lecture 7: gait Flashcards
- A 15-year-old patient is demonstrating a right compensated
Trendelenburg gait pattern.
Which hip abductor is weak? Which direction is the lateral trunk flexion?
Which hemipelvis will drop?
What are conditions of observational gait analysis?
- clothing
- barefoot vs braced
- AD vs no AD
- gait speed (gait deviations will get worse with speed)
What are the planes of motion with gait analysis?
sagittal and coronal (pretty easy to see these deficits)
transverse (difficult to see these deviations, especially at the pelvis)
What can help see rotation/transverse plane deviations in gait?
IGA
Examination of atypical gait can be done by
- planes
- phases RANCHOS
- 5 major attributes
- rockers
how much double limb support is in stance?
20%
2 phases (LR, PreSw)
what are the 5 attributes of gait?
- stability in stance
- foot clearance in swing
- pre-positioned foot for IC
- adequate step length
- energy conservation
stance phase (60%) includes
LR
midstance
terminal stance
preswing
1st rocker
heel rocker
IC to LR
2nd rocker
ankle rocker
midstance
3rd rocker
forefoot rocker
heel rise
4th rocker
toe rocker
most anterior
margin of medial forefoot and
great toe; preswing
excessive trunk motion is best seen at —- (not really sagittal plane)
coronal plane
bilateral excessive trunk lateral flexion
hip deviation seen in sagittal plane
excessive hip flexion
hip deviation in coronal plane
excessive adduction (scissoring)
excessive abduction
hip deviation occurring in transverse plane
malrotation
*bony
*secondary to overactivity of internal femoral rotators (add)
excessive intoeing or out toeing due to hip rotation
hip deviations in CP (ex. hip flexors, adductors, IRs over active) cause….
mm imbalance –> weakness or bony deformities –>
when bony levers are not adequate, then inadequate power generation***
–> compensatory movements
2 common hip compensatory movements
- compensated trendelenburg (lateral trunk flexion)
- hip circumduction
foot drop –> 2 compensations that are common
- high steppage gait
excessive hip flexion
OR 2. hip circumduction
3 reasons for hip circumduction
inadequate hip flexor and/or knee flexor (usually hip)
excessive hip IRs
ankle PF (foot drop)
scissoring gait happens due to
bilateral spasticity in adductors (CP)
stance phase errors at the KNEE are usually
- abnormal position
- malrotation
- both
swing phase KNEE errors are commonly associated with
inadequate ROM and/or weakness
rotational errors at the KNEE are due to
femur twisted out of plane of progression
One of the most common stance phase knee deviations is
excessive knee flexion
*knee flexion drives GRF posteriorly
*reduces normal knee extension movement
*increased demand on quads, hip extensors, HUGE ENERGY EXPENDITURE
2 stance phase knee deviations
recurvatum
excessive knee flexion (most common)
most common swing phase knee deviation
decreased knee flexion
(need 60 at midswing normally)
impaired PEAK and dynamic ROM
loss of knee flexion during swing results in
stiff knee gait pattern
Why is stiff knee gait or decreased knee flexion often in children with CP?
RECTUS FEMORIS
2 joint muscle (crosses 2 joints, harder to ask RF to perform isolated motor control bc of UMN issue)
*often used to hip flex, but its also a knee extensor! both turn on –> knee extended in swing
3 major categories of foot/ankle deviations
- excessive PF
- excessive DF
- bony deformity: malrotation
Excessive PF in stance affect what phases?
IC and midstance
1st rocker (heel)
2nd rocker (ankle)
plantar flexion knee extension couple
gastroc inserts into posterior distal femur, pulls knee back into extension.
most common stance phase error at ankle caused by excessive PF
excessive PF knee extension couple
*hyperextension!
If child with spastic CP has OVERLENGTHENED gastroc soleus, they will be stuck in
crouched gait
*over lengthened gastroc soleus
If walking in crouched gait, GRF is ___ knee
behind knee, not anterior like they should be during second rocker
The PF knee extension force couple stabilizes ____ and ____
knee and later hip
PF-knee extension couple
abnormal gait pattern characterized by excessive DF
crouched gait
*weak soleus
*excessive hip and knee flexion
*excessive DF, no push off
due to impaired PF-knee ext couple
crouched gait: increases demand on
quadriceps
CROUCH GAIT:
In terminal stance, loss of ____ occurs, and less ___ is generated
loss of heel rise
less power
(no push off)
energy consuming, impairs swing phase knee mechanics
stiff knee gait is a __ phase gait deviation
SWING
inadequate peak knee flexion
inadequate dynamic knee flexion ROM
malrotation of the foot
inversion/ev of hindfoot
causes lever arm dysfunction
*stance phase instability
hemiplegic CP: over activity of the —- is common putting the foot and ankle in
an equinovarus position (calcaneal inversion)
post tib and
gastroc
diplegia CP: overactivity of the ____ is common putting the foot and
ankle in an equinovalgus position (calcaneal
eversion)
peronus brevis
and gastroc
Excessive PF in Swing can be caused by
- ant tib weakness
- gastro soleus tightness
- over activity, combination
of above
also can be bc of inadequate knee flexion during swing
is in toeing typical?
NO
Is out-toeing typical?
a little is
too much is not
foot progression angle
where is their feet facing when walking?
*in toe or out toe?
Lever Arm Dysfunction adversely effects the __
moment
moment = force * distance
less power or force produced
4 types of lever arm dysfunction
1). Malrotation
2). Loss of Stable Fulcrum
3). Loss of bony rigidity
4). Shortening of the lever arm
What is malrotation?
ER/IR
external tibial rotation or out toeing
What is an example of a loss of a stable fulcrum?
hip subluxation
poor pivot point
poor abductor control
What is an example of a loss of bony rigidity?
pes valgus
severe: Pes planovalgus: subluxation of talus on calcaneus
*Foot can no longer act as an efficient rigid lever arm during terminal stance when heel comes off
ground
What is an example of shortened lever arm?
coxa breva/valga of hip
affect the hip joint,
This results in a reduction of the magnitude of the
moment the hip abductors can generate
What is part of a rotational profile?
- foot progression angle
- medial and lateral hip rotation
- ryder’s test - test for hip anteversion
- thigh-foot angle
- transmalleolar axis-thigh angle
- foot configuration
how to check medial and lateral hip rotation
prone w/ knee bent
medial: 40
lateral: 50
Ryder’s or Craig’s test
hip anteversion
babies have a ton, then get less. Adults should have 15 ish degrees
Thigh foot angle
line bissecting thigh
line bissecting bottom of foot
*should always be EXTERNAL
trnasmalleolar axis-thigh angle
lateral/medial malleoli –> TIBIA vs femur
*how much is rotation from foot or from tibia
foot configuration: reason for intoeing could be…
some ppl have a metatarsus adductus where its just from the toes!
excessive anteversion happens a lot for children with CP. Why
newborn has a lot of anteversion, and with WB, will have derotation.
without WB, not enough derotation of long bones + adductor spasticity pulling in on hips
pes planal valgus
calcaneal eversion
What is “Miserable
Malignment”
knee pointed in,
foot pointed out (compensating body)
*KNEE PAIN
*increased femoral anteversion = increased IR hip = knee in = *squinting patella
squinting patella
Transverse Plane Deviation***
Malrotation of the femur and tibia can look like a
valgus knee deformity instead of a transverse
plane deformity
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