widened BOS
3. Narrow BOS
4. Hemiplegic gait
5. Sensory ataxic gait
6. Festinating gait

Question 6

list some causes for the hip deviation Forward Lean

Answer 6

1. weak quads (decreases flexor moment of knee)
2. Hip flexor contracture
3. weak lumbar or hip extensors
4. hypomobile joint capsule

Question 7

list some hip deviations in gait

Answer 7

1. Forward trunk lean
2. decreased hip extension
3. Glute max gait/backward trunk lean
   
   • “Rocking horse gait”
4. Hip drop/glute medius gait
   
   • “trendelenburg gait”

Question 8

what are some possible causes of the gait deviation decreased hip extension?

Answer 8

1. tight hip flexors
2. decreased joint mobility
3. weak glutes

Question 9

what is the role of the glute max during IC?

Answer 9

contracts at IC, slowing forward motion of the trunk by resisting flexion of the hip and initating extension

Question 10

if the glute max is weak, how does the body compensate during gait (IC)?

Answer 10

the trunk will quickly shift posteriorly during IC to try and offset forward momentum and promote hip extension

(this is called rocking horse gait)

Question 11

list some knee deviations in gait

Answer 11

1. knee hyperextension
   
   • “genu recurvatum gait”
2. Decreased knee extension
3. Excessive genu valgum
   
   • “knock knee gait”
4. Excessive genu varum
   
   • “bow leg gait”

Question 12

what are some causes of the gait deviation knee hyperextension?

Answer 12

1. weak quads → thrust knee backwards so their knee doesn’t buckle due to weak quads
2. weak hamstrings
3. increased tone of quads
4. compensation for PF contracture or spasticity

Question 13

what are some causes for the gait deviation, decreased knee extension?

Answer 13

1. weak quads
2. tibiofemoral joint hypomobility
3. hamstring contracture or stiffness
4. strategy to avoid heel rocker

Question 14

what are some potential impairments/sources of the gait deviation excessive genu valgum?

Answer 14

1. boney deformity (most likely arthitis)
2. pain
3. excessive foot pronation
4. glute med weakness
5. excessive femoral adduction
6. ipsilateral trunk lean

Question 15

what are some potential impairments/sources of the gait deviation excessive genu varum?

Answer 15

1. degenerative changes
2. pain
3. boney deformity (arthritis)

Question 16

list some foot and ankle deviations in gait

Answer 16

1. Excessive PF during gait
   
   • “equinus gait”
2. Increased DF
   
   • “calcaneal gait”
3. Equinovarus gait
   
   • “club foot”
4. Foot drop
   
   • “foot slap gait”
5. Foot flat
6. Excessive supination (pes cavus)
7. Excessive pronation
8. Inadequate push off

Question 17

what are some potential causes for excessive plantarflexion during gait (equinus gait)?

Answer 17

1. tibialias anterior weakness
2. PF contracture
3. hypomobility of talocrural joint
4. compensation for short leg/short stride leg
5. painful heel/avoiding heel rocker

Question 18

how would excessive plantarflexion impact gait? what would it make difficult?

Answer 18

walking/running without tripping

Question 19

what could cause increased DF with gait (calcaneal gait)?

Answer 19

1. tib anterior contracture
2. weak gastroc
3. hypomobile talocrural

Question 20

describe the gait deviation equinovarus

Answer 20

club foot

ankle PF + subtalar inversion

they will be walking on the outside of their foot

Question 21

what is the most often cause of foot drop?

Answer 21

DF weakness caused by paralysis of common peroneal nerve

Question 22

what muscle should you MMT with foot drop gait?

Answer 22

Tibialis anterior

Question 23

how is the talocrural joint invovled with foot drop/foot slap gait?

Answer 23

this deviation isn’t normally caused by the joint capsule being tight

but over time expect the posterior capsule to become tighter

Question 24

what might cause the gait deviation foot flat?

Answer 24

1. weak DF
2. limited ROM/hypomobility
3. normal immature gait pattern (neonatal)

Question 25

what may cause pes cavus during gait?

Answer 25

(excessive supination) 1. hypomobility of subtalar and or midtarsal joints 2. spastic invertors or intrinsic foot muscles 3. weak evertors 4. genu varum

Question 26

what may cause the gait deviation excessive pronation at the ankle?

Answer 26

1. weak foot intrinsic muscles 2. weak posterior tibialis 3. weak hip abductors 4. hypomobile subtalar or midtarsal joints

Question 27

what are some possible causes of the gait deviation inadequate push off?

Answer 27

1. weak PF 2. tight/spastic DF 3. hypomobile talocrural joint 4. pain in forefoot

Question 28

list some pelvic deviations in gait

Answer 28

1. excessive anterior pelvic tilt 2. excessive posterior pelvic tilt

Question 29

what is normal for anterior pelvic tilt during gait?

Answer 29

10-30 degrees

Question 30

what are some potential causes of excessive anterior pelvic tilt during gait?

Answer 30

1. weak hip extensors 2. hip flexor contracture 3. abdominal muscle weakness 4. limited hip extension ROM

Question 31

what are some causes of excessive posterior pelvic tilt during gait?

Answer 31

1. most commonly caused by tight hamstrings 2. hip flexor weakness 3. LBP 4. limited lumbar extension ROM

Question 32

define anatomical LLD

Answer 32

legs are actually different lengths as confirmed with x-rays or tape measurements

Question 33

define functional LLD

Answer 33

functional LLD means on x-ray the leg lengths are equal, but for some reason they appear longer could be due to tightness, weakness, or compenstations

Question 34

List some gait compensations for LLD

Answer 34

1. Circumduction 2. Hip hiking 3. steppage gait 4. vaulting

Question 35

what is waddling gait?

Answer 35

done when someone is trying to regain balance lots of trunk lean

Question 36

what are some causes of waddling gait?

Answer 36

1. tight IT band 2. contralateral hip abductor weakness 3. limited hip or knee flexion → leans to contralateral side to compensate to clear foot 4. commonly seen with pain in hip related to arthritis

Question 37

what types of populations will you observe an abnormal BOS and what can it suggest?

Answer 37

observed with decreased proprioception, cerebellar ataxia, etc. may indicate imbalance or fear of falling

Question 38

what is a narrow BOS during gait clinically referred to?

Answer 38

scissoring gait

Question 39

what are some clincal correlations to scissoring gait?

Answer 39

1. adduction deformity of the hip 2. valgus deformity at the knee 3. increased hip adduction * increased tone, muscle tightness during swing causing swing limb to cross over stance limb for contact 4. commonly observed in those with CP

Question 40

describe hemiplegic gait

Answer 40

* hip into extension, adduction and IR * knee in extension * ankle in drop foot w/PF and Inversion * present during both stance and swing phase * spastic muscles wont allow the hip and knee to flex to clear the foot * usually no reciprocal arm swing * step length tends to be lengthened on involved side and shortened on uninvolved side

Question 41

describe sensory ataxic gait

Answer 41

defined as presence of abnormal and uncoordinated movements referred to as ataxic because walking is uncoordinated and appears to be "not ordered" often seen in individuals with cerebellar disorders

Question 42

describe festinating gait

Answer 42

due to rigidity all joints will want to flex forward displaces COG anteriorly in order to keep COG within BOS patient will shuffle their steps