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anatomy 241 > Lecture 20 - The Gait Cycle > Flashcards

Lecture 20 - The Gait Cycle Flashcards

1
Q

Hip joint anteriorly responsible for

A

hip flexion

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2
Q

Hip joint posteriorly responsible for

A

hip extension

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3
Q

knee joint anteriorly responsible for

A

extension

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4
Q

knee joint posteriorly responsible for

A

flexion

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5
Q

Ankle joint anteriorly responsible for

A

dorsiflexion

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6
Q

Ankle joint posteriorly responsible for

A

plantar flexion

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7
Q

Anterior compartment of leg comprises of

A
  • Tibialis Anterior
  • Extensor hallucis longus
  • Extensor digitorum longus

important for dorsiflextion

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8
Q

Deep compartment (posterior) of leg comprises of

A
  • Tibialis Posterior
  • Flexor hallucis longus
  • Flexor digitorum longus

important for plantarflextion

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9
Q

Lateral compartment of leg comprises of

A
  • Fibularis (peroneus) Longus
  • Fibularis Brevis
  • Both evert the foot
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10
Q

Both tibialis muscles

A

invert

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11
Q

Superficial compartment (posterior) of leg comprises of

A

Gastrocnemius and soleus

for plantarflexion and gastrocnemius for flexion of the knee joint as well as it is the only one that cross the knee joint in this compartment

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12
Q

Lateral side leg muscles =

A

eversion

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13
Q

Medial side leg muscles =

A

inversion

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14
Q

Blood supply to the leg and foot …

A

Femoral artery passes through the adductor hiatus and once it passes through the name changes to the popliteal artery

Popliteal artery is behind the knee in the popliteal fossa and it dividdes into an anterior tibial, posterior tibial and fibular branch

Tibial arteries run parallel to the tibia and fibular/peroneal artery runs parallel to the fibula

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15
Q

Sciatic nerve

A

Legs and feet are supplied by the branches of the sciatic nerve

Sciatic nerve divides into:
• Tibial nerve

  • Common fibular/ peroneal nerve (splits into 2 branches)
    * Superficial fibular nerve
    * Deep fibular nerve
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16
Q

Sciatic nerve divides into:

A

• Tibial nerve (quite central)

  • Common fibular/ peroneal nerve (splits into 2 branches) (lateral)
    * Superficial fibular nerve
    * Deep fibular nerve
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17
Q

Tibial nerve in terms of injury

A

Rarely injured because it is quite deep

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18
Q

Common peroneal (common fibular) nerve in terms of injury

A

common for injury because quite superficial

injury means that they can’t dorsiflex so develop a foot drop condition

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19
Q

Leg innervation - anterior compartment of leg

A

Supplied by the deep fibular nerve

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20
Q

Leg innervation - posterior compartment of leg

A

Supplied by the tibial nerve

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21
Q

Leg innervation - lateral compartment of leg

A

Supplied by the superficial fibular nerve

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22
Q

Consequence of tibial nerve injury?

A

Note that it is not common because the nerve is deep

Paralysis of plantarflexors and intrinsic foot muscles

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23
Q

Common fibular nerve divides into

A

superficial and deep branches, near the head of fibula

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24
Q

Common fibular nerve innervates

A
  • Short head of biceps femoris
  • Lateral leg muscles (through the superficial branch)
  • Anterior leg muscles (through the deep branch)
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25
Q

Deep fibular nerve path

A

Descends in the leg along with the anterior tibial artery and vein

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26
Q

Deep fibular nerve innervates….

A

Anterior leg muscles = tibialis anterior, extensor digitorum longus, extensor hallucis longus

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27
Q

Functions of the anterior leg muscles that the __________ nerve innervates

A

Deep fibular nerve

  • Dorsiflexion (all)
  • Toe extension (extensors)
  • Inversion (Tibialis anterior)
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28
Q

Superficial fibular nerve innervates…

A

Lateral compartment muscles = fibularis longus, fibularis brevis

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29
Q

Function of the lateral compartment muscles that the _______ nerve innervates

A

Superficial fibular nerve

Function - foot eversion

30
Q

Common fibular nerve damage …

A

Most common nerve in the lower limb to be damaged
• Relatively unprotected at fibular neck
• Trauma: fracture of fibula head
• Compression, e.g., plaster cast

Common fibular nerve injury leads to foot drop

31
Q

Gait cycle

A

Movements of the lower limbs during walking involve alternating stance and swing phases

Note: the stance phase of one limb does not end immediately when the opposite limb strikes the ground (i.e., there is a time when both limbs are on the ground)

32
Q

Double support

A

One foot is leaving the ground and one foot is at the start of stance

33
Q

Heel strike

A

part of stance phase, heel in contact with the ground

34
Q

Support phase

A

Part of stance, going from heel strike to toe off

35
Q

Toe-off phase

A

Last thing in contact with the ground, part of stance phase

36
Q

Running and double support

A

no period of double support in running

37
Q

Running

A
  • There is no period of double support during running
  • Time and frequency of the stance phase is reduced
  • There are times when both feet are off the ground (float/aerial phase) - difference between walking and running
38
Q

What muscle groups maintain standing?

