Ankle/Foot deviations in gait Flashcards
What gait phases are affected by excessive plantarflexion?
IC, MS,TS, Msw, Tsw
If someone has bone spurs on the bottom of their heel, what position may they keep their foot during gait?
in voluntary excessive plantarflexion to avoid heel contact
What is a low heel strike?
When the foot hits the ground not at 90 degrees; hits more flat and loses the heel rocker
What compromises can be made in midswing to allow an excessively plantar-flexed foot to clear floor? (4)
1) increase KF and HF
2) circumduction
3) lateral trunk lean toward unaffected foot
4) contralateral vaulting
- toe drag may occur
What can cause excessive DF?
- AFO
- soleus weakness
- ankle locked (PF stop)
Excessive DF can lead to what?
- too much heel rocker, causing too much knee flexion
- limb instability
How does a limb that has excessive dorsiflexion present in midstance?
decreased knee extension, unstable limb
How does excessive dorsiflexion affect the load response?
too much heel rocker, causing increased KF
What happens to the heel with increased dorsiflexion?
delayed heel rise and prolonged heel contact
With a child who has excessive plantarflexion, what do you expect to see during initial contact?
initial contact = forefoot contact or low heel strike
What rocker(s) do you lose with excessive plantar flexion?
ankle and heel rockers
With what presentation at the foot may you see a forward trunk lean?
excessive plantarflexion: tibia not advancing forward, so trying to get body to go forward another way
With what foot deviation do you see a premature heel rise?
excessive plantar flexion
What gait phases does excessive dorsiflexion impact?
loading, midstance, terminal stance, preswing
Which indicates more severe DF weakness, foot slap or foot drop?
foot slap
Describe foot slap/drop.
- weakness of the ankle DFs results in the foot slapping or dropping into immediate plantar flexion upon initial contact
- instead of DFs controlling the plantar flexion that occurs after initial contact, the foot just falls to the ground
What can cause a foot slap or foot drop?
common fibular nerve palsy and peripheral neuropathy
Delayed heel rise: what is it? What gait deviation causes this?
- delayed heel rise = heel stays on floor well into terminal stance
- weakness or paralysis of the plantar flexors can cause delayed heel rise
- can be from CNS or PNS disorder, or achilles tendon lengthening surgically
With an achilles tendon repair, what may you see in this patient?
Delayed heel rise b/c not much plantar flexion
What can cause a foot flat gait deviation?
foot flat = hitting ground this way
- marked weakness of ankle dorsiflexors, overactive hams, KF contracture
Will you see normal ROM for DF in a foot flat gait deviation?
yes: normal stance dorsiflexion occurs if ROM is there. Just can’t get dorsiflexion to occur after initial contact, so you lose
In what gait deviation(s) will you see knee hyperextension and a forward trunk lean?
1) plantarflexion contractures
- knee hyperextension in midstance to get heel to hit ground after forefoot initial contact
- forward trunk lean maintains the forward progression
2) weak quads (basically same scenario except you throw leg back into extension to get stability in loading)
T/F: A correction for weak quads can simply be a forward trunk lean.
true, because this moves CoM anterior to knee, making extensors not work as hard, which is what these patients want
What is a spatial-temporal descriptor of gait?
walking speed, normally 1.37 m/s
When an increase in walking speed is needed, what can we increase in our gait to make this happen?
increase step/stride, increase cadence
All values obtained from measurements of walking vary based on what?
walking speed
At what percentage of gait does toe off occur?
60% of gait
At what percentage of gait cycle does preswing occur?
50-60%
At what point in gait is a point of minimal kinetic energy and max potential energy?
mid stance
When is CoM the lowest, and thus at the least potential energy?
in the middle of double limb support
T/F: No active dorsiflexion during swing with a foot drop and forefoot-heel contact deviation.
true; only get to neutral DF during swing, nothing more
What causes foot flat?
markedly weak DF or KF contracture or overactive hams
- can also be voluntary to increase stability
What do you see in crouched gait at the hip, knee, and ankle?
HF, KF, PF
What can cause foot drop with forefoot-heel contact?
severe weakness of DF and/or PF contracture (pes equinus)
What causes forefoot-delayed heel contact?
PF contraction or spasticity of PFs
- can be the result of upper motor lesion from CP or CVA, or from the fusion of the ankle in a plantar flexed position
What happens at the knee with forefoot-delayed heel contact?
hyperextension to drive the tibia back to get the heel down
What happens in terminal stance for forefoot-delayed heel contact?
hip flexion and forward trunk lean during terminal stance occur to shift body weight over foot
T/F: Excessive knee extension can cause toes or forefoot only contact with gait.
false, excessive knee flexion
Toes or forefoot only contact leads to what kind of specific gait, often found in kids with CP?
crouched gait: HF, KF, PF
Lateral foot weight bearing can occur with what foot deformity?
soleus contracture or pes cavus, like matthew!
T/F: Rearfoot valgus can cause excessive dynamic pronation.
false: rearfoot varus and forefoot varus can cause excessive dynamic pronation, as well as a weak tib posterior and soleus
What causes delayed heel rise?
weakness or paralysis of PFs, or pes calcaneus deformity
To avoid weight bearing on the heel, what gait deviation might you observe?
toes or forefoot only contact, can lead to crouched gait
What’s the difference between “foot drop and forefoot-heel contact” vs “forefoot-delayed heel contact”?
1) foot drop and forefoot-heel contact: due to severely weak DFs or PF contracture, caused by common fibular nerve palsy/peripheral neuropathy
2) forefoot-delayed heel contact = PF contracture or spasticity, caused by upper motor lesion, CP, CVA
- you see knee hyperextension here
When would one “vault”?
any time the contralateral limb needs to be “lengthened” to clear the floor; maybe if it’s not getting enough DF, HF, or KF
What causes foot flat?
markedly weak DFs or KF contracture or overactive hams
T/F: The medial longitudinal arch is not present during swing in dynamic excessive pronation.
false, it is
- it’s not present in static excessive pronation
Which deviation presents with a constantly floppy foot?
static excessive pronation
Excessive anteversion causes what to happen at the toe?
toe in
What can cause static excessive pronation? What causes dynamic pronation?
static pronation = upper motor lesion, congenital deformity
dynamic = congenital deformity
What likely impairments are found with static pronation vs dynamic pronation?
- static = weak/paralyzed ankle inverters, pes planus deformity
- dynamic = rearfoot varus, forefoot varus, soleus/tib posterior weakness
