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O & P > Gait > Flashcards

Gait Flashcards

1
Q

Rockers of Gait Cycle

A
  1. Heel rocker
  2. Ankle rocker
  3. Toe rocker
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2
Q

Heel Rocker

A

preserves momentum generated by falling onto stance limb

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3
Q

Ankle Rocker

A

advances tibia over stationary foot

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4
Q

Toe Rocker

A

Serves as axis for progression of body vector to advance beyond are of foot support

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5
Q

Normal Progression of Gait on Plantar Surface

A
  • contact begins at midline of heel
  • slight lateral deviation through midfoot
  • progression is between 1st & 2nd rays
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6
Q

Closed-Chain Supination

A
  • calcaneus inverts
  • talus abducts & DF
  • lower leg ER
  • knee extension
    (high arch)
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7
Q

Closed-Chain Pronation

A
  • calcaneus everts
  • talus adducts & PF
  • lower leg IR (knee valgus)
  • knee flexion
    (flat foot)
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8
Q

Purpose of STJ Motion***

A
  • allows foot to adapt to ground on flat foot
  • dissipates forces at heel strike
  • prepares for rigid lever at push-off
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9
Q

STJ Neutral

A
  • position where neither pronation or supination occurs

- 2:1 inversion:eversion

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10
Q

Plntarflexed 1st Ray

A
  • functional forefoot valgus if rigid
  • associated with uncompensated rearfoot farus
  • doesn’t absorb shock well
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11
Q

Forefoot Varus

A
  • Rays 2-4 inverted relative to bisector of calcaneus
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12
Q

Forefoot Valgus

A
  • Rays 2-4 everted relative to bisector of calcaneus
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13
Q

Compensated Foot Type

A
  • total amount of varus needs to be equal to amount of calcaneal eversion for the foot to be on the ground
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14
Q

Faulty Cuboid Pulley

A
  • when STJ remains abnormally pronated in late stance
  • cuboid tunnel orientation is altered
  • lose advantage of peroneus longus, which decelerates PF/inversion
  • leads to ankle sprains
  • MTP joint unstable
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15
Q

Morton’s Toe

A
  • 2nd ray longer than 1st
  • abnormal axis of motion
  • unstable foot
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16
Q

Intrinsic Orthosis

A

posting added within orthosis

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17
Q

Extrinsic Orthosis

A

posting added onto orthosis

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18
Q

Orthosis Uses***

A
  • control, guide, limit, and/or immobilize body segment
  • restrict movement in given direction
  • prevent deformity
  • assist general movement
  • reduce axial load bearing forces
  • aid rehab from fractures after cast removal
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19
Q

Negative Mold

A
  • plaster impression of body part
  • remove cast while maintaining impression
  • gravity eliminated
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20
Q

Positive Mold

A
  • pouring plaster into negative cast & smoothing out imperfections
  • make orthosis by heating up material & using vacuum press to form around positive mold
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21
Q

Trim Line***

A
  • line where orthosis ends
  • longer = more control/stability
  • anterior to malleoli = inversion/eversion controlled
  • posterior to malleoli = inversion/eversion allowed
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22
Q

Functional Foot Orthosis

A
  • orthopedic device designed to promote structural integrity by resisting GRF’s that cause abnormal skeletal motion during stance phase
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23
Q

Accommodative Orthosis

A
  • doesn’t alter alignment
  • supports foot in WB position
  • unload areas by dissipating force over entire SA of foot
  • total contact
  • diabetic/insensitive foot
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24
Q

Biomechanical Orthosis

A
  • alters alighment with intrinsic or extrinsic posting
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25
Q

Shoe Function

A
  • Stability: height & density of heel counter, flares to heel
  • Flexibility: enhance toe rocker for progression of gait
  • Traction: leather = slick
  • Heel Height: WB on met heads increased with more than 1.5”
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26
Q

Medial Heel Wedge

A
  • controls rearfoot

- decelerate pronation

27
Q

Shoe type with V-shaped closure

A
  • tongue is separate piece sewn into vamp
28
Q

Shoe type with open closure 1/2 way down shoe

A
  • tongue is extension of vamp & can be opened slightly wider
  • allows for more modification
29
Q

Shoe type with open closure all the way to toe

A
  • for patients with fixed deformity or fragile neuropathic feet
30
Q

Sole Purpose

A
  • protects plantar surface of foot
  • allows for normal progression of gait
  • leather = slippery
  • thick = interfere with proprioception
31
Q

Effect of Obesity on Gait

A
  • increase 1 full size with increase of 9 lbs in 5 years

- impacts gait pattern

32
Q

Effect of Edema on Gait

A
  • increase foot size & alter shoe fit
33
Q

Goal of Shoe Prescription for Metatarsalgia

A
  • transfer weight away from met heads
  • encourage flexion of MTP joints
  • encourage extension of PIP joints
34
Q

Metatarsal Bar

A
  • prevents undue pressure at met heads during push off in late stance
  • facilitates normal progression of gait
35
Q

Rocker Bottom Shoe

A
  • facilitates gait rockers

- can cause rolling too far & hyperextension of knee (ACL)

