Abnormal Gait

Question 1

Tightness vs weakness

Answer 1

COWS

Contractures affect opposite side step length/ROM
- hip flexion contracture will lead to decreased hip extension on same side and decrease in step length on opposite side

Weakness affects same side step length/ROM
- weakness of hip flexors will cause decreased hip flexion on same side and decrease in step length on same side

Question 2

Muscle activity in the gait cycle: hip abductors

Answer 2

Hip Abductors
Gluteus medius, Gluteus minimus, Tensor fascia lata

Stance phase
Eccentric contraction – stabilize pelvis

Question 3

Muscle activity in the gait cycle: hip adductors

Answer 3

Hip Adductors
Adductor longus/brevis, Gracilis, Adductor magnus (horizontal and
vertical heads)

Early and late stance
Concentric contraction - stabilize pelvis

Question 4

Muscle activity in the gait cycle: gluteus maximus

Answer 4

Initial stance phase
Eccentric contraction - decelerate forward momentum

Question 5

Muscle activity in the gait cycle: erector spinae

Answer 5

Heel strike through toe-off
Maintain trunk posture

Question 6

Causes of backward lean

Answer 6

In stance:
weak hip extensors
hip flexion rigid contracture (2/2 anterior pelvic tilt compensation)

In swing:
Weak hip flexors

Question 7

Causes of forward lean

Answer 7

In stance:
Weak hip flexors
Hip flexion contracture
Weak quadriceps
Plantar flexor contracture or spasticity

Question 8

Muscle activity in the gait cycle: peroneus longus and brevis

Answer 8

Stance phase
Concentric contraction - maintain medial and lateral stability of the foot

Question 9

Muscle activity in the gait cycle: foot intrinsics

Answer 9

Stance phase
Concentric contraction - support plantar fascia

Question 10

Excessive knee extension (hyperextension) causes

Answer 10

Quad weakness
Excessive ankle plantar flexion

Question 11

Excessive plantarflexion impact on gait

Answer 11

Causes loss of progression - leads to shortened stride length and reduce velocity

Low heel contract at initial contact and forefoot contact

3 substitutions/compensations
- premature heel off
- knee hyperextension
- forward trunk lean

Question 12

Excessive PF deviation

Answer 12

Causes: plantar flexor contracture or spasticity, fused ankle in PF

Occurs during MSt and/or TSt

IC is made by the forefoot, and the heel is brought to the ground by displacing the tibia posteriorly at MSt; forward trunk lean and hip flexion during TSt to shift weight of the
body over foot for forward progression

Early heel-off

Question 13

Excessive DF deviation

Answer 13

Causes: inability of plantar flexors to control tibial advancement; knee and/or hip flexion contractures; fixed DF deformity

Occurs during MSt and/or TSt

Late heel-off; reduced push-off; shorter step length

Question 14

Foot slap deviation

Answer 14

Causes: mild weakness of dorsiflexors

After heel strike, rapid ankle flexion
➤ Phase: LR

Characteristic noise: foot slap when the foot hits the ground

Ankle dorsiflexors have enough strength to dorsiflex but not enough to control ankle PF after heel strike

Question 15

Foot flat deviation

Answer 15

Causes: marked weakness of dorsiflexors, PF contracture, knee flexion contracture

Entire plantar aspect of foot comes into contact with the ground at IC, followed by normal passive ankle DF

Ankle dorsiflexors have enough strength to partially dorsiflex the ankle during the swing phase

Normal DF in the stance phase present if there is normal ankle ROM

Question 16

Excessive inversion deviation

Answer 16

Causes: overactive invertors, contracture of invertors, weakness of evertors, primitive extensor pattern

Excessive subtalar joint inversion

Stance or swing phase

High medial longitudinal arch

Question 17

Excessive eversion deviation

Answer 17

Causes: overactive evertors, contracture of evertors, weakness of invertors, primitive flexor pattern

Excessive subtalar joint eversion

Stance or swing phase

Flattening of medial longitudinal arch and internal rotation of lower extremity (LE) during the stance phase

Normal medial longitudinal arch noted during the swing phase