Gait - DSA

Question 1

Gait cycle

Answer 1

From heel strike to next heel strike of SAME foot

i.e. from left hell strike to left heel strike = 1 gait cycle

Question 2

What provides maximum shock absorption during contact?

Answer 2

• Calcaneus everting and talus dropping/adducting to unlock midtarsal joints

Question 3

Which muscles lower foot eccentrically to ground?

Answer 3

• Extensor digitorum longus

- Tibialis anterior

Question 4

What’s the cycle progression of Mid-stance

Answer 4

Foot-flat to heel-off

Question 5

Describe in detail mid-stance

Answer 5

Rearfoot fully pronates, metatarsals hit ground to bring foot flat on gound, and body’s center of gravity passes from behind to over foot

Question 6

What happens to subtalar joint during mid-stance phase?

Answer 6

-Sub-talar joint resupinates (calcaneus everts and talus abducts), locking midtarsal joint, transforming foot from a shock absorber to a rigid lever

Question 7

What muscle is an important restraint to overpronation and is an active foot supinator?

Answer 7

Tibialis posterior

Question 8

What’s the definition of propulsion during gait cycle?

Answer 8

Heel-lift progresses to toe-off

Question 9

Extension of which joint results in windlass effect of plantar fascia that elevates the arch an further assists in supination of the foot

Answer 9

Metatarsophalangeal (MTP) joint, especially 1st MTP (think powerful toe-off)

Question 10

Proulsion phase concludes with?

Answer 10

Body weight moving over great toe at toe-off

Question 11

What compromised 60% of the gait cycle

Answer 11

From heel strike (initial contact) to toe off (pre-swing)

Question 12

During what phase do most problems occur?

Answer 12

• During stance phase

- Foot on ground and weight bearing

Question 13

What compromises 40% of the gait cycle

Answer 13

• Swing phase

- From toe off to heel strike

Question 14

Foot clearance in swing requirement?

Answer 14

• Ankle dorsiflexion
• Knee flexion
• Hip flexion
• Retain stability in stance

Question 15

How is energy conserved during gait?

Answer 15

• Pelvic lift

- In early stance, as weight is transferred, hip on non-weight bearing side DROPS about 2”

Question 16

What’s Antalgic gait?

Answer 16

• Painful joint
• Swing enhanced on affected side
• Stance phase shortened on affected side

Question 17

What’s Arthrogenic gait?

Answer 17

• Stiff joint —> Circumduction
• Plantarflexion of foot opposite to affected side during stance phase to increase clearance (this raises the hip)
• Affected leg is circumducted (passive circular motion)

Question 18

What’s Ataxic gait?

Answer 18

• Unsteady/uncoordinated
• Needs broad base of support
• Loss of sensation or control

Question 19

Causes of ataxic gait?

Answer 19

• Vestibular
• Cerebellar abscess
• Friedreich’s ataxia
• Pontine-cerebellar atrophy
• Chronic mercury poisoning
• Posterior fossa tumor
• Wernicke’s syndrome
• Drugs

Question 20

What’s Hemiplegic (circumduction) gait?

Answer 20

• Cerebrovascular event –> Semicircle
• Leg is stiff WITHOUT FLEXION at the knee or hip
• Leg rotated away from body then towards it creating a semicircle
• Seen in strokes and spinal cord injuries

Question 21

What’s Parkinsonian (Festinating) gait?

Answer 21

• Shuffling! (small shuffling steps)
• Hypokinesia (general slowness of movement)
• Exhibited by SOME pt’s with Parkinson’s disease

Question 22

Steppage gait?

Answer 22

• Foot drop + High stepping + Neuropathic
• Full foot drop
• Hip raised very high to clear toe
• Clomping sounds with high steps

Question 23

What causes steppage gait?

Answer 23

• Peroneal nerve injury secondary to:
• Lumbar disc herniation
• Poliomyelitis
• MS
• Guillain-Barre syndrome
• Parkinson’s disease

Question 24

Heel strike (R) = ? (L)
Flat foot (R) = ? (L)
Mid stance (R) = ? (L)
Heel off (R) = ? (L)

Answer 24

Heel off
Toe off
Mid-swing
Heel strike