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Assistive Tech > O - Abnormal Gait > Flashcards

O - Abnormal Gait Flashcards

1
Q

what are the pronatory functions of the foot (3)

A
  1. adaptation
  2. shock absorption
  3. torque conversion

pronation is normal
becomes a problem if excessive

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2
Q

what is the supinatory function of the foot

A

rigid lever -> heel raise as tibia moves over foot

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3
Q

what are the triplanar motions in pronation and their respective planes

A

DF - sagittal
ABD - transverse
eversion - frontal

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4
Q

what are the triplanar motions in supination and their respective planes

A

PF - sagittal
ADD - transverse
inversion - frontal

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5
Q

what 3 motions happen at the STJ during pronation in OKC

A

calcaneal:
* eversion
* ABD
* DF

same as the triplanar motions

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6
Q

what 3 motions happen at the STJ during supination in OKC

A

calcaneal:
* inversion
* ADD
* PF

same as triplanar motions

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7
Q

what 3 motions happen at the STJ during pronation in CKC

A

calcaneal eversion
talar ADD/PF
tibial IR

talar ADD/PF lowers arch, tibia has to IR bc of talar motion

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8
Q

what motion stays consistent b/w OKC and CKC pronation vs supination

A

in pronation - calcaneal eversion
in supination - calcaneal inversion

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9
Q

what happens up the chain during CKC pronation

A

calcaneal eversion
talar ADD/PF
tibial IR
knee flex
hip IR
ant pelvic tilt
inc lumbar lordosis

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10
Q

what 3 motions happen at the STJ during supination in CKC

A

calcaneal inversion
talar ABD/DF
tibial ER

talar ABD/DF - elevates arch
tibia follows talar motion

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11
Q

what happens up the chain during CKC supination

A

calcaneal inversion
talar ABD/DF
tibial ER
knee ext
hip ER
post pelvic tilt
dec lumbar lordosis

tibia ER - screw home mechanism

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12
Q

what are the components to look at for intrinsic normalcy

A
  1. post bisect calcaneus parallel to post bisect of lower 1/3 of leg
  2. MT heads perp to calcaneus bisection
  3. MT heads in same plane
  4. 10deg of ankle DF

STJ in neutral for these things

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13
Q

why don’t you measure DF by pushing straight back

A

measuring DF of multiple joints

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14
Q

why do you need 10deg of DF in STJ neutral

A

in late midstance:
* STJ supinating to prep for heel raise
* ankle/TC DF as tibia and body advances over limb

placing STJ in neutral mimics demands of gait

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15
Q

what is compensation

A

mvmt of one body part to neutralize the effects of a mvmt or alignment of another body part

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16
Q

what is normal compensation

A

allows for normal function
* compensatory pron or sup to allow for rotation higher in kinetic chain

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17
Q

what is excessive compensation

A

when motion required surpasses supportive tissue tolerance resulting in soft tissue trauma
* this is when people start to have problems and discomfort

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18
Q

what are the two goals during gait that the RF or FF might compensate for

A
  1. plantar surface of calcaneus to ground (RF)
  2. MT heads to ground (FF)

overall goal is to get foot flat on the ground

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19
Q

how could the RF compensate to get the plantar surface of calcaneus to ground (goal #1)

A

STJ may pron or sup

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20
Q

how might the FF compensate to get MT heads to the ground (goal #2)

A

STJ and MTJ may pron or sup

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21
Q

what in general does an uncompensated foot present with

A

RF or FF doesn’t reach flat contact w the ground

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22
Q

what are two reasons for an uncompensated foot presentation and which is the most common

A

STJ mobility (most common)
abnormal LE alignment

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23
Q

what foot type are uncompensated feet usually

A

more rigid - lack mobility to compensate

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24
Q

what do calluses form from

A

uneven weight distribution
* friction –> skin build up

abnormal shear forces
* biomechanical

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25
Q

after identifying a callus pattern what do you do w this info

A

NOT diagnostic
can use it to think ab a possible cause

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26
Q

describe normal STJ motion during:
* contact
* midstance
* propulsion

A

contact:
* STJ in slight sup at HS
* STJ pron 3-5deg by FF

midstance:
* STJ re-sup to neutral or slight sup
* need a rigid lever
* should be neutral by heel rise

propulsion:
* STJ cont to sup

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27
Q

what is subtalar varus and how is it measured

A

position of inversion
measure amt calcaneus inverted
varus if >4deg

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28
Q

why is subtalar a common foot type

A

born w ~10deg STJ varus
body derotates to neutral w age

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29
Q

reason for subtalar varus in OKC vs relaxed stance

A

OKC - incomplete derotation
relaxed - dynamic problem

relaxed stance - doesn’t look too bad, slight arch lowering

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30
Q

what is the main difference in dynamic function b/w normal STJ and compensated STJ varus

