FINAL: Gait deviations Flashcards
What may cause foot drop with a forefoot-heel contact?
common fibular nerve palsy and peripheral neuropathy
- this results in very weak DFs and/or pes equinus
T/F: There is no active dorsiflexion during swing for a foot drop with forefoot-heel contact.
true, just passive DF during stance, no active DF during swing
Why would one have a foot flat gait?
common fibular nerve palsy and peripheral neuropathy
What does the deep fibular n. innervate?
anterior compartment of leg (DFs)
What does superficial n. innervate?
lateral compartment of leg (everter/PFs)
What can cause a foot slap or drop?
weak DFs from common fibular nerve palsy or peripheral neuropathy
What major issues may follow at the ankle with a common fibular nerve palsy or peripheral neuropathy?
- foot slap/drop
- flat foot
- foot drop with forefoot heel contact
- all these are issues with the DFs
What are some ways we can compensate to help clear the floor?
hip hike, circumduct, vault, more KF/HF/DF
What likely impairments cause a forefoot-delayed heel contact gait?
spastic PFs or PF contracture; pes equinus
What happens at the tibia with a forefoot-delayed heel contact gait?
it needs to be thrust backwards to get the foot down, so you go into a good amount of extension at knee
What likely impairments occur with a foot flat gait?
- markedly weak DFs, knee flexion contracture, overactive hamstrings
What pathological precursors can cause a forefoot-delayed heel contact gait?
UMN lesion, CP, CVA
Why would someone be a toe walker?
- due to calcaneal pain
- upper motor neuron lesion, CP, CVA causing PF contracture or PF spasticity
What does a crouched gait look like?
may present in a toe walker: HF, KF, PF
What other excessive motions may accompany plantar flexor weakness during gait?
hip flexion and knee flexion
- no PF = no tibia control, causing more KF
Delayed heel rise is due to what deformity?
weak PFs, due to peripheral or CNS disorders
- or lengthening of Achilles tendon
What happens to gait when you have weak PFs?
no push off, shortened step length, prolonged heel contact
What can cause lateral foot weight bearing?
a supinated foot position (pes cavus) due to SCI, congenital structural deformity
With what gait deviation may you see reduced midfoot mobility?
lateral foot weightbearing
Dynamic excessive pronation can be due to a weak ___________ muscle.
tibialis posterior
In dynamic excessive pronation, the foot stays pronated too long in what stance?
midstance: should be moving from pronation to supination here and it doesn’t
What can cause static excessive pronation?
floppy foot can be caused by paralyzed inverters or pes planus deformity
- can be due to UMN lesion or congenital structural deformity
T/F: Subtalar joint is constantly everted with a floppy foot.
true
During what phase of gait does vaulting present?
midstance
An overall excessive internal rotation of the lower extremity in stance can be seen in what gait deviation?
floppy foot, or static excessive pronation
Why might someone present with a backward lurch during their gait?
to bring the LoG posterior to help the gluts not work as hard, they may be paralyzed or weak
- decreases forward progression of body
- this lurch can also help bring the swing limb forward
Excessive toe out can be caused by what bony alignment issue?
retroversion
Inadequate knee flexion affects what stages?
loading and most of swing phases
LR = no shock absorption PSw = toe off is difficult ISw = dragging toe here MSw = continued toe drag
What can cause a knee extensor thrust?
upper motor neuron lesion causing spastic quads
What can cause weak quads?
UMN lesion, femoral nerve palsy, arthritis pain, L3-4 compression neuropathy
What does a person with weak quads present like?
knee stays extended during loading, may not be in recurvatum during stance
What other compensation can accompany weak quads?
anterior trunk lean
What can cause chronic KE weakness?
poliomyelitis
Constant recurvatum in stance and swing is labeled as what?
chronic quad weakness
Which gait deviation results in a vertical thigh? Why does this happen?
no HF results in vertical thigh
- can be caused by femoral nerve lesion
With hip flexor weakness, what must happen at the knee now?
increased flexion from BFSH
What can cause a varus thrust in gait?
laxity of lateral and posterior knee ligaments, also traumatic injury
T/F: A varus thrust is typically accompanied by genu recurvatum.
true
A flexor synergy can be found in what gait deviation?
flexed knee during stance and swing
What can cause excessive knee flexion throughout stance and swing?
