Clinical Correlations -Gait

Question 1

True or false? In both running and walking, there are times when both feet are touching the ground.

Answer 1

false; in running, only one foot touches

Question 2

The gait cycle is form the initial contact of a foot on the ground to the next initial contact of the same foot. It has 2 major phases, what are they? also describe

Answer 2

stance phase: when the foot is on the ground (60% of walking gait cycle)

swing phase: when the foot is in the air (40% of walking gait cycle)

Question 3

We initiate ____ by simultaneously shifting body weight to one limb while lifting the other limb out infant of our base of support.

Answer 3

stepping

Question 4

In regards to the 60% of the stance phase, breakdown the percentages of initial double support (both feet on ground), one foot on ground, and a second double support

Answer 4

initial double support (both feet on ground): 10%
one foot on ground: 40%
second double support: 10%

Question 5

This is the act of transferring body weight from the contralateral limb to the ipsilateral limb

Answer 5

weight acceptance

Question 6

The first part of weight acceptance is the heel strike. What is the position of the ipsilateral knee and ankle?

Answer 6

knee: extended
ankle: dorsiflexed

Question 7

In regards to the heel strike, the quadriceps femurs contract strongly to reduce knee flexion, anterior leg muscles reduce/slow plantar flexion; this is key for _____ disorders

Answer 7

neuropathic (ex: foot-slap)

Question 8

What is the issue with the heel strike?

Answer 8

desires a secure interface (non-slip, level)

Question 9

What is the second part of weight acceptance?

Answer 9

loading response - continuation of double support, until the contralateral limb initiates its swing phase

Question 10

In the loading response, the ipsilateral ankle plantar flexes create ____-___, the entire sole is on the ground

Answer 10

foot-flat

Question 11

How is shock absorbed in the loading response?

Answer 11

knee flexes, the foot pronates along with medial rotation of the tibia

Question 12

In regards to the loading response, if the timing of the knee, tibia and foot motion do not coincide, then the stress is created along the tibia or at the joints; a common cause is ___-___ of the foot

Answer 12

over-pronation

Question 13

What are the issues with with the loading response?

Answer 13

shock absorption is important; preserving progression (not too much deceleration is wanted); the movement to foot flat should be controlled by the dorsiflexors, if not then there is foot slap

Question 14

Single limb support is the act of supporting body weight, in order to advance the contralateral limb. The first part is the mid-stance period. The second part is terminal stance. Describe each one.

Answer 14

mid-stance: full transfer of weight to ipsilateral limb (contralateral in swing). The body advances over the stationary foot by ankle dorsiflexion, while the ipsilateral knee and hip extend.

terminal stance: the body has advanced over and starts to move forward accelerating past the stance foot. During this period, heel-off occurs at about the same moment that the contralateral foot strikes the ground, ending single-support

Question 15

How does mid-stance termination occur?

Answer 15

with the body weight centered over the stance foot, ending deceleration and beginning acceleration; the contralateral limb is at midswing

Question 16

What are the issues with the mid-stance period ?

Answer 16

pathology anywhere (hip, knee, ankle, or foot) can modify this period

Question 17

What are the issues with the termination period?

Answer 17

maintaining pelvic, trunk and limb stability; preparing for transfer to contralateral limb for second double support

Question 18

Swing preparation is sometimes categorized as the initial part of the swing phase due to its function for initiating the swing phase. The ____-____ is the final part of the stance phase, as the second double support.

Answer 18

pre-swing

Question 19

From heel-off to toe-off (terminal stance + pre-swing = ____ phase -> acceleration)

Answer 19

propulsion

Question 20

In regards to swing preparation, the goal of pre-swing is to initiate the task of what?

Answer 20

limb advancement - by propelling the body forward, transferring weight from the ipsilateral to the contralateral limb

Question 21

In regards to swing preparation, the ____ muscle activates to accelerate the limb into swing by flexing the hip

Answer 21

iliopsoas

Question 22

In regards to swing preparation, ____is vital, while pre-swing limb muscles are acting to prepare for rapid swinging

Answer 22

momentum

Question 23

What are the issues with swing preparation?