A

on contact:
* inc calcaneal inversion @HS
* inc STJ pronation to meet goal #1 (getting foot flat)

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31
Q

what is a common callus pattern for most hyperpronatory foot types

A

under 2nd and 3rd MT heads

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32
Q

what role does peroneus longus play in gait

A

stabilizing and holding foot to ground in CKC
as foot resupinates, holds foot to ground for a rigid lever

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33
Q

describe the callus pattern for compensated STJ and why

A

under 2nd and 3rd MT heads
* MTJ unstable
* peroneus longus not strong enough to stabilize 1st ray
* weight forces shift laterally to 2nd and 3rd

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34
Q

STJ varus compensated

how could spring ligament pathology be a resulting pathology and how would it present

A

talus moving down and in
calcaneus is everting

medial arch/ache pain

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35
Q

STJ varus compensated

how could plantar fascia pathology be a resulting pathology

A

plantar fascia is inelastic
* when talus displaced ant w/ pronation, drops down and in
* foot overpronates and get tension on periosteal attachment
* with excessive and repetitive tension can get a bony growth on calcaneus as it lays down more bone -> traction heel spur

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36
Q

STJ varus compensated

how can post tib tendinitis/tendinosis be a resulting pathology

A

being overused:
* working to decel pronation via ecc contraction after heel strike
* in midstance has to help resup - contracts conc and iso
* working too much

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37
Q

STJ varus compensated

how can trochanteric bursitis be a resulting pathology

A

femoral IR compensating for resulting tibial IR
* places shear forces on bursa

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38
Q

STJ varus compensated

how can patellofemoral dysfunction be a resulting pathology

A

places valgus thrust forces on knee

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39
Q

STJ varus compensated

how can medial knee pain be a resulting pathology

A

places strain on medial capsule and meniscus

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40
Q

STJ varus compensated

how can sinus tarsi syndrome be a resulting pathology and what are presenting sx

A

excessive pronation compresses lateral calcaneus and talus

diffuse pain ant to lat malleolus
* increased w WBing
* difficulty w uneven surfaces

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41
Q

STJ varus compensated

how can tarsal tunnel syndrome be a resulting pathology and what are presenting sx

A

talar displacement compresses post tib n.

burning, numbness, tingling on medial side

if getting those sx, screen lumbar spine and if that is neg then think tarsal tunnel syndrome

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42
Q

STJ varus compensated

what pt pop has a higher incidence of tarsal tunnel syndrome

A

DM

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43
Q

STJ varus compensated

what will and won’t address the shear forces

A

will - control pronation
won’t - padding

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44
Q

STJ varus compensated

what orthotic and footwear should be prescribed

A

biomechanical - medial RF post
motion control - duo density midsole

45
Q

STJ varus compensated

what are 3 PT interventions

A

proximal weakness/hip IR - gluts
foot intrinsics
ecc tib post strength

46
Q

STJ varus UNcompensated

how will this foot look in relaxed stance

A

hypomobile & stable
stays in inverted position

doesn’t have mobility to compensate

47
Q

STJ varus compensated

how will this foot look in relaxed stance

A

not too bad - slight arch lowering
this is a dynamic problem

48
Q

STJ varus UNcompensated

what does the dynamic function look like in gait

A

CONTACT
* inc calcaneal inversion @ HS
* dec STJ motion to compensate

MIDSTANCE
* calcaneus remains inverted
* lateral WB-ing

PROPULSION
* WB-ing shifts medially late as heel rises

49
Q

STJ varus UNcompensated

what is the callus pattern and why

A

lateral border of foot
5th MT head

lateral WBing d/t lack of pronation
* lateral heel whip

50
Q

STJ varus UNcompensated

what is the main reason for pathologies to result from this

A

not pronating, no shock absorption
GRF goes up the chain

51
Q

STJ varus UNcompensated

what proximal sx can result

A

lateral knee
hip/LBP

52
Q

STJ varus UNcompensated

what is haglund’s deformity

A

“pump bump”
posterolateral exostosis

this is common in rigid foot types

53
Q

STJ varus UNcompensated

how could lateral ankle sprains be a resulting pathology

A

weight bearing staying lateral, easy to roll laterally

54
Q

STJ varus UNcompensated

how can medial joint pain be a resulting pathology? how does it present? what are 2 alternative dx?

