Gait Deviations

Question 1

Definition of “gait abormality or deviation”

Answer 1

• Any variations from the standard gait phases that involve the arms, trunk, pelvis, hip, knee or ankle
• The etiology (cause) of the gait abnormality may be b/c of
  1. Normal aging
  2. Pharmaceutical
  3. Disease
  4. Injury

Question 2

Gait deviations

Answer 2

• The deviation itself by biomechanical (joint, skeleton), muscular, and neuromuscular (cortex, brain, cerebellum, and peripheral nerve) pathologies.
• A gait deviation (for instance foot drop) may be caused by several different systems (muscular and skeletal). It is critical that PTs assess (chart review, question and exam) to pinpoint the cause of the deviation.

Question 3

Various gait deviations

Answer 3

• Muscular gait deviations
  -muscular dystrophy
  -lateral lean
  -excessive hip flex
  -glut max lurch
  -cannot dorsiflex
• Skeletal deformities and gait
  -femoral head out of socket
  -hip socket shallow
  -extreme shortening of one leg

Question 4

Gait abormalities

Answer 4

• Typically, a pt will come yo a PT with a diagnosis and a gait abnormaility. The diagnosis will assist you in knowing if the problem stems from a muscular, skeletal or nervouse system problem
• before performing a gait analysis, be sure to have a diagnosis or a condition to assist you in the analysis of gait

Question 5

Gait deviations: clinical assessment

Answer 5

• for example: a person comes to your clinic complaining of frequent falls
• take a history (recent accidents, changes in physical function, recent illness, ect.)
• Perform an assessment:
  -ROM (both limbs, unaffected 1st)
  -MMT
  -Sensation
  -Reflexes
  -Pain
  -Gait observation
  1. An observational gait analysis is always performed with a clinical assessment
  2. Note the gait deviations using a form or note deviations by: Swing phase deviations, stance phase deviations
  3. Additional outcome measures: gait velocity, specific gait measures (functional gait analysis), kinematics (stride length, cadence, step length)

Question 6

Trunk Gait Deviation Terminology

Answer 6

• Lateral lean left/right (ex. above knee amputations)
• Lateral lean back/forward
• Lateral rotation left/right

Question 7

Pelvis Gait Deviations

Answer 7

• excessive pelvic rotation: hip is fused & moves pelvis & hip together-skeletal issue
• Anterior pelvic tilt
• Pelvic elevation: elevating pelvis during swing phase provides a method to swing limb forward

Question 8

Gluteus medius and pelvic/trunk deviations

Answer 8

1. Abductor lurch or gluteus medius gait: lateral lean toward involved side (to decrease torque changing COM not on top of leg)
2. Trendelenburg gait: contralateral pelvic drop (much more common)
   * Two distinct hip deviations: weak gluteus medius
   * Pelvic drop from leg length discrepency: ipsilateral pelvic drop: short limb syndrome
   * Waddling gait: bilateral pelvic drop

Question 9

Hip Gait Deviations

Answer 9

• Gluteus maximus lurch (hip extending in stance phase, change in COM, not common)
• Hip hike and circumduction (ex. after CVA)
• hip circumduction (ex. amputee circumduction, knee joint in extension for better stance phase on other leg)

-Look at videos in this slide

Question 10

Knee Gait Deviations

Answer 10

• Knee hyperextension (SLS in midstance): knee hyperextension recurvatum knee
• Knee flexion (SLS): knee flexion during stance (not full knee ext, check ROM, accelerates osteoathritis)
• Knee Varus (SLS)

Question 11

Ankle Gait Deviations

Answer 11

• Foot drop or high steppage gait
  -full foot contact, no heel strike, could be weakness of anterior tib, common
  -Various etiologies: peripheral nerve injury, neuromuscular diseases
  -Deviation: observed throughout the gait cycle especially with the major deviation occuring throughout entire swing phase
• Flat foot gait or calcaneal gait
  -somewhat of heel strike
• Vaulting: excessive plantarflexion during stance phase
• Foot slap
  -foot slap on ground w/prostetic
• Heel off
  -heels off at all time
  -hemiperisis