36
Q

Heel Lifts

A
  • 3/8” inside shoe
  • more lift increase weight of shoe & affects cosmesis
  • increases WB on met heads
37
Q

Diabetic Neuropathy

A
  • nerve damage that interferes with ability to sense pain & temperature caused by high sugar levels associated with uncontrolled diabetes
  • can affect function of foot muscles, leading to improper alignment & injury
38
Q

Protective Sensation

A
  • amount of sensation to protect from trauma
  • 5.07 Semmes-Weinstein monofilament***
  • ABI 0.9+
39
Q

ABI

A
  • Ankle/Brachial Index
  • ankle systolic pressure / brachial systolic pressure
  • <0.45 = unlikely wound healing
40
Q

Clinical Signs of Peripheral Vascular Disease (PVD)

A
  • absent pulses
  • cold feet
  • dependent rubor
  • shiny skin
  • intermittent claudication
  • hair loss on foot/leg
  • atrophy of subcutaneous fat
  • dependency relieves rest pain
  • delayed capillary filling time
  • ischemic lesions
41
Q

Causes of Tissue Damage***

A
  • continuous pressure
  • concentrated high pressure
  • heat/cold
  • repetitive mechanical stress
  • pressure on infected tissue
42
Q

Prevention of Damage Due to Repetitive Stress

A
  • frequent foot checks

- limit repetitive activities

43
Q

Prevention of Damage Due to Continuous Pressure

A
  • frequent foot checks
  • correct shoe fit
  • change shoes part-way through day
44
Q

Prevention of Damage Due to Heat/Cold

A
  • check water before placing feet in

- avoid exposure for prolonged periods of time

45
Q

Prevention of Damage Due to Concentrated High Pressure

A
  • always wear shoes
  • ideally never wear open toed shoes
  • shake out shoes before wearing
46
Q

Prevention of Damage Due to Pressure on Infected Tissue

A
  • never step on infected foot
47
Q

Charcot Foot

A
  • neurogenic arthropathy
  • degenerative form of arthritis that progresses rapidly
  • causes joint/bone damage
  • starts with peripheral neuropathy (true neuropathy takes decades to develop, not weeks/months)
  • can lead to amputation
  • early stages mimic cellulitis or DVT
48
Q

Symptoms of Charcot Foot

A
  • warmer than normal
  • redness
  • small hairline fractures
  • swelling
  • ## entire foot becomes swollen/inflamed later
49
Q

Plantar Fasciitis Differentiation

A
  • pain at medial calcaneal tubercle
  • SLR with sensitizer
  • severe heel pain in AM or after rest
  • windlass
50
Q

Plantar Fasciitis Intervention

A
  • temporary orthosis
  • TrP therapy + stretching
  • manual therapy to LE & calf
  • taping to limit pronation
  • night splint
51
Q

Bunions

A
  • caused by injury or varus deformity

- treated with splints, foot orthosis, or surgery

52
Q

Metatarsalgia

A
  • pain in 1+ met heads

- treated with orthosis to cushion met head or limit joint

53
Q

Hallux Rigidux

A
  • no 3rd rocker

- treated with mobilization, orthosis, or surgery

54
Q

Excessive Flexion at Heel Strike

A
  • c/o increased anterodistal tibial pressure
  • heel too firm
  • foot too posterior
  • foot too DF
  • socket too flexed
  • shoe heel too high
  • weak knee extensors
55
Q

Hyperextension at Heel Off

A
  • c/o patella discomfort
  • c/o feel like climbing hill
  • foot too anterior
  • foot too PF
  • insufficient socket flexion
  • foot heel too long/stiff
  • shoe heel too low
  • excessive use of knee extensors
  • weak quads
56
Q

Foot Whips

A
  • suspension cuff not aligned evenly
  • prosthesis rotated
  • uncompensated foot deformity
57
Q

Lateral Trunk Bending

A
  • prosthesis too short
  • high medial wall of socket
  • improper lateral wall shape of socket
  • prosthesis in abduction
  • poor balance
  • hip abduction contracture
  • residual limb sensitivity
  • short limb
  • weak abductors
58
Q

Abducted Gait

A
  • prosthesis too long
  • prosthesis in abduction
  • high medial wall of socket
  • improper lateral wall shape of socket
  • hip abduction contractures
  • weak quads or hip extensors
59
Q

Circumduction

A
  • prosthesis too long
  • excessive knee friction
  • hip abduction contracture
  • weak quads or hip extensors
60
Q

Vaulting

A
  • prosthesis too long
  • inadequate socket suspension
  • foot in PF
  • lack knee flexion
61
Q

Foot Slap

A
  • too little PF resistance
  • heel too soft
  • socket flexed too much
  • poor knee extension control
  • driving foot into floor to ensure knee extension
  • weak DF
62
Q

Exaggerated Lordosis

A
  • improper shape of posterior wall
  • insufficient socket flexion
  • tight hip flexors
  • weak abs
  • weak hip extensors
63
Q

Prosthetic Knee Instability

A
  • knee joint too medially
  • insufficient socket flexion
  • PF resistance too great
  • inability to limit DF in stance
  • weak hip extesnsors
  • tight hip/knee flexors

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