8.1 Pathological Gait: Foot and Ankle Flashcards

1
Q

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

A

Impairments in

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

What phases are plantar flexors active in?

A
  1. Mid stance

2. Terminal Stance

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3
Q

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

A
  1. Mid Stance

2. Terminal Stance

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4
Q

Which phase of the Gait cycle are inverters active?

A

Loading Response
Mid stance
Terminal stance

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5
Q

What is the definition of a loose packed position?

A

A Mid-range position

The intra-articular pressure within a joint

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6
Q

What is the definition of a closed packed position?

A

Maximum Joint congruency

Usually an end range

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7
Q

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

A

Intra-articular pressure is high

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8
Q

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

A

Decreased

it is at its lowest at 15° of plantar flexion

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9
Q

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

A

The intra-articular pressure is at its highest point.

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10
Q

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

A

about 15° of plantar flexion

Lease amount of Intra-articular pressure within the joint

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11
Q

What does it mean to have a Plantar Flexion contracture?

A

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.

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12
Q

The most common restriction at the ankle is what?

A

Plantar Flexion Contracture

A Loss of dorsiflexion about the ankle.

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13
Q

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

A

Excessive Plantar Flexion

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14
Q

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

A

Excessive Dorsiflexion

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15
Q

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

A

Excessive Plantar Flexion

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16
Q

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

A

Excessive plantar flexion.

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

17
Q

What are the 5 potential causes of Excessive Plantar Flexion?

A
  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
18
Q

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

A

Decreased Stance Phase Progression

LACK OF HEEL ROCKER

19
Q

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?”

-

A

Decreased Stance Phase Progression

-Due to Lack of Heel Rocker

20
Q

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

A
  1. Calve Tightness and/or Contracture
  2. Excessive Plantar Flexor Activity
  3. Shortened Step Length
    - (Patients are unable to reach 5°-10°of dorsiflexion)
21
Q

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

A
  1. Compensatory for Hip and/or Knee Extensor Weakness

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

22
Q

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

A
  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
23
Q

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

A

Potential Causes

  • Dorsiflexor Weakness
  • Calf Tightness and or Contracture
  • Excessive Calf Activity
24
Q

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

A

Diminished Foot Clearance

25
What are some compensations for Excessive Plantar Flexion in Initial and Mid Swing?
Excessive Hip Flexion Excessive Knee Flexion
26
During Initial contact and loading response, what are some potential causes for excessive Ankle Dorsiflexion?
1. Ankle Foot Orthosis | 2. Prosthetic Foot
27
What angle do Foot Orthosis and Prosthetic foots usually get set in?
5-8° Dorsiflexion
28
What are the penalties for having excessive dorsiflexion in Initial Contact and Loading response?
1. Excessive Heel Rocker | 2. Excessive Knee Flexion and Quadricep Activity
29
During Mid Stance, terminal stance, and Pre-swing, what could be a cause for Excessive Ankle Dorsiflexion?
Calf Weakness
30
What are the penalties for having excessive ankle dorsiflexion in Mid stance, terminal stance, and pre-swing?
1. Quadricep overuse | 2. Excessive Lowering of COM
31
What phases in the Gait cycle do we expect to find Excessive Foot Pronation?
1. Loading Response | 2. Midstance
32
What phases in the gait cycle do we expect foot pronation to be occurring in the wrong phase of gait?
Terminal Stance
33
What are the causes of excessive Foot Pronation in Loading Response and Terminal Stance?
1. Limited Ankle Dorsiflexion 2. Hypomobile Subtalar Joint 3. Hypermobile Rearfoot/Midfoot 4. Inverter Weakness 5. Dynamic Knee Valgus
34
What are the causes of limited Foot Pronation?
1. Hypomobile Rearfoot 2. Medial Point of Contact 3. Dynamic "Splinting" 4. Cavus Foot
35
What are the penalties associated with Abnormal Foot Pronation?
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
36
What phase of the Gait cycle are dorsiflexors active?
1. Initial Swing 2. Mid Swing 3. Terminal Swing 4. Loading Response