A

STJ compression

dull joint line ache
worse on hard surfaces or in shoes w inadequate shock absorption

plantar fasciitis
tib post tendon

55
Q

STJ varus UNcompensated

what is the concern with a jones or dancers fx

A

high non union rate

56
Q

STJ varus UNcompensated

what fx are common resulting pathologies

A

stress fx - tib/fib
jones - 5th shaft
dancers - base of 5th

not absorbing GRF forces

57
Q

STJ varus UNcompensated

what PT intervention is appropriate

A

mobilizations to restore normal mobility
* subtalar
* midtarsal
* talocrural

58
Q

STJ varus UNcompensated

what orthotic and footwear should be prescribed

A

orthotic - accommodative (softer)
footwear - cushion shoe

59
Q

why will you only ever see RF varus or neutral, and not ever valgus

A

RF valgus would mean that they developmentally derotated past neutral

60
Q

why is forefoot varus such a common foot type

A

born with 10-15deg at birth

61
Q

FF varus compensated

how will this foot look in relaxed stance

A
  1. classic “flat foot”
  2. lateral toe sign (see 3rd & 4th toe sticking out)
  3. “false malleolus” - navicular bone drops down and in
62
Q

FF varus compensated

why is this type of foot very problematic with dynamic function

A

person never really resupinates so getting excessive pronation in wrong phases of gait
* pronation thru late stance
* don’t have a rigid lever to push from
* tibia IR when knee needs to extend
* can see CIFR as a result

CIFR = compensatory internal femoral rotation

63
Q

FF varus compensated

describe the callus pattern and why

A

2nd and 3rd MT heads
* peroneus longus isn’t able to stabilize 1st ray to ground during gait

pinch callus at medial hallux
* ABD FF
* inc toe out

common callus pattern for most hyperpronator foot types

64
Q

what is the most destructive foot type

A

FF varus

65
Q

FF varus compensated

what is compensatory internal femoral rotation (CIFR)

A

during midstance foot pron, knee and hip should be ext
* as knee ext –> tib ER

since tib is stuck in IR, get CIFR to get knee to ext
* femur IR produces relative ER at tibia which gives knee ext

66
Q

FF varus compensated

how can metatarsalgia be a resulting pathology

A

d/t shearing forces at an unstable FF

67
Q

FF varus compensated

how can plantar fasciitis be a resulting pathology

A

talus ant displaced, drops down and in resulting in excessive pronation which places inc stress on plantar fascia

68
Q

FF varus compensated

how can achilles tendinitis be a resulting pathology

A

achilles attaches medial on calcaneus –> inc pull with excessive pronation
* achilles then working to decelerate pronation

69
Q

FF varus compensated

how can hallux abducto valgus (HAV) be a resulting pathology

A
  • peroneus longus not doing its job
  • oblique forces of body mass
70
Q

FF varus compensated

what are 4 PT interventions

A

control pronation
GS complex flexibility - address lack of DF
foot intrinsics
balance activities (NM control)

moving too much, want to control it

71
Q

FF varus compensated

why would you want to address any lack of DF in this pt

A

pronation is often common compensation for a lack of DF

72
Q

FF varus compensated

what orthotic and footwear would you prescribe in this foot type

A

biomechanical - medial FF post
* controlling excessive medial drop w compensatory pronation

motion control shoes – duo density midsole

73
Q

what pt pop is uncompensated FF varus more common in

A

men

losers

74
Q

FF varus UNcompensated

what does this foot type look like in relaxed stance

A

1st ray stays up
rigid foot type

75
Q

FF varus UNcompensated

when doing a differential dx what is an important consideration if you suspect this foot type based on relaxed stance

A

this can be an antalgic compensation
* s/p bunionectomy
* turf toe

76
Q

FF varus UNcompensated

what is the callus pattern and why

A

lateral border of foot
5th met head

more WBing on the lateral side

77
Q

FF varus UNcompensated

what is the reason you see resulting pathologies

A

don’t have pronatory function to shift weight lateral to med
* don’t want to be walking/WBing on 5th
* poor shock absorption leading to prox sx
* c/o diffuse pain d/t WBing at a capsular end point

78
Q

FF varus UNcompensated

what are 3 PT interventions

A

restore mobility - joint mobs
control GRFs
provide cushion - encouraging pron/mobility in kinetic chain (ankle, knee flex, hip IR)

79
Q

FF varus UNcompensated

what orthotic and footwear would you prescribe

A

accommodative device
medial bias

footwear - cushion shoe
* shock absorption
* promote mobility

80
Q

FF varus UNcompensated

what is a bias and why would we use this

A

bias = post made of softer material

since uncompensated, need post to be softer w more cushioning
* don’t want to have anything stiffening it bc already lacking motion

FF varus - needs medial posting
* material of post depends on if compensated or not

81
Q

can FF valgus be compensated or uncompensated?

