POG: Pathological Gaits

Question 1

what causes lack heel first contact?

what mms can be weak?

what does weak DF lead to?

What contracture?

What happens in TSt that can cause this?

Answer 1

Weak DF → cant eccentrically lower foot

Foot drop → weak DF

PF contracture

Excess knee flexion in TWs b/c quads cant extend

Excess PF in TSw, decreased DF in TSw
Compensatory for weak quads to avoid normal LR

Question 2

knee extended at LR

what is normal range?
what is weak?
contracture?

Answer 2

Normally knee is 15 flexed

Quad weakness → turns off quad

PF contracture → causes leg to stay extended

Pt trying to avoid knee bucking

Question 3

limited DF at Midstance and terminal stance
causes

Answer 3

PF tightness
PF spasticity

Question 4

limited DF at Midstance and terminal stance

compensations for tight PF

Answer 4

Early heel rise
Foot pronation
External rotation of foot

Question 5

limited knee flexion causes

what mm?

Answer 5

PF contracture/weak → calves push off force allows passive knee flexion

Weak hip

Question 6

excessive knee flexion (Crouch gait)

causes

what can be weak?

what can be spastic?

contracture of?

Answer 6

Quad weakness
PF weakness

Hamstring spasticity

Knee flexion contracture

Question 7

Weak PF → tibia moves forward → knee collapses into __

Answer 7

flexion

Question 8

excessive DF in stance causes

what is weak?

Answer 8

PF weak

Tibial advancement not controlled

Question 9

contralateral hip drop

causes

Answer 9

Weak glute med/min → seen in mid stance

Question 10

lateral trunk lean toward weak side

causes

Answer 10

Hip abductor weakness → reduce moment arm of body weight

Question 11

Lean toward weak side is called a ___

Answer 11

compensated Trendelenburg gait

Question 12

Lean toward strong side usually __

Answer 12

pain

antalgic gait

Question 13

excessive trunk flexion in stance

causes

what is weak?
contracture of ?

Pt shifts COM ____

Answer 13

Weak glute med

Hip flexion contracture

Pt shifting COM anterior to reduce hip extensor demand

Question 14

increased double limb support

causes

Answer 14

Painful limb
Poor balance

Question 15

increased BOS
causes

Answer 15

Balance deficits

Question 16

increase toe out causes

Answer 16

Tight PF

Hip ER contracture

Balance compensation

Question 17

Weak plantarflexors often cause THREE things simultaneously

Answer 17

Excessive DF
Excessive knee flexion
Reduced push-off

Question 18

Foot drag in swing
causes

whats weak?

Answer 18

Weak DF
Weak hip flexors
Weak knee flexors

Long limb or inadequate limb shortening

Question 19

Excessive PF in swing
causes

whats weak?
contracture?

Answer 19

Weak DF
PF contracture

Question 20

what does Excessive PF in swing result in ___

how do they compensate?

Answer 20

Toe drag

Need for compensation with circumduction, hip hiking

Question 21

Stiff Knee swing causes

whats weak?
spastic?
Szots main thing?

Answer 21

Weak knee flexors - hamstrings

Weak hip flexors

Quad spastic

Poor push off PF

Question 22

Hip ER, hiking, circumduction causes

what phase of gait?

Answer 22

weak hip flexors
weak knee flexors
stiff knee swing
LLD
foot drop

swing phase!

Question 23

Your patient demonstrates decreased knee flexion/stiff knee gait pattern in swing phase of gait. Which of the following is the most likely cause of this gait deviation?

Answer 23

weakness in plantarflexors → calf mms must control ankle DF allowing heel rise.

Question 24

in LR weak quads leads to knee buckling why

Answer 24

Normal: quads work eccentrically to control knee flexion as body accepts weight.
GRF initially passes posterior to knee, this creates knee flexion. Quads eccentrically control flexion and prevent knee from collapsing

GRF stays posterior to knee, weak quads cant resist so knee collapse into flexion

Question 25

LR weak quads can lead to knee hyperextension why

Answer 25

avoid knee buckling by moving GRF anterior to knee → knee hyperextension. Forward trunk lean

Question 26

what controls the tibial advancement

Answer 26

The gastrocnemius soleus control this eccentrically to slow tibial advancement

Question 27

tibia normally advances forward over the foot this the __ rocker that occurs in what phase of gait?