Answer 23

non-slip surface is important, positioning of limb for swing and conservation of momentum is crucial, various hallux pathologies affect toe-off

Question 24

When toeing off, the 1st digit is usually the last to have contact. The foot ___ momentarily but then goes back to neutral during the swing

Answer 24

inverts

Question 25

The swing phase fulfills one task, limb advancement. It is broken into three periods; initial swing, mid-swing, and terminal swing. Describe initial swing

Answer 25

involves acceleration of the limb; from toe-off to being adjacent the contralateral stance foot; involves flexion of the hip and knee, with dorsiflexion of the ankle, allowing for proper toe clearance at mid-swing

Question 26

What muscle is the primary instigator of strong hip flexion?

Answer 26

iliopsoas

Question 27

What are the issues with the initial swing?

Answer 27

foot clearance to avoid tripping

Question 28

Describe the mid-swing (second part of the swing phase)?

Answer 28

starts when limb is adjacent to the contralateral stance foot and continues until the tibia is perpendicular to the ground; the hip is flexing, the knee is extending to create equal hip and knee flexion angles; the foot is still dorsiflexed to clear the ground and to prepare for heel strike

Question 29

What is the goal of the mid-swing (second part of the swing phase)?

Answer 29

place the swinging limb anterior to the body

Question 30

What are the issues of the mid-swing (second part of the swing phase)?

Answer 30

foot clearance to avoid tripping

Question 31

Describe the terminal swing (final part of the swing phase)

Answer 31

decelerating to prepare for heel strike; from tibia being perpendicular to the ground until the heel strikes the ground; the hip stops flexing, but the knee extends with a fully dorsiflexed ankle; prior to heel strike the limb/foot must be slowed

Question 32

What is the goal of the terminal swing (final part of the swing phase)?

Answer 32

the smooth, slow play event of the heel to initiate stance

Question 33

What are the issues with the terminal swing (final part of the swing phase)?

Answer 33

trajectory and velocity of foot prior to heel strike help determine the possibly of slipping

Question 34

Subtalar movements occur concurrently in the frontal and horizontal planes, thus rotations of the tibia are translated to rations of the foot. True or false?

Answer 34

true

Question 35

At heel strike, what should occur simultaneously?

Answer 35

1. the foot should quickly pronate and then supinate to neutral 2. the leg should medially rotate and then laterally rate to neutral 3. the knee should flex and then extend

Question 36

The following description is of what component of normal gait: the pelvic crest on the side of the swing leg drops 5 degrees below the horizontal at mid stance of the contralateral limb

Answer 36

pelvic tilt

Question 37

The following description is of what component of normal gait: the pelvis rotates 4 degrees; anteriorly for swing limb, posteriorly for stance limb, maximizing the rotation at terminal swing and terminal stance. The torso simultaneously performs the opposite rotation

Answer 37

pelvic rotation

Question 38

The following description is of what component of normal gait: during the stance phase, the pelvis and trunk translate about 1 inch toward the stance limb

Answer 38

lateral shift note: shifts CoG and conserves energy

Question 39

The following description is of what component of normal gait: normally about 3 inches wide - distance between feet during double support

Answer 39

step width

Question 40

The following description is of what component of normal gait: distance from the point of heel strike of one foot to the subsequent heel strike of the same foot (length of one gait cycle)

Answer 40

stride length

Question 41

The following description is of what component of normal gait: distance from the point of heel strike of one foot to the heel strike of the contralateral foot

Answer 41

step length

Question 42

In regards to the gait cycle, muscles work to accomplish what 3 things?

Answer 42

1. accelerate or decelerate limbs 2. counterbalance force of gravity 3. counterbalance the ground reaction forces

Question 43

Limb shortening (flexing joints), pelvic motions, momentum, and elastic recoil result in what?

Answer 43

minimizing muscle activity -> an efficient, economical system

Question 44

This is important for injury prevention and maintaining clear vision. Peak vertical ground reaction forces at heel strike indicate how much needs to be dealt with.

Answer 44

shock absorption

Question 45

For each activity, give the associated peak GRF (in relation to body weight): 1. walking 2. jogging 3. sprinting

Answer 45

1. walking: 1X body weight 2. jogging: 2.5X body weight 3. sprinting: 3.5X body weight

Question 46

From the point of view of energy expenditure, it is more economical to lower the center of mass during walking than to maintain it level. True or false?