A

no

can think of it as uncompensated foot type bc more rigid and stiff

82
Q

FF valgus

how will this foot type present in relaxed stance

A

supinatory foot type
typically high arch

83
Q

FF valgus

what limits pronation on contact

A

pre-mature loading of 1st ray

84
Q

FF valgus

what compensation for this foot type is seen in midstance and why

A

early re-supination
* need to get 2-5mets down to ground
* when sup pushes weight medial to lateral

problem is we don’t want weight to be lateral in midstance

85
Q

FF valgus

what is the callus pattern and why

A

1st MT head
* premature load

5th MT head
* pivots to shift weight to contralateral foot

86
Q

FF valgus

how can chronic lateral ankle sprains be a resulting pathology

A

WB-ing along lateral border of foot
* not difficult to continue motion laterally and roll ankle
* place stress on ATFL and CFL

87
Q

FF valgus

how can peroneus longus tendinitis be a resulting pathology

A

overuse in stabilizing 1st ray
decelerating STJ supination (bc supinating early)

88
Q

FF valgus

how can lateral / posterolateral knee pain be a resulting pathology

A

supination results in:
* varus
* recurvatum

structures loaded:
* biceps fem
* LCL / lateral joint capsule
* lateral gastroc
* ITB
* popliteus - IR tib / ER femur –> controls excessive ER of tibia associated w supination

89
Q

FF valgus

how can pelvic girdle dysfunction be a resulting pathology

A

limited shock attenuation
forces transmitted proximally

think of FF valgus as uncompensated/hypopronatory foot type

90
Q

FF valgus

what are 3 PT interventions

A

encourage pronation
control supination
NM re-ed
* adapt to uneven terrain

91
Q

FF valgus

what orthotic and footwear would you prescribe

A

flexible biomechanical
* lateral FF post
* 1st ray cut out if rigid (accommodating)

footwear - cushion shoe

if 1st ray is flexible - biomechanical
cut out is an accommodative option if rigid

92
Q

what is ankle equinus

A

lack of 10deg TC DF in STJN or supination

this is why we measure DF in supination to see ROM in TC

93
Q

why is an ankle equinus deformity significant for gait mechanics

A

DF is what allows tibia to advance over foot

94
Q

what are common impairments resulting in ankle equinus

A

joint restriction (TC)
ms length (GS complex)

95
Q

ankle equinus

what are components to your assessment and how do you sus out muscle (soleus or gastroc) or joint restriction

A

prone DF
* knee flex - soleus
* knee ext - gastroc

any sx with overpressure?
* posterior sx = muscle
* anteiror sx = joint

end feels:
* capsular (joint)
* muscle

96
Q

ankle equinus

what is a HUGE factor in if and how the pt compensates

A

MTJ mobility - flexible or rigid

97
Q

ankle equinus

how will a stable vs flexible MTJ impact compensation seen

A

stable - early heel raise (vault)
flexible - compensate @ “little ankle”
* pronation thru oblique MTJ axis

98
Q

ankle equinus

what are biomechanical adaptations w dec DF (3)

A

hip ER
genu recurvatum
dec step length

99
Q

ankle equinus

dynamic function mechanics during gait look similar to what other foot type

A

FF varus

100
Q

ankle equinus

what happens in midstance depending on if MTJ is stable or unstable

A

reach TC end range - tibia can’t advance over foot anymore

stable joint = vault
unstable = break thru MTJ axis & cont pronation

101
Q

ankle equinus

what is the callus pattern and why

A

2nd and 3rd MT heads

hypermobile FF

102
Q

ankle equinus

how can metatarsalgia be a resulting pathology

A

premature FF loading and prolong loading time
* inc pressures and fx

callus formation

103
Q

ankle equinus

how can tib post tendinitis/tendinosis be a resulting pathology

A

trying to control excessive pron

104
Q

ankle equinus

how can achilles tendinitis be a resulting pathology

A

excessive tension
working @ end ROM

105
Q

ankle equinus

what is an important consideration when stretching GS complex

A

don’t let them turn foot out and break through joint axis into pronation

106
Q

ankle equinus

what are 2 PT interventions

A

TC posterior joint mobs
GS complex stretching

107
Q

ankle equinus

why should you be careful with the use of orthotic therapy in this pