Gait Deviations Flashcards
Foot Slap Causes
- 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 - poor motor control
Foot slap treatment
strengthen dorsiflexors: NMES or KT Tape
address coordination issue, proprioception awareness-> joint approximation, weight vest
Foot Flat initial contact andthen normal passive DR ROM
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
initial contact by forefoot then heel.
Normal passive ROM of DF during stance
severly weak or flaccid DF’s
weak=strengthen
flaccid= facilitate
*maybe an AFO
initial contact by forefoot but heel never makes contact with ground during stance
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
premature elevation of heel in mid-stance
CAUSES:
limited DF ROM
tight or spastic PF
Bouncing gait pattern
TREATMENT:
stretch PF
inhibition of PF
Heel remains in contact with the ground late in terminal stance
CAUSES: elongated plantarflexors -achilles rupture weak or flaccid PF -possible surgical overrelease
TREATMENT:
elongated PF-notify PT
strengthening NMES for weak or flaccid
Supinated Foot position and WB on the lateral aspect of the foot during stance
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
Excessive foot pronation with WB on medial portion of foot during stance. Medial longitudinal arch remains absent during swing
CAUSES:
weakness (paralysis) of ankle inverters
Pes Planus deformity
TREATMENT:
strengthen inverters
orthotics
Excessive inversion and PF of foot and ankle during swing and at initial contact
CAUSES:
spasticity of PF and invertors
Flaccidity or weakness of DF and evertors
Extensor pattern
TREATMENT:
inhibition techniques
facilitate and strengthen
bracing or taping
Drop Foot
CAUSES
weakness/flaccidity in DF
Spasticity/contracture inf PF
TREATMENT:
strengthen/facilitate
inhibit/strengthen
Vaulting-compensentory PF of stance leg during mid stance
CAUSES:
any impairment of the contralateral LE that reduces hip flexion, knee flexion or DF during swing phase
TREATMENT:
figure out what impairment is
out-toeing in stance
CAUSES
tightness/spasticity of external rotators
weakness of internal rotators
TREATMENT
inhibit/stretch external rotators
strengthen internal rotators
in-toeing during stance
CAUSES
tightness/spasticity of adductors and/or internal rotators
weakness of external rotators
TREATMENT
inhibit/stretch adductors and IR
strengthen ER
Genu recurvatum-hyperextension during stance
CAUSES
weak quad
spastic quad
limited ankle DF ROM
TREATMENT
strengthen quad
inhibit quad
orthotic-bracing ankle or knee
flexed position of the knee during stance and lack of knee extension in terminal swing
CAUSES
knee flexion contracture
hamstring spasticity
knee pain and joint effusion
TREATMENT
stretch flexors
inhibit hamstring
treat pain or talk to MD
reduced or absent knee flexion during swing phase
CAUSES
spasticity of knee extensors
knee extension contracture or brace/cast
TREATMENT
inhibit
stretch/mobilize
Knee is kept in flexion during stance despite the kne having normal ROM
CAUSES hip/ankle impairments -hip flex contracture -pes calcaneus deformity-DF CONTRACTURE -PF weakness
TREATMENT
stretch/joint mob
hyper-extension genu recurvatum from initial contact to pre-swing phase
CAUSE
ankle PF contracture
spasticity of ankle PH
TREATMENT
joint mob-ankle
stretch/inhibit PF
heel lift on opp. foot
Antalgic gait
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
Excesssive knee flexion in swing
CAUSE
lack of ankle DF on swing leg
short stance leg
TREATMENT
increase ROM
heel lift for shorter limb
lateral trunk lean toward stance leg
compensated trendelenberg
CAUSE
weakness of hip ABD
Hip pain
TREATMENT
strengthen
address pain
forward bending of trunk during mid and terminal stance as the hip is moved over the foot
CAUSE
hip flexion contracture
hip pain
TREATMENT
stretch
joint mob
trunk lurches backward and toward the unaffected stance leg from heel off to mid swing
CAUSES
hip flexor weakness
-trunk throws leg forward
TREATMENT
strengthen hip flex
Excessive hip and knee flexion during swing
CAUSE
flexor tone
compensation for foot drop
LLD:short stance leg
TREATMENT:
inhibit tone
address drop foot-AFO
heel lift
hip circumduction or hip hiking during swing
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