A

Primarily extensor muscles of the back and plantarflexors

Erector spinae muscles help keep us upright (they are active when standing)

39
Q

WHat happens at lower limb joints when standing?

A

Hip and knee joint are extended - both are in full extension so all the ligaments are tight which helps to stabilise joints and hold upper body weight

The knees are ‘locked’ (all ligaments are taut)

40
Q

Centre of gravitiy is _____ to the ankle joint ….

A

anterior - so people tend to fall forward but plantarflexors counteract this ‘fall’

41
Q

Joints behind the centre of gravity tend to …

A

fall forward

42
Q

Atlanto-occipital joint and centre of gravity

A

Between the head and neck (between the atlas and occipital bone)

Centre of gravity is anterior to it

For this reason, we need to keep our head upright and the erector spinae muscles help with this

43
Q

Joints in front of the centre of gravity tend to …

A

fall backwards

44
Q

Thoracic vertebrae and centre of gravity

A

Centre of gravity is anterior to thoracic vertebrae

walk slightly leaning forward

45
Q

Hip joint and centre of gravity

A

Hip joint in full extension

Centre of gravity is slightly posterior to the hip joint, for this reason that we start to go slightly backward at the hip joint

Iliopsoas prevents falling backwards

46
Q

Ankle joint and centre of gravity

A

Centre of gravity is anterior to ankle joint

Tend to fall forward and plantarflexors prevent this (triceps surae)

47
Q

Gait cycle involves a repetitious sequence of:

A

Propulsion

Support

48
Q

From a standing position, the gait cycle is initiated by:

A
  • Relaxation of plantarflexors
  • Dorsiflexion of the ankle joint
  • Then the limb enters into the swing phase
49
Q

Phases of the gait cycle

A

1 - Heel strike
2- Support
3- Toe off
4 - Carry through

2 and 3 = stance
4 = swing

50
Q

Stance phase

A

• Stance begins with heel strike, ends with toe off
• Limb needs to accept weigh, decelerate mass, stabilize
pelvis, preserve foot arches

51
Q

Swing phase

A

• Swing begins with toe off, ends with heel strike

52
Q

During heel strike ,…

A
  • Ankle joint is dorsiflexed
  • Knee joint is extended
  • Hip joint is flexed
53
Q

What muscles are involved during heel strike?

A
  • Dorsiflexors: Anterior leg muscles
  • Knee extensors: Quadriceps femoris
  • Hip flexors: Iliopsoas and rectus femoris
54
Q

Hip joint during stance phase

A

Initial contact (heel strike)
Hip joint flexion (anterior muscles contract) to extension
Shock absorption
Flexed hip gets extended after heel strike
Hip extensors = hamstrings

Mid-stance
Hip abductors are active (gluteus medius and minmus)
Body moving from behind foot to in front of the foot
Progress body over stationary foot
Maintain limb and trunk stability
Hip extension
Hip abductors = Gluteus medius, minimus, TFL

Late stance
Hip joint extended and starts to flex at the end
Body moving even further forward
Change from hip extension to flexion
Progress body beyond supporting foot
Accelerate body
Hips start to flex in preparation for swing

55
Q

Hip joint during stance phase - Initial contact (Heel strike)

A

Initial contact (heel strike)
Hip joint flexion (anterior muscles contract) to extension
Shock absorption
Flexed hip gets extended after heel strike
Hip extensors = hamstrings

56
Q

Hip joint during stance phase - Mid-stance

A

Mid-stance
Hip abductors are active (gluteus medius and minmus)
Body moving from behind foot to in front of the foot
Progress body over stationary foot
Maintain limb and trunk stability
Hip extension
Hip abductors = Gluteus medius, minimus, TFL

57
Q

Hip joint during stance phase - Late-stance

A

Late stance
Hip joint extended and starts to flex at the end
Body moving even further forward
Change from hip extension to flexion
Progress body beyond supporting foot
Accelerate body
Hips start to flex in preparation for swing

58
Q

Hip joint during swing

A 
Mid-swing 
Limb advancement
Foot clearance off the ground
Hip flexors are active = iliopsoas, rectus femoris 
Active to move thigh forward 
Hip in approximate anatomical postion 
Late swing 
Complete limb advancement
Prepare for stance phase (deceleration)
Hip extensors contract to decelerate the forward movement. (contract to prepare for stance, to slow down the swinging motion) 
Hip is flexed
59
Q

Hip joint during swing - Mid-swing

A 
Mid-swing 
Limb advancement
Foot clearance off the ground
Hip flexors are active = iliopsoas, rectus femoris 
Active to move thigh forward 
Hip in approximate anatomical postion
60
Q

Hip joint during swing - late swing

A 
Late swing 
Complete limb advancement
Prepare for stance phase (deceleration)
Hip extensors contract to decelerate the forward movement. (contract to prepare for stance, to slow down the swinging motion) 
Hip is flexed
61
Q

High heel shoes

A

Increased pressure on metatarso-phalangeal joints during stance.

