Gait Flashcards
Rockers of Gait Cycle
- Heel rocker
- Ankle rocker
- Toe rocker
Heel Rocker
preserves momentum generated by falling onto stance limb
Ankle Rocker
advances tibia over stationary foot
Toe Rocker
Serves as axis for progression of body vector to advance beyond are of foot support
Normal Progression of Gait on Plantar Surface
- contact begins at midline of heel
- slight lateral deviation through midfoot
- progression is between 1st & 2nd rays
Closed-Chain Supination
- calcaneus inverts
- talus abducts & DF
- lower leg ER
- knee extension
(high arch)
Closed-Chain Pronation
- calcaneus everts
- talus adducts & PF
- lower leg IR (knee valgus)
- knee flexion
(flat foot)
Purpose of STJ Motion***
- allows foot to adapt to ground on flat foot
- dissipates forces at heel strike
- prepares for rigid lever at push-off
STJ Neutral
- position where neither pronation or supination occurs
- 2:1 inversion:eversion
Plntarflexed 1st Ray
- functional forefoot valgus if rigid
- associated with uncompensated rearfoot farus
- doesn’t absorb shock well
Forefoot Varus
- Rays 2-4 inverted relative to bisector of calcaneus
Forefoot Valgus
- Rays 2-4 everted relative to bisector of calcaneus
Compensated Foot Type
- total amount of varus needs to be equal to amount of calcaneal eversion for the foot to be on the ground
Faulty Cuboid Pulley
- 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
Morton’s Toe
- 2nd ray longer than 1st
- abnormal axis of motion
- unstable foot
Intrinsic Orthosis
posting added within orthosis
Extrinsic Orthosis
posting added onto orthosis
Orthosis Uses***
- 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
Negative Mold
- plaster impression of body part
- remove cast while maintaining impression
- gravity eliminated
Positive Mold
- pouring plaster into negative cast & smoothing out imperfections
- make orthosis by heating up material & using vacuum press to form around positive mold
Trim Line***
- line where orthosis ends
- longer = more control/stability
- anterior to malleoli = inversion/eversion controlled
- posterior to malleoli = inversion/eversion allowed
Functional Foot Orthosis
- orthopedic device designed to promote structural integrity by resisting GRF’s that cause abnormal skeletal motion during stance phase
Accommodative Orthosis
- doesn’t alter alignment
- supports foot in WB position
- unload areas by dissipating force over entire SA of foot
- total contact
- diabetic/insensitive foot
Biomechanical Orthosis
- alters alighment with intrinsic or extrinsic posting
Shoe Function
- 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”
Medial Heel Wedge
- controls rearfoot
- decelerate pronation
Shoe type with V-shaped closure
- tongue is separate piece sewn into vamp
Shoe type with open closure 1/2 way down shoe
- tongue is extension of vamp & can be opened slightly wider
- allows for more modification
Shoe type with open closure all the way to toe
- for patients with fixed deformity or fragile neuropathic feet
Sole Purpose
- protects plantar surface of foot
- allows for normal progression of gait
- leather = slippery
- thick = interfere with proprioception
Effect of Obesity on Gait
- increase 1 full size with increase of 9 lbs in 5 years
- impacts gait pattern
Effect of Edema on Gait
- increase foot size & alter shoe fit
Goal of Shoe Prescription for Metatarsalgia
- transfer weight away from met heads
- encourage flexion of MTP joints
- encourage extension of PIP joints
Metatarsal Bar
- prevents undue pressure at met heads during push off in late stance
- facilitates normal progression of gait
Rocker Bottom Shoe
- facilitates gait rockers
- can cause rolling too far & hyperextension of knee (ACL)
Heel Lifts
- 3/8” inside shoe
- more lift increase weight of shoe & affects cosmesis
- increases WB on met heads
Diabetic Neuropathy
- 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
Protective Sensation
- amount of sensation to protect from trauma
- 5.07 Semmes-Weinstein monofilament***
- ABI 0.9+
ABI
- Ankle/Brachial Index
- ankle systolic pressure / brachial systolic pressure
- <0.45 = unlikely wound healing
Clinical Signs of Peripheral Vascular Disease (PVD)
- 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
Causes of Tissue Damage***
- continuous pressure
- concentrated high pressure
- heat/cold
- repetitive mechanical stress
- pressure on infected tissue
Prevention of Damage Due to Repetitive Stress
- frequent foot checks
- limit repetitive activities
Prevention of Damage Due to Continuous Pressure
- frequent foot checks
- correct shoe fit
- change shoes part-way through day
Prevention of Damage Due to Heat/Cold
- check water before placing feet in
- avoid exposure for prolonged periods of time
Prevention of Damage Due to Concentrated High Pressure
- always wear shoes
- ideally never wear open toed shoes
- shake out shoes before wearing
Prevention of Damage Due to Pressure on Infected Tissue
- never step on infected foot
Charcot Foot
- 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
Symptoms of Charcot Foot
- warmer than normal
- redness
- small hairline fractures
- swelling
- ## entire foot becomes swollen/inflamed later
Plantar Fasciitis Differentiation
- pain at medial calcaneal tubercle
- SLR with sensitizer
- severe heel pain in AM or after rest
- windlass
Plantar Fasciitis Intervention
- temporary orthosis
- TrP therapy + stretching
- manual therapy to LE & calf
- taping to limit pronation
- night splint
Bunions
- caused by injury or varus deformity
- treated with splints, foot orthosis, or surgery
Metatarsalgia
- pain in 1+ met heads
- treated with orthosis to cushion met head or limit joint
Hallux Rigidux
- no 3rd rocker
- treated with mobilization, orthosis, or surgery
Excessive Flexion at Heel Strike
- 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
Hyperextension at Heel Off
- 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
Foot Whips
- suspension cuff not aligned evenly
- prosthesis rotated
- uncompensated foot deformity
Lateral Trunk Bending
- 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
Abducted Gait
- 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
Circumduction
- prosthesis too long
- excessive knee friction
- hip abduction contracture
- weak quads or hip extensors
Vaulting
- prosthesis too long
- inadequate socket suspension
- foot in PF
- lack knee flexion
Foot Slap
- 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
Exaggerated Lordosis
- improper shape of posterior wall
- insufficient socket flexion
- tight hip flexors
- weak abs
- weak hip extensors
Prosthetic Knee Instability
- knee joint too medially
- insufficient socket flexion
- PF resistance too great
- inability to limit DF in stance
- weak hip extesnsors
- tight hip/knee flexors