Answer 27

ankle mid stance

Question 28

if PF is weak in mid stance what happens to tibia

Answer 28

reclined

Question 29

With plantarflexor weakness in midstance, the tibia may remain reclined because the patient limits forward tibial advancement to maintain stability, often resulting in a ____ moment and possible ____ .

Answer 29

knee extension knee hyperextension

Question 30

Hip abductor weakness is a __ sign pelvis drops on what side?

Answer 30

trendelenburg sign (pelvis drops on swing side),

Question 31

Decreased DF in mid stance can be due to

Answer 31

PF contracture weak quads - avoids knee buckle by keeping tibia from moving forward, position foot more flat or PF, knee hyperextension with forward trunk lean weak PF - b/c controls forward mvmt of tibia over foot. Body limit forward tibial mvmt to stay stabke

Question 32

uncontrolled tibial advancement in TSt due to

Answer 32

weak PF -often can see crouched gait and more DF

Question 33

TSt we see excessive knee flexion why demand on what mm to prevent this?

Answer 33

b/c tibia is moving forward the knee is pulled into flexion increased quad demand keep knee from collapsing

Question 34

Tst we see short step length early heel rise on other foot due to

Answer 34

tight or contracted PF normally: tibia moves forward over foot creates DF before push off BUT if PF tight then ankle cant DF, early heel rise

Question 35

if we see hamstring weakness in terminal stance what can it lead to in IC

Answer 35

Hamstring weakness → cant decelerate knee extension leads to hyperextension at IC normal: hamstrings help control hip extension and stabilize knee hamstrings weak: cant help control knee extension, knee may move into hyper extension

Question 36

swing phase into IC DF weakness

Answer 36

foot slap in IC swing phase compensations: steppage gait (Excessive knee and hip flexion), hip hiking, circumduction, contralateral vaulting normal: swing phase - DF lift foot for toe clearance DF weak: ankle cant stay DF so foot slap or flat foot IC

Question 37

Initial swing hip flexor weakness can lead to what compensations

Answer 37

circumduction hip hiking increased pelvic rotation normal: hip flexors initiate limb advancement in initial swing

Question 38

at IC/LR if glute max is weak

Answer 38

posterior trunk lean to move gravity behind hip creating hip extension moment to staiblize joint

Question 39

what gait can be due to weak DF

Answer 39

steppage gait *increased knee and hip flexion

Question 40

in swing, hip flexion helps to

Answer 40

advance the limb

Question 41

terminal swing what if knee cant extend because of weak quads

Answer 41

land flat foot with knee bent b/c knee stays flexed at IC

Question 42

if you dont have recoil for swing in terminal stance do you get knee flexion for swing

Answer 42

no

Question 43

If the patient presents with forefoot or foot-flat contact in IC, what is the most likely cause?

Answer 43

* secondary to excess KNEE FLEXION in TSw * secondary to excess PF in TSw * compensatory for weak quads to avoid normal LR

Question 44

If the patient presents with foot slap in IC, what is the most likely cause?

Answer 44

Weak pretibials

Question 45

If a pt has excess PF in Weight Acceptance, what is the most likely cause?

Answer 45

plantar flexion contracture

Question 46

This card is to make sure you understand the abbreviations/acronyms:

Answer 46

WA = weight acceptance SLS = single limb support SLA = swing limb advancement

Question 47

If pt has excess PF in SLS, what is the most likely cause?

Answer 47

* PF hypertonicity * weak quads --> hyperextension

Question 48

If pt has excess PF in *SLA*, what is the most likely cause?

Answer 48

* weak pretibials * PF hypertonicity or contracture

Question 49

If the pt has excess DF in WA, what is the most likley cause?

Answer 49

secondary to excess hip or knee flexion

Question 50

If the pt has excess DF in SLS, what is the most likely cause?

Answer 50

* weak calf * secondary to excess hip/knee flexion If the plantarflexors are weak, they cannot control tibial advancement. So the tibia moves too far forward.

Question 51

if pt has decreased limb advancement on swing, what could be weak

Answer 51

either hip flexors or PLANTARFLEXORS

Question 52

if you have knee hyperextension early in IC vs late like mid stance and terminal stance what cause?

Answer 52

early: quad weakness, may be PF late in stance: PF weakness b/c this mm is on

Question 53

increased knee crouch during stance phase due to

Answer 53

PF weakness *not a quad b/c person is using quad to maintain stance