Gait - Deviations/Abnormal

Question 1

Foot Slap / Foot Drop (foot/ankle deviation)

Answer 1

• Audible slap on ground immediately following heel strike/initial contact
• In normal gait, the neutral ankle positioning should happen with slow lowering to ankle PF immediately afterwards
• Caused by poor DF strength and poor eccentric control of ant tib
• May use functional e-stim to wake up muscle before strengthening muscle

Question 2

Vaulting (foot/ankle deviation)

Answer 2

• Excessive ankle PF on stance limb in order to help clear the swing limb
• In normal gait, ankle moves from 10-15 degrees of PF to neutral ankle positioning
• Caused by one limb being longer than other, so pt excessively PFs on stance side to clear longer limb
• This is something that patient actively and voluntarily does in order to clear long limb (so this cannot be caused by PF spasticity)

Question 3

Delayed Heel Off (foot/ankle deviation)

Answer 3

• Delayed heel rise at end of terminal stance and beginning of pre-swing
• In normal gait, ankle moves to 10-15 degrees of DF
• Caused by weak PFs (tibial nerve palsy), excessive DF mobility, or pes planus (because foot is unlocked and we need a rigid foot for propulsion)

Question 4

Early Heel Off (foot/ankle deviation)

Answer 4

• Early rise of heel prior to completion of midstance
• In normal gait, ankle in neutral during midstance and transitions to 10-15 degrees of DF
• Caused by PF spasticity, PF contracture, DF limitation, heel pain, or limited hip extension
  — Side note —> DF limitation is caused by decreased posterior glide to talocrural joint

Question 5

Knee Extensor Thrust (genu recurvatum / knee hyperextension)

Answer 5

• Rapid and abrupt locking of knee into extension
• In normal gait, knee moves into 15-20 degrees flexion
• Caused by spastic quads (MS with extensor tone, CP, and ACA with extensor synergy pattern), weak quads, PF spasticity, and no proper eccentric lowering of knee into flexion
  — Side note —> ankle PF goes with knee extension AND ankle DF goes with knee flexion

Question 6

High Steppage (hip deviations)

Answer 6

• Quick and excessive increase in hip flexion during initial swing in order to clear long limb
• In normal gait from preswing to initial swing, the hip moves from 10 degrees of extension to 20 degrees of flexion
• Caused by compensatory swing strategy to clear longer limb, increased ankle DF, or diminished knee flexion

Question 7

Circumduction (hip deviation)

Answer 7

• Abduction and semi-circular movement of affected hip secondary to inability to achieve adequate clearance of foot
• In normal gait from preswing to initial swing, hip moves from 10 degrees of extension to 20 degrees of flexion
• Caused by lack of hip mobility, knee, and ankle mobility in order to clear the longer limb or diminished LE mobility

Question 8

Trendelenburg (pelvis deviation)

Answer 8

• Abnormal lateral trunk lean towards stance limb during stance
• In normal gait during midstance, pelvis moves from 4 degrees to 0 degrees on swing side through concentric hip abductors on stance side
• Caused by tightness of adductors or weakness of abductors
• If pt has weak abductors but did not do trendelenburg then you would see contralat fall, contralat hip drop, or contralat hip hike (hip hike done by quad lumborum)

Question 9

Forward Rotation (pelvis deviation)

Answer 9

• Diminished forward rotation = limits ipsilat step length
• In normal gait during mid swing to terminal swing, pelvis moves from 0 degrees to 4 degrees on swing side
• Caused by diminished hip/pelvis mobility or lack of pelvic coordination
• Common on NPTE — CVA with retracted pelvis could cause this

Question 10

Backward Rotation (pelvis deviation)

Answer 10

• Diminished backward rotation which limits contralat step length
• In normal gait between midstance to terminal swing, pelvis should rotate backward from neutral to 5 degrees on stance side
• Caused by diminished hip/pelvis mobility or lack of pelvis coordination

Question 11

Backward Trunk Lean

Answer 11

• Excessive extension of trunk during early to midstance phases (secondary to hip extensor weakness)
• In normal gait during heel strike through midstance, trunk maintains pretty close alignment with pelvis with slight extension throughout
• Caused by diminished hip extensor strength which causes body to compensate by shifting COM behind pelvis, weak glut max
• This is called Lurch Gait*

Question 12

Forward Trunk Lean

Answer 12

• Excessive forward trunk lean early to midstance phases secondary to LE weakness or diminished hip mobility
• In normal gait from loading response through midstance, trunk maintains pretty close alignment with pelvis, slight extension throughout
• Caused by diminished quad strength which causes body to compensate by shifting COM anterior to knee