Gait Analysis and Deviations

Question 1

Initial Contact normal motion

Answer 1

Heel strikes the ground
Hip is flexed 20° and slight external rotation
Knee extended
Ankle at 90° (or neutral)

Question 2

Initial Contact mm action

Answer 2

Hip-glut max/hamstrings to reduce flexion
Erector spinae to resist trunk flexion
Ankle dorsiflexors

Question 3

Initial Contact Problems

Answer 3

No heel strike (step on flat foot)
Foot slap (L4, dorsiflexors)
Excessive trunk extension (glut max)
Equinus deformity
Plantar flexor spasticity

Question 4

Loading Response Normal Motion

Answer 4

Hip in ER moving toward IR
Knee has slightly flexed and begins extension
Ankle plantar flexed moving toward dorsiflexion.
Foot moves into pronation

Question 5

Loading Response mm Actions

Answer 5

Glut max, hamstrings resisting flexion moment
Knee extensors extending knee
Triceps surae eccentric

Question 6

Loading Response Problems

Answer 6

Backward trunk lean
Anterior trunk lean
Plantar flexion contracture/spasticity
Knee remains flexed

Question 7

Midstance normal motion

Answer 7

Trunk has moved over foot - Weight evenly distributed
Slight drop in contralateral pelvis
Maximum extension of hip (10-15°)
Knee reaches full extension - Just before heel off at terminal stance
Ankle rolls into dorsiflexion (closed chain)
Foot pronation

Question 8

Midstance mm Actions

Answer 8

Iliopsoas eccentrically working
Gluteus medius
Quads beginning to decrease with extension
Gastroc eccentrically working

Question 9

Midstance Problems

Answer 9

Trendelenburg sign (of stance leg) - Compensated/uncompensated
Antalgic gait (shortened stance)
Forward trunk bend (contracture)
Excessive lordosis (contracture)
Genu recurvatum (weak quad)
Flexed knee > 10°(Contracture of capsule or Spasticity of hamstring)
Premature heel off (hypomobile ankle)
Excessive supination
Excessive pronation (Invertor weakness, Rearfoot valgus, or Forefoot varus)

Question 10

Terminal Stance Normal Motion

Answer 10

Hip is in full extension, external rotation - Continued eccentric iliopsoas, (hip extension moment)
Knee moving toward full extension at toe off
Pronation moving toward supination - External rotation of tibia and femur, Maximum dorsiflexion (15°), Moving toward maximum (20°) plantar flexion

Question 11

Terminal Stance mm Actions

Answer 11

Eccentric iliopsoas
Ankle plantar flexors (concentric)

Question 12

Terminal Stance Problems

Answer 12

Problems:
Trendelenburg sign
Excessive lumbar lordosis/forward trunk (Hip pain or contracture or Forward bending from pes equinus)
Trunk lurches backward during terminal stance (Passive flexion of hip (hip flexor weakness))
Genu recurvatum
Flexed knee (Pain, contracture, hamstring spasticity)
Lack of ankle dorsiflexion
Weak plantar flexors
Excessive pronation (Weak invertors or Rearfoot valgus/forefoot varus)

Question 13

Preswing Normal motion

Answer 13

Slight posterior pelvic rotation
Hip back at 0° flexion
Knee moving toward 40° flexion
Ankle 20° plantar flexion, pushing off
MTP 60° extension

Question 14

Preswing mm actions

Answer 14

Increasing concentric hip flexors
Concentric plantar flexors
Minimal eccentric quads, glut medius - 2 leg support

Question 15

Preswing problems

Answer 15

Weak plantar flexors (S1-2) - Reduced contralateral step length
MTP dysfunction/pain - Turf toe, hallux rigidus; Shift weight to lateral portion of foot
Backward trunk lurch (L2-3) - Passive hip flexion

Question 16

Initial Swing normal motion

Answer 16

Slight posterior rotation 5°
15° hip flexion, increasing
60° knee flexion, decreasing
10° plantar flexion, decreasing
Goal is to clear foot, advance limb

Question 17

Initial swing mm actions

Answer 17

Ankle dorsiflexors L5, deep peroneal
Hip flexors L2-3, femoral nerve

Question 18

Initial swing problems

Answer 18

Posterior pelvic tilt/backward trunk lean (Passive hip flexion, Hip flexor weakness)
Vaulting and circumducting (Knee stiffness, contracture)
Drop foot/steppage gait

Question 19

Midswing and terminal swing normal motion

Answer 19

Hip flexion to about 30°
25° knee flexion moving to 0°
Foot remains in neutral dorsiflexion

Question 20

Midstance and terminal swing mm action

Answer 20

Concentric quads extending knee
Eccentric hamstrings and gluteus max (Slowing limb)
Isometric dorsiflexion

Question 21

Midswing and terminal swing Problems

Answer 21

Weak hamstrings/gluteals (Backward lurch just before initial contact)
Quad weakness (Forward trunk just before initial contact)
Vaulting and circumducting (Knee stiffness, contracture)
Drop foot/steppage

Question 22

Antalgic Gait

Answer 22

Decreased weight bearing
Normal ipsilateral step length
Short contralateral step length

Question 23

Ataxic Gait

Answer 23

Staggering with wide BOS

Question 24

Equinus Gait

Answer 24

Toe walking
Spastic or shortened triceps surrae
Club foot

Question 25

Gluteus Maximus Gait

Answer 25

Backward lurch at IC

Question 26

Gluteus Medius Gait

Answer 26

Trendelenburg sign
Contralateral hip drop during stance
If bilateral, wobbling pelvis
If compensated, lateral trunk lean

Question 27

Hemiplegic Gait

Answer 27

Circumducted
Possible spastic plantar flexors
Often requires an AFO

Question 28

Parkinsonian Gait

Answer 28

Festinating
Short rapid steps
Difficulty initiating movement

Question 29

Weak Quadriceps Gait

Answer 29

Forward lurch during IC
Attempts to extend/hyperextend knee
Shift COG ahead of axis of rotation

Question 30

Scissor Gait

Answer 30

Spastic adductors

Question 31

Steppage Gait

Answer 31

Increased knee and hip flexion
Weak dorsiflexors

Question 32

Increased Toe In Gait

Answer 32

Femoral anteversion

Question 33

Increased Toe Out Gait

Answer 33

Femoral Retroversion

Question 34

What phase of gait would Trendelenburg be seen?

Answer 34

Terminal stance (according to PTFE)