Ankle is pretty much in plantarflexion

Prone to hallux valgus (bunion), calluses, metatarsalgia, etc.

Research has found that in extreme cases it can lead to pain all the way up to the spine

62
Q

Ankle joint during stance

A 
Heel strike 
Initial impact deceleration
Shock absorption
Dorsiflexors contract to lower foot to ground
Ankle is dorsiflexed 
Mid stance 
Foot has been lowered to the ground
Movement forward
Dorsiflexors contract to pull tibia forwards over the foot, then gravity and momentum take over - dorsiflexors are active again but helping move the leg forward, contraction beings the leg forward 
Ankle in anatomical position 
Fixed on the ground 
Late stance 
Prepare for swing phase 
Accelerate body forward
Plantarflexors = triceps surae (active so it is hitting the ground) 
Toe-off propulsion
Foot stabilisers active
63
Q

Ankle joint during stance - heel strike

A 
Heel strike 
Initial impact deceleration
Shock absorption
Dorsiflexors contract to lower foot to ground
Ankle is dorsiflexed
64
Q

Ankle joint during stance - mid stance

A 
Mid stance 
Foot has been lowered to the ground
Movement forward
Dorsiflexors contract to pull tibia forwards over the foot, then gravity and momentum take over - dorsiflexors are active again but helping move the leg forward, contraction beings the leg forward 
Ankle in anatomical position 
Fixed on the ground
65
Q

Ankle joint during stance - late stance

A 
Late stance 
Prepare for swing phase 
Accelerate body forward
Plantarflexors = triceps surae (active so it is hitting the ground) 
Toe-off propulsion
Foot stabilisers active
66
Q

Ankle joint during swing

A

Mid swing
Limb advancement
Foot clearance off the ground - so that the foot does not hit the ground
Dorsiflexors = anterior leg muscles
Toe extensors = extensor hallucis longus, extensor digitorum longus
Ankle is dorsiflexed, toes extended

Late swing (deceleration)
Complete limb advancement
Prepare for stance phase (deceleration)
Dorsiflexors and toes extensors ensure foot is in optimal position for heel strike
Dorsiflexors are active to prepare for heel strike

67
Q

Ankle joint during swing - mid swing

A

Mid swing
Limb advancement
Foot clearance off the ground - so that the foot does not hit the ground
Dorsiflexors = anterior leg muscles
Toe extensors = extensor hallucis longus, extensor digitorum longus
Ankle is dorsiflexed, toes extended

68
Q

Ankle joint during swing - late swing

A

Late swing (deceleration)
Complete limb advancement
Prepare for stance phase (deceleration)
Dorsiflexors and toes extensors ensure foot is in optimal position for heel strike
Dorsiflexors are active to prepare for heel strike

69
Q

Gait changes with age

A
  • Muscles get weaker/atrophy
  • Flexed posture in lower limb during standing, flexed neck (knee and neck become slightly flexed so centre of gravity relaitonship is now different)
  • Balance compromised
  • Gait is slower, decreased stride length, increased stance time, more time in double stance, less propulsive forces developed
70
Q

Other causes of gait changes - medical treatment

A

Medical treatment – e.g., androgen deprivation (stops production of testosterone) therapy (ADT) causes muscle atrophy and increase fat in men

Shows shrinkage in muscles on xray when before and after compared

  • Reduced muscle force (e.g., quadriceps, iliopsoas, soleus) (muscles smaller therefore smaller amount of force generation)
  • Step width increases
  • Forward acceleration decreases
  • At risk of falling & bone fracture - there is a higher risk of loss of balance and bones more easy to fracture due to lack of testosterone
71
Q

Gait changes - Hip abductors damae due to superior gluteal nerve injury

A
  • Unable to maintain pelvis level during single leg stance (contralateral drop)
  • Compensation: contralateral lateral trunk flexion (pelvis tilts to opposite side during stance phase)
72
Q

Gait changes - anterior leg muscles damage due to common fibular nerve injury

A
  • Weak dorsiflexion ( dorsiflexors not active)
  • Toes don’t clear during swing
  • Foot slap/ foot drop after heel strike
  • Compensation: Knee raised high during swing

anatomy 241 (29 decks)

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