Gait Flashcards
Forces on hip, knee, and ankle at rest:
- hip extension
- knee extension
- ankle dorsiflexion
Extension at the hip is resisted by:
- hip flexors:
- iliofemoral ligament
- ischiofemoral ligament
- iliopsoas (resists extreme extension)
- rectus femoris (resists extreme extension)
Flexion at the hip is resisted by:
- hip extensors: gluteus maximus, hamstrings
Extension at the knee is resisted by:
- posterior joint capsule of the knee
- oblique popliteal and arcuate popliteal ligaments
- knee flexors: hamstrings
Flexion at the knee is resisted by:
quads
Dorsiflexion at the ankle is resisted by:
plantar flexors (gastrocnemius and soleus)
Plantar flexion at the ankle is resisted by:
- ankle extensors: tibialis anterior, Ext. Dig. Longus
What muscle is active at the time of heel strike to prevent flexion of the pelvis at the hip?
- gluteus maximus - hip extensor
- upper torso wants to continue moving forward, causing hip flexion
Inferior gluteal nerve ventral rami levels:
L5, S1, S2
Gluteus maximus innervation:
inferior gluteal nerve (L5, S1, S2)
Gluteus maximus gait cause and clinical manifestation:
LEAN BACKWARD/POSTERIORLY
- inferior gluteal nerve (L5, S1, S2) injury
- unable to counter hip flexion at time of heel strike
- patient leans torso posteriorly to use gravity as hip extensor
What muscle is active at the time of midstance to prevent gravitational ADDuction of the pelvis at the hip?
- hip ABductors: gluteus medius and gluteus minimus
Gluteus medius and gluteus minimus innervation:
- Superior gluteal nerve (L4, L5, S1)
Superior gluteal nerve ventral rami levels:
L4, L5, S1
Tredelenburg gait cause and clinical manifestation:
LEAN LATERALLY
- superior gluteal nerve (L4, L5, S1) injury
- unable to counter hip ADDuction due to gravity midstance
- patient leans torso laterally to the supported side to use gravity as hip ABductor
What muscle is active throughout the stance phase to control gravitational flexion of the thigh at the knee?
quads
Quadriceps gait:
- femoral nerve (L2-L4) injury
- knee fully extended and locked through stance phase
- converts gravity from a knee flexor into a knee extensor and thus
- avoids the need for contraction of this muscle
What muscles are active during the swing phase to dorsiflex the foot and thus avoid having the toes hitting the ground?
- anterior leg muscles
- tibialis anterior, extensor hallucis longus, extensor digitorum
“foot slap” immediately after heel strike is due to:
WEAKENED anterior leg muscles
“steppage gait” cause and clinical manifestation:
- PARALYZED anterior leg muscles
- cannot dorsiflex during swing
- enter stance phase with toe strike
- To avoid having the toes hit the ground during the swing phase, increase flexion at the hip and knee to thereby bring the foot higher above the ground.
Manifestation of superficial fibular nerve injury:
- ankle everters paralyzed
- foot hits ground inverted, lateral side hits first
- “circumduction steppage gait”
Paralyzed anterior leg muscle manifestation:
- steppage gait
- deep fibular nerve lesion
- cannot dorsiflex at all
Weakened anterior leg muscle manifestation:
- foot slap
- cannot dorsiflex at heel strike
- deep fibular nerve lesion
Manifestation of common fibular nerve injury/severing:
- circumducted steppage gait
- cannot evert (circumduct gait)
- cannot dorsiflex (steppage gait)
