Gait Deviations

Question 1

Foot Slap Causes

Answer 1

1. mild weakness of dorsi flexors
   * grade 3 at least because the forefoot had enough strength to hold the foot off theground and allow the heel to contact the ground first
   * no eccentric strength/control to slowly lower foot
2. poor motor control

Question 2

Foot slap treatment

Answer 2

strengthen dorsiflexors: NMES or KT Tape

address coordination issue, proprioception awareness-> joint approximation, weight vest

Question 3

Foot Flat initial contact andthen normal passive DR ROM

Answer 3

weak dorsiflexors- strength less than 3

if we dont see normal passive ROM during tibial advancement, we may consider a contracture or fixed joint at ankle

Treatment: strengthen DF

Question 4

initial contact by forefoot then heel.

Normal passive ROM of DF during stance

Answer 4

severly weak or flaccid DF’s

weak=strengthen

flaccid= facilitate

*maybe an AFO

Question 5

initial contact by forefoot but heel never makes contact with ground during stance

Answer 5

causes: 
heel pain
contracture/shortened PF's
spasticity in plantarflexors
leg length discrepancy 

TREATMENT:
if its pain-figure out what is causing pain
inhibition=spasticity
stretch=tight or shortened
standing fram or tilt table= position for prolonged stretch

Question 6

premature elevation of heel in mid-stance

Answer 6

CAUSES:
limited DF ROM
tight or spastic PF
Bouncing gait pattern

TREATMENT:
stretch PF
inhibition of PF

Question 7

Heel remains in contact with the ground late in terminal stance

Answer 7

CAUSES:
elongated plantarflexors
-achilles rupture
weak or flaccid PF
-possible surgical overrelease

TREATMENT:
elongated PF-notify PT
strengthening NMES for weak or flaccid

Question 8

Supinated Foot position and WB on the lateral aspect of the foot during stance

Answer 8

CAUSES:
fixed ankle
Pes Cavus deformity-high arch
rigidity/co-contraction of PF/DF
Pain

TREATMENT
fixed ankle-contact PT
pes cavus-orthotic
rigitiy-inhibition techniques, joint mobs
pain-figure out what is causing the pain

Question 9

Excessive foot pronation with WB on medial portion of foot during stance. Medial longitudinal arch remains absent during swing

Answer 9

CAUSES:
weakness (paralysis) of ankle inverters
Pes Planus deformity

TREATMENT:
strengthen inverters
orthotics

Question 10

Excessive inversion and PF of foot and ankle during swing and at initial contact

Answer 10

CAUSES:
spasticity of PF and invertors

Flaccidity or weakness of DF and evertors

Extensor pattern

TREATMENT:
inhibition techniques
facilitate and strengthen
bracing or taping

Question 11

Drop Foot

Answer 11

CAUSES
weakness/flaccidity in DF
Spasticity/contracture inf PF

TREATMENT:
strengthen/facilitate
inhibit/strengthen

Question 12

Vaulting-compensentory PF of stance leg during mid stance

Answer 12

CAUSES:
any impairment of the contralateral LE that reduces hip flexion, knee flexion or DF during swing phase

TREATMENT:
figure out what impairment is

Question 13

out-toeing in stance

Answer 13

CAUSES
tightness/spasticity of external rotators
weakness of internal rotators

TREATMENT
inhibit/stretch external rotators
strengthen internal rotators

Question 14

in-toeing during stance

Answer 14

CAUSES
tightness/spasticity of adductors and/or internal rotators
weakness of external rotators

TREATMENT
inhibit/stretch adductors and IR
strengthen ER

Question 15

Genu recurvatum-hyperextension during stance

Answer 15

CAUSES
weak quad
spastic quad
limited ankle DF ROM

TREATMENT
strengthen quad
inhibit quad
orthotic-bracing ankle or knee

Question 16

flexed position of the knee during stance and lack of knee extension in terminal swing

Answer 16

CAUSES
knee flexion contracture
hamstring spasticity
knee pain and joint effusion

TREATMENT
stretch flexors
inhibit hamstring
treat pain or talk to MD

Question 17

reduced or absent knee flexion during swing phase

Answer 17

CAUSES
spasticity of knee extensors
knee extension contracture or brace/cast

TREATMENT
inhibit
stretch/mobilize

Question 18

Knee is kept in flexion during stance despite the kne having normal ROM

Answer 18

CAUSES
hip/ankle impairments
-hip flex contracture
-pes calcaneus deformity-DF CONTRACTURE
-PF weakness

TREATMENT
stretch/joint mob

Question 19

hyper-extension genu recurvatum from initial contact to pre-swing phase

Answer 19

CAUSE
ankle PF contracture
spasticity of ankle PH

TREATMENT
joint mob-ankle
stretch/inhibit PF
heel lift on opp. foot

Question 20

Antalgic gait

Answer 20

CAUSE
painful stance leg
-shorter step length and stance time on painful side
-may be accompanied by ipsilateral trunk lean if due to hip pain
-contralateral trunk lean if knee or foot in pain

Question 21

Excesssive knee flexion in swing

Answer 21

CAUSE
lack of ankle DF on swing leg
short stance leg

TREATMENT
increase ROM
heel lift for shorter limb

Question 22

lateral trunk lean toward stance leg

compensated trendelenberg

Answer 22

CAUSE
weakness of hip ABD
Hip pain

TREATMENT
strengthen
address pain

Question 23

forward bending of trunk during mid and terminal stance as the hip is moved over the foot

Answer 23

CAUSE
hip flexion contracture
hip pain

TREATMENT
stretch
joint mob

Question 24

trunk lurches backward and toward the unaffected stance leg from heel off to mid swing

Answer 24

CAUSES
hip flexor weakness
-trunk throws leg forward

TREATMENT
strengthen hip flex

Question 25

Excessive hip and knee flexion during swing

Answer 25

CAUSE
flexor tone
compensation for foot drop
LLD:short stance leg

TREATMENT:
inhibit tone
address drop foot-AFO
heel lift

Question 26

hip circumduction or hip hiking during swing

Answer 26

CAUSE
compensation for leg length
-actual LLD 
-spasticity or contracture in quad
-fixed joint at knee
-painful knee
-long leg cast
-extensor tone

TREATMENT
inhibition