8.1 Pathological Gait: Foot and Ankle

Question 1

If one had weakness in their dorsiflexors, we would probably see…

Answer 1

Impairments in

1. Initial Swing
2. Mid swing
3. Terminal Swing
4. Loading Response

Question 2

What phases are plantar flexors active in?

Answer 2

1. Mid stance

2. Terminal Stance

Question 3

Weakness in plantar flexor muscles would influence which stages of the gait cycle?

Answer 3

1. Mid Stance

2. Terminal Stance

Question 4

Which phase of the Gait cycle are inverters active?

Answer 4

Loading Response
Mid stance
Terminal stance

Question 5

What is the definition of a loose packed position?

Answer 5

A Mid-range position

The intra-articular pressure within a joint

Question 6

What is the definition of a closed packed position?

Answer 6

Maximum Joint congruency

Usually an end range

Question 7

When the ankle is maximally dorsiflexed, What happens to the intraarticular pressure?

Answer 7

Intra-articular pressure is high

Question 8

When the ankle is Plantar flexed to about 15°, what happens to the intra-articular pressure?

Answer 8

Decreased

it is at its lowest at 15° of plantar flexion

Question 9

When happens to the intra-articular pressure when the foot is maximally plantar flexed?

Answer 9

The intra-articular pressure is at its highest point.

Question 10

What is the most common seat resting position of the ankle and what is the significance of knowing this?

Answer 10

about 15° of plantar flexion

Lease amount of Intra-articular pressure within the joint

Question 11

What does it mean to have a Plantar Flexion contracture?

Answer 11

Losing the ability to have full Range of Motion in dorsiflexion.

a 15° Plantar flexion contracture means you can plantar flex to anything beyond 15°, but you cannot dorsiflex blow 15°of PF.

Question 12

The most common restriction at the ankle is what?

Answer 12

Plantar Flexion Contracture

A Loss of dorsiflexion about the ankle.

Question 13

This is termed as a lack of ROM for dorsiflexion and is coupled with too much plantar flexion

Answer 13

Excessive Plantar Flexion

Question 14

This is termed as a lack of normal plantar flexion and having too much dorsiflexion

Answer 14

Excessive Dorsiflexion

Question 15

If someone has 20° of plantar flexion during loading response, this is known as?

Answer 15

Excessive Plantar Flexion

Question 16

If one has 4° of dorsiflexion in terminal stance, a Gait analyst would suggest the individual has…

Answer 16

Excessive plantar flexion.

-We do not say lack of, only excessive for a Contracture

Question 17

What are the 5 potential causes of Excessive Plantar Flexion?

Answer 17

1. Dorsiflexor Weakness
2. Calf Tightness and/or Contracture
3. Excessive Calf Activity (abnormal motor control)
4. Purposeful Strategy to Reduce Heel Rocker
5. Heel Pain

Question 18

During Initial Contact, what is the penalty associated with Excessive Plantar Flexion?

Answer 18

Decreased Stance Phase Progression

LACK OF HEEL ROCKER

Question 19

Example Final Exam Question.

What is the Deviation at the ankle?
-You look for abnormal gait patterns and list them

Next, what is the penalty now that you found “Excessive Plantar Flexion?”

-

Answer 19

Decreased Stance Phase Progression

-Due to Lack of Heel Rocker

Question 20

During Mid Stance-Terminal stance, what is the most common causes for Excessive Ankle Plantarflexion?

Answer 20

1. Calve Tightness and/or Contracture
2. Excessive Plantar Flexor Activity
3. Shortened Step Length
   - (Patients are unable to reach 5°-10°of dorsiflexion)

Question 21

During Midstance and terminal stance, What are the most common causes of Excessive Calf Activation?

Answer 21

1. Compensatory for Hip and/or Knee Extensor Weakness

2. Push Body forward as opposed to hip and knee extension pulling body forward

Question 22

What are the penalties for excessive plantar flexion in Mid-stance and Terminal-stance

Answer 22

1. Decreased Forward Progression
   - (Lack of Ankle Rocker)
2. Requires Compensatory strategies to augment forward progression
   - Knee Hyperextension
   - Midfoot Pronation
   - Early Heel Raise and Elevated COM

Question 23

During Initial Swing and Mid swing, what are the potential causes of Excessive Ankle Plantarflexion?

Answer 23

Potential Causes

• Dorsiflexor Weakness
• Calf Tightness and or Contracture
• Excessive Calf Activity

Question 24

What is a penalty for having Excessive ankle Plantarflexion during Initial and mid Swing?

Answer 24

Diminished Foot Clearance

Question 25

What are some compensations for Excessive Plantar Flexion in Initial and Mid Swing?

Answer 25

Excessive Hip Flexion

Excessive Knee Flexion

Question 26

During Initial contact and loading response, what are some potential causes for excessive Ankle Dorsiflexion?

Answer 26

1. Ankle Foot Orthosis

2. Prosthetic Foot

Question 27

What angle do Foot Orthosis and Prosthetic foots usually get set in?

Answer 27

5-8° Dorsiflexion

Question 28

What are the penalties for having excessive dorsiflexion in Initial Contact and Loading response?

Answer 28

1. Excessive Heel Rocker

2. Excessive Knee Flexion and Quadricep Activity

Question 29

During Mid Stance, terminal stance, and Pre-swing, what could be a cause for Excessive Ankle Dorsiflexion?

Answer 29

Calf Weakness

Question 30

What are the penalties for having excessive ankle dorsiflexion in Mid stance, terminal stance, and pre-swing?

Answer 30

1. Quadricep overuse

2. Excessive Lowering of COM

Question 31

What phases in the Gait cycle do we expect to find Excessive Foot Pronation?

Answer 31

1. Loading Response

2. Midstance

Question 32

What phases in the gait cycle do we expect foot pronation to be occurring in the wrong phase of gait?

Answer 32

Terminal Stance

Question 33

What are the causes of excessive Foot Pronation in Loading Response and Terminal Stance?

Answer 33

1. Limited Ankle Dorsiflexion
2. Hypomobile Subtalar Joint
3. Hypermobile Rearfoot/Midfoot
4. Inverter Weakness
5. Dynamic Knee Valgus

Question 34

What are the causes of limited Foot Pronation?

Answer 34

1. Hypomobile Rearfoot
2. Medial Point of Contact
3. Dynamic “Splinting”
4. Cavus Foot

Question 35

What are the penalties associated with Abnormal Foot Pronation?

Answer 35

Excessive Motion

1. Stress on Inverters and Plantar Fascia
2. Stress on Inner-tarsal Ligaments
3. Hallux Valgus
4. Increased Tibia rotation and Stress on Knee

Limited Motion
1. Poor Shock Absorption

Question 36

What phase of the Gait cycle are dorsiflexors active?

Answer 36

1. Initial Swing
2. Mid Swing
3. Terminal Swing
4. Loading Response