8.1 Pathological Gait: Foot and Ankle Flashcards
If one had weakness in their dorsiflexors, we would probably see…
Impairments in
- Initial Swing
- Mid swing
- Terminal Swing
- Loading Response
What phases are plantar flexors active in?
- Mid stance
2. Terminal Stance
Weakness in plantar flexor muscles would influence which stages of the gait cycle?
- Mid Stance
2. Terminal Stance
Which phase of the Gait cycle are inverters active?
Loading Response
Mid stance
Terminal stance
What is the definition of a loose packed position?
A Mid-range position
The intra-articular pressure within a joint
What is the definition of a closed packed position?
Maximum Joint congruency
Usually an end range
When the ankle is maximally dorsiflexed, What happens to the intraarticular pressure?
Intra-articular pressure is high
When the ankle is Plantar flexed to about 15°, what happens to the intra-articular pressure?
Decreased
it is at its lowest at 15° of plantar flexion
When happens to the intra-articular pressure when the foot is maximally plantar flexed?
The intra-articular pressure is at its highest point.
What is the most common seat resting position of the ankle and what is the significance of knowing this?
about 15° of plantar flexion
Lease amount of Intra-articular pressure within the joint
What does it mean to have a Plantar Flexion contracture?
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.
The most common restriction at the ankle is what?
Plantar Flexion Contracture
A Loss of dorsiflexion about the ankle.
This is termed as a lack of ROM for dorsiflexion and is coupled with too much plantar flexion
Excessive Plantar Flexion
This is termed as a lack of normal plantar flexion and having too much dorsiflexion
Excessive Dorsiflexion
If someone has 20° of plantar flexion during loading response, this is known as?
Excessive Plantar Flexion
If one has 4° of dorsiflexion in terminal stance, a Gait analyst would suggest the individual has…
Excessive plantar flexion.
-We do not say lack of, only excessive for a Contracture
What are the 5 potential causes of Excessive Plantar Flexion?
- Dorsiflexor Weakness
- Calf Tightness and/or Contracture
- Excessive Calf Activity (abnormal motor control)
- Purposeful Strategy to Reduce Heel Rocker
- Heel Pain
During Initial Contact, what is the penalty associated with Excessive Plantar Flexion?
Decreased Stance Phase Progression
LACK OF HEEL ROCKER
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?”
-
Decreased Stance Phase Progression
-Due to Lack of Heel Rocker
During Mid Stance-Terminal stance, what is the most common causes for Excessive Ankle Plantarflexion?
- Calve Tightness and/or Contracture
- Excessive Plantar Flexor Activity
- Shortened Step Length
- (Patients are unable to reach 5°-10°of dorsiflexion)
During Midstance and terminal stance, What are the most common causes of Excessive Calf Activation?
- Compensatory for Hip and/or Knee Extensor Weakness
2. Push Body forward as opposed to hip and knee extension pulling body forward
What are the penalties for excessive plantar flexion in Mid-stance and Terminal-stance
- Decreased Forward Progression
- (Lack of Ankle Rocker) - Requires Compensatory strategies to augment forward progression
- Knee Hyperextension
- Midfoot Pronation
- Early Heel Raise and Elevated COM
During Initial Swing and Mid swing, what are the potential causes of Excessive Ankle Plantarflexion?
Potential Causes
- Dorsiflexor Weakness
- Calf Tightness and or Contracture
- Excessive Calf Activity
What is a penalty for having Excessive ankle Plantarflexion during Initial and mid Swing?
Diminished Foot Clearance
What are some compensations for Excessive Plantar Flexion in Initial and Mid Swing?
Excessive Hip Flexion
Excessive Knee Flexion
During Initial contact and loading response, what are some potential causes for excessive Ankle Dorsiflexion?
- Ankle Foot Orthosis
2. Prosthetic Foot
What angle do Foot Orthosis and Prosthetic foots usually get set in?
5-8° Dorsiflexion
What are the penalties for having excessive dorsiflexion in Initial Contact and Loading response?
- Excessive Heel Rocker
2. Excessive Knee Flexion and Quadricep Activity
During Mid Stance, terminal stance, and Pre-swing, what could be a cause for Excessive Ankle Dorsiflexion?
Calf Weakness
What are the penalties for having excessive ankle dorsiflexion in Mid stance, terminal stance, and pre-swing?
- Quadricep overuse
2. Excessive Lowering of COM
What phases in the Gait cycle do we expect to find Excessive Foot Pronation?
- Loading Response
2. Midstance
What phases in the gait cycle do we expect foot pronation to be occurring in the wrong phase of gait?
Terminal Stance
What are the causes of excessive Foot Pronation in Loading Response and Terminal Stance?
- Limited Ankle Dorsiflexion
- Hypomobile Subtalar Joint
- Hypermobile Rearfoot/Midfoot
- Inverter Weakness
- Dynamic Knee Valgus
What are the causes of limited Foot Pronation?
- Hypomobile Rearfoot
- Medial Point of Contact
- Dynamic “Splinting”
- Cavus Foot
What are the penalties associated with Abnormal Foot Pronation?
Excessive Motion
- Stress on Inverters and Plantar Fascia
- Stress on Inner-tarsal Ligaments
- Hallux Valgus
- Increased Tibia rotation and Stress on Knee
Limited Motion
1. Poor Shock Absorption
What phase of the Gait cycle are dorsiflexors active?
- Initial Swing
- Mid Swing
- Terminal Swing
- Loading Response