- KF contracture, KF spasticity due to UMN lesion
- knee pain/effusion due to arthritis or trauma
What can cause an excessively extended knee throughout stance and swing?
KE contracture/spasticity via UMN lesion or through surgical fusion
Impairments at the ankle or hip like a pes calcaneus deformity, PF weakness, or HF contracture can cause what to the knee?
excessive flexion during stance
- knee is forced into flexion via excessive DF or HF
What can occur at the ankle to cause knee hyperextension during stance?
PF contracture, PF spasticity
Why would someone have excessive KF in swing?
to compensate for lack of DF or HF
What motion is occurring at the hip during midstance?
moving out of flexion into extension
What are some causes of excessive hip flexion?
- hip or ITB contracture/spasticity
- HS weakness (doesn’t pull hip into extension)
- hip pain (put it into position of comfort)
- can coincide with other flexion as flexor synergy
Excessive ankle PF can cause what at the hip to compensate?
HF
Excessive HF can cause what two groups of muscles to fatigue?
HE and KE, so they’re unable to get a neutral thigh in stance
What gait phases are affected in excessive HF?
IC, LR, MS, TS, and MSw
- these are where you want hip extension, basically from beginning to terminal stance
How do we compensate for excessive HF in midstance? (4)
- anterior trunk lean
- anterior pelvic tilt (brings thigh back)
- lumbar lordosis (see above)
- flexed knee with increased DF (synergy)
How much hip extension occurs at terminal stance?
10 degrees at hip
20 degrees at thigh (due to ant tilt and ER of pelvis)
The loss of the trailing thigh occurs in what phase for what gait deviation of the hip?
loss of trailing thigh occurs in TS due to excessive hip flexion
T/F: If patient is unable to extend R thigh, there will be a decreased step length on the ipsilateral side.
false, decreased step length on contralateral side
A forward trunk lean results in what at the pelvis?
lumbar lordosis to keep head and trunk erect
In what impairments are you likely to see a forward trunk lean? (3) * think about when you need to bring the body forward*
weak quads, HF contracture, PF contracture
What phase is most affected by excessive hip flexion?
terminal stance
What is normal HF ROM during swing? What happens with excessive HF during swing?
20-30 degrees
- with excessive HF, this may be more, which can cause an increased anterior tilt
If a patient is unable to extend their hip in terminal stance, what can result?
- lumbar lordosis with anterior pelvic tilt
- loss of trailing thigh
- increased KF
- decreased step length on contra side
What are the pathological precursors for forward trunk lean?
hip osteoarthritis, pain, UMN or LMN
During what phases does a forward trunk lean occur?
midstance and terminal stance
During what phases would you see a backward trunk lean? On what side?
during loading and through the rest of stance
- see the lurch when the weakened side heel strikes
How does limited hip flexion interfere with stance and swing?
stance = interferes with KF and PF swing = interferes with thigh momentum, shortens step length, may cause toe drag
A trunk posterior lurch can be compensating for what weaknesses?
HE weakness or HF weakness
- HF = lurch toward the unaffected side to bring other one into HF
- HE = lurch toward the affected side during heel strike
What can cause limited HF?
