I. Introduction Flashcards
Pronation in gait
Eversion
Lateral movement of calcaneus, pronation subtalar joint
Supination in gait
Inversion
Medial movement calcaneus, supination subtalar joint
Name the phases (and percentages) of gait
Stance phase - 60%
- heel strike - 27%
- midstance - 40%
- propulsive period - 33%
Swing phase - 40%
- acceleration phase
- midswing
- deceleration
Stance phase is the _____ phase while swing phase is the ______.
weight bearing; toe-off to heel strike
What happens in heel strike phase?
Toe-off opposite foot
Knee extended
Foot dorsiflexed
Leg decelerating
Subtalar joint pronating throughout (foot itself is supinated)
Function of heel strike phase
Transfer weight and shock absorption
Key points of midstance phase:
- Weight-bearing period between foot flat and heel lift
- Toe-off completed for opposite foot
- Foot in full contact with floor
- Subtalar joint supinated (though food is moving to pronation)
Major functions of midstance
- Bearing weight
- Convert foot from adaptive shock absorber to rigid lever for propulsion
Propulsive period key points:
- Period between heel life and toe-off
- Subtalar supination continued and completed (foot is pronated
Functions of propulsive period
Transfer weight from lateral to medial side of foot and to ball and toes for even propulsion
Shifting weight of body to other foot
Swing phase includes:
Toe-off to heel strike
Acceleration phase key points
Toe-off to midswing
Hip flexes to propel leg forward
Functional significance of acceleration phase
Transfer foot forward for next step
Midswing key points
Transition period between acceleration and deceleration
Halfway point of swing phase
Deceleration key points
Midswing to heel strike
Major function of deceleration
Decelerates limb to prep for contact and weight transfer
Six classical gait determinants
- Pelvic rotation
- Pelvic tilt
- Pelvis shift
- Knee flexion
- Knee-ankle relationship
- Hip flexion
Efficient gait has minimal [vertical/horizontal] oscillations
Vertical
What are determinants?
Biomechanical properties which decrease vertical oscillations and allow for more efficient motion
What is normal oscillation pattern?
High point is midstance
Low point is double weight bearing (10% of gait)
What is pelvic rotation
Rotation of entire pelvic away from the side of the forward leg
What is the degree of pelvic rotation is walking gait?
4˚ to each side
In pelvic rotation, vertical displacement decreased by
3/8”
What is the result of pelvic rotation?
Decreased angle between leg and floor, and between hip and leg
What happens in pelvic tilt?
Pelvis dips inferiority on swing side (4-6˚)
Opposite hip adducts (weight bearing hip)
What muscle prevents excessive adduction of weight bearing hip in pelvic tilt?
Gluteus medius
Pelvic tilt decreases vertical displacement
1/8”
What happens in pelvis shift?
Pelvis shifts toward stance side about 1”
Hip adduction on stance side
What does pelvis shift do?
Smoothies pelvic motion, helps maintain balance
What happens in knee flexion?
Stance knee goes from full extension at heel strike to 15˚ flexion
What is an important shock absorber?
Knee flexion
Knee flexion decreases vertical displacement by
1/8”
Knee-ankle relationship is saying:
Ankle is 90˚ at heel strike, then plantar flexion, then dorsiflexion
As heel raises during toe-off = vertical lift
Hip flexion is the
Acceleration stage of swing phase
What is happening in hip flexion?
Moves foot forward with minimal vertical undulation
What are the prime movers of the muscles of gait
Hip flexors/extensor
What are the stabilizers of the muscles of gait
Hip abductors/adductors
What are the decelerates of the muscles of gait
Hamstrings and Gluteus Maximus to slow down swing
7 Majors muscles of gait
Gluteus Maximus and medius Hamstrings Gastrocnemius and soleus Tibialis anterior Quadriceps Iliopsoas TFL
Muscle activity in stance phase: heel strike
- Hamstring activity decreases
- Quads extend knee
- Gluteus medius stabilizes pelvis, controls hip adduction with eccentric contraction
- Paraspinal muscles keep pelvis from dipping excessively
- Tibialis anterior dorsiflexes foot, eccentric contraction as foot makes contact
Muscle activity in stance phase: mid stance
- Body weight being pulled over foot by the body’s momentum
- Gastrocnemius, soleus, and TFL braking and controlling
Muscle activity in stance phase: toe off
Gastrocnemius and soleus contraction
Muscle activity in swing phase: acceleration
Hip flexors (iliopsoas and quad and rectus femoris) flex hip and accelerate forward
Tibialis anterior contracts so toes clear floor
Muscle activity in swing phase: deceleration
- Gluteus Maximus contracts
- Hamstrings decelerates and prepares limb for heel strike
Concentric contraction
Muscle shortens - force generated is sufficient to overcome resistance
Eccentric contraction
Muscle lengthens - force generated is insufficient to overcome resistance
What does a physical exam show?
- Integrity of the neuromuscular system
- Nervous system integrity
- Coordination and integration of movements
- Muscle strength and health
- Biomechanical integrity and stability of involved joints
What is happening in gluteus medius lurch?
- Weak or paralyzed gluteus medius (hip abductor)
- Lean toward weak side to center gravity over stance leg
What is Trendelenburg gait?
- Weak gluteus medius
- Lets opposite side hip sag excessively during swing phase
What kind(s) of gait abnormality do you get with a weak/paralyzed Gluteus Medius?
- Gluteus medius lurch or
- Trendelenburg Gait
What is the gluteus Maximus lurch?
- Weak gluteus maximus
- Shift pelvis anterior and thorax posterior to maintain hip extension
What kind(s) of gait abnormality do you get with a weak/paralyzed Gluteus Maximus?
Gluteus maximus lurch
What is the waddling gait?
- Proximal lower extremity (hip, etc.) muscle atrophy, dystrophy
- Feet wide apart; walk resembles a duck
What kind(s) of gait abnormality do you get with weak quads?
Knees buckle into flexion
Ataxic gait
Unsteadiness, staggering
A gait that looks unsteady may be broadly categorized as:
Ataxic gait
What is propulsive gait (festination)
- Walk on toes as though being pushed, small steps
- Starts slowly, then gets faster; may need to grab something to stop
Festination is a typical gait abnormality of:
Parkinson’s disease
Cerebellar gait
Reeling gait, may wander off to one side or the other
Meniscus and crucial ligament tears lead to instability, called:
Joint injury gait
Pain can cause gait abnormality from:
- Trauma
- Joint disease
- Limping
Antalgic gait results from pain, what is it?
Protective gait; pain anywhere in the body
What kind(s) of gait abnormality do you get with a weak dorsiflexor?
- Foot drop
- Steppage
What phase of gait does weak dorsiflexor fit into?
Swing phase
Foot drop could be a sign of:
L4 nerve lesion
What kind(s) of gait abnormality do you get with a hypomobile joint (ie hip or knee)?
Swing leg out to the side (circumsduction gait)
Swing hip higher (hip hike gait)
What is spastic paraplegia or scissors gait:
Legs cross midline
Bilateral contractural changes (adductors)
Partial paralysis