Answer 46

false; it is more economical to elevate the center of mass by keeping the hips and knees bent (groucho walking)

Question 47

In regards to energy expenditure, when is the high point and low point in the gait cycle reached?

Answer 47

high point: mid stance (going over the extended stance limb) | low point: double support

Question 48

What phase are most abnormal gaits seen? Why?

Answer 48

stance phase because this is when pain, muscle weakness, and joint abnormalities will produce their predominant effect

Question 49

Antalgic gait = against pain. For all painful gaits, ____ in the painful limb is decreased to get weight off the painful limb, thus ___ in the pain-free limb is also decreased

Answer 49

stance; swing

Question 50

If there is an antalgic gait due to hip pain, the person may shift weight over the painful stance limb, balancing above the hip, rather than allowing the pelvis to drop and reducing the pain on the hip. This results in what?

Answer 50

a lateral shift of the trunk by more than 1 inch because body weight plus the force on the hip created by contraction of the abductors wilds increased pressure within the hip joint, thus increasing pain of a pathologic hip

Question 51

This type of gait lacks coordination

Answer 51

ataxic

Question 52

In ____ ____, the gait is lurching/staggering like a drunk, moments are exaggerated, wide stance, unsteadiness, trunk tremors, lateral jerking of limbs

Answer 52

cerebellar ataxia note: nemonic is "if you are drunk, then you need to call a taxi cab"

Question 53

This type of gait is a neuropathic gait with weakness of ankle dorsiflexors. It is typically audible, asymmetric, and no pain associated

Answer 53

foot-slap gait

Question 54

In regards to foot-slap gait, if fully paralyzed dorsiflexors, then likely have a ___-____ gait brought about by excessive hip and knee flexion of the ipsilateral limb; if the hip and/or knee flexors are also weak or paralyzed or knee is stiff, then the patient may use a ___-___ gait

Answer 54

high-step; hip-hike note: in addition to hip-hike, limb circumduction may be used

Question 55

In this abnormal gait, abductors of stance limb must contract to keep pelvis from tilting down more than the normal 5 degrees; if abductors are too weak, then the contralateral pelvis drops

Answer 55

myopathic gait (gluteus medius gait) note: if the patient allows the pelvis to drop, this is called Trendelenburg Gait - leans over hip to keep hip from dropping

Question 56

In regards to myopathic gait; a ____ results with unilateral drop or a ___ gait results with bilateral drop

Answer 56

lurch; waddling note: may be brought about by polio, L5 nerve root lesion, gluteal injection damage of the superior gluteal nerve

Question 57

In regards to the myopathic gait, if the patient has weak hip flexors, acceleration of swing is impaired. How do they compensate?

Answer 57

rotate the pelvis excessively

Question 58

What is a positive trendelenburg test?

Answer 58

when the hip abductors are weak, the pelvis sags when one limb is lifted off the ground note: the vertebral column is side bent towards the side of the supporting limb

Question 59

This type of abnormal gait is characterized by unilateral weakness and spasticity, lacks flexion of joints yielding a long limb, must circumduct or swing limb laterally to bring forward. The affected upper limb is flexed toward the chest

Answer 59

Hemiplegic gait note: decorticate posture = upper limb flexed, lower limb extended

Question 60

When jogging, the single support phase is ___% of the gait cycle and the flight phase is ___%

Answer 60

80; 20

Question 61

When sprinting, the single support phase is ___% of the gait cycle and the flight phase is ___%

Answer 61

56; 44

Question 62

When running, leg muscles have to work much harder. Why?

Answer 62

GRFs are higher; increased joint movements

Question 63

Tendon recoil returns ___% of the energy used to stretch it

Answer 63

93

Question 64

The most important spring of the lower limb is the ____ tendon. This tendon stores 35% of the energy lost in the stance phase

Answer 64

achilles

Question 65

The foot also acts like a spring, returning ___% of the energy used to force it down. The primary ligaments involved are the plantar aponeurosis, the long and short plantar and the plantar calcaneonavicular ligament

Answer 65

78