HF weakness
hip pain
hams spasticity
compensating for weak HE
How do we compensate for limited HF?
posterior lurch
posterior tilt of pelvis
hip circumduction (rely on frontal motion vs sagittal)
T/F: An anterior tilt brings the thigh forward.
false, anterior tilt brings the thigh backwards
How does lurching to the unaffected limb help the opposite side go into HF?
that affected side is now unweighted, so it can be brought forward with momentum
- also brings trunk to unaffected side, helping with balance
Why will the patient exhibit toe drag during swing if they have limited hip flexion?
foot won’t clear floor; you lose momentum to drive knee into flexion and DF won’t be enough on it’s own
If a patient has difficulty clearing the floor due to limited hip flexion, what motion at the pelvis can help?
posterior tilt
When does past retract occur at the thigh?
during terminal stance the thigh starts to go forward but then starts going backward
What can cause past retract?
weak quads (past retract voluntarily to not use quads) mass extensor pattern hypertonic hams (drive thigh back)
What are the causes of excessive adduction?
muscle weakness, spasticity, or voluntary substitution as a HF
what is a scissor gait?
adduction with genu valgus
What is the normal degree amount for pelvic drop?
4 degrees
What compensation can occur to overcome a pelvic drop?
hip hike on the affected side
With steppage gait, what position are the feet in?
equinas: hitting the floor like a horse
How do we compensate for a long swing leg?
hip hike, circumduction, increase flexion at joints, vaulting
With ankle instability, what position would you put the foot in? How would you clear the floor in this position?
ankle instability = put foot in plantarflexion
- clear floor now via hip hike
Waddling gait indicates what weakness?
hip abductor weakness
What can cause waddling or compensated trendelenburg gait? (compensated with lateral trunk lean)
guillain barre, poliomyelitis,
How does a hemiplegic gait present in the lower extremity?
LE = mass extension (HE, KE, PF, IR, ADD, INV)
How does a patient with trendelenburg compensate to make their weakness less noticeable?
trunk lean to affected side
Excessive anteversion causes what excessive motion in the horizontal plane?
excessive anteversion = excessive IR
What can cause excessive IR?
overactive IR, weak ER, CP (scissor gait) , pronation, anteversion
What is happening at the hindfoot and forefoot to cause excessive pronation?
hindfoot = everts (valgus) forefoot = inverts (varus)
To fix pronation, what motions would we address at the hip?
we want to fix excessive adduction and IR at hip to improve pronation at foot
How does excessive PF lead to excessive hip ER?
PF causes a nonprogressive tibia, so ER at the hip helps this move forward
If you’re stuck in PF tightness and need dorsiflexion, what can you do at the hip to make this happen?
ER at the hip helps force DF when you’re in tight PF
Tight plantar flexion can be turned into dorsiflexion movement via what movement?
ER at the hip
A short left limb will cause a pelvic drop on what side?
left side (ipsilateral)
Right calf muscle weakness can cause a pelvic drop on what side?
right side (ipsilateral)
An ipsilateral hip adduction contracture can cause a pelvic drop on what side?
contralateral
A contralateral hip abductor contracture causes a pelvic drop on what side?
contralateral (whaaaat)
Pelvic girdle weakness can cause pelvic drop on what side?
both ipsilateral and/or contralateral
How does backward rotation of the pelvis help with PF weakness?
PF weakness = no pushoff, decreased step length
- ER of pelvis lengthens limb and maintains adequate step length, improves trailing limb extension
Ipsilateral pelvic IR does what to the ipsilateral limb when in swing?
ipsilateral pelvic IR causes that same limb to drive more forward
When does increased lumbar lordosis occur with excessive HF?
in terminal stance (to keep body erect)
T/F: Trunk follows cane during gait when cane is on impaired side.
true
What’s the difference in width between a wide base and a narrow base?
wide = 4+ inches narrow = 2- inches
T/F: Genu varum causes a wider base.
false, feet are actually closer together so cause a narrower base
What three things can cause a narrow base?
genu varus
genu valgus
spasticity
What do patients with PD do to increase their stability during gait?
they crouch and lower CoM to the ground, as well as widen their stance, thus increasing their base of support
What is festination?
short, shuffly steps that patients with PD often display
What does an AFO do?
helps prevent foot drop
- increases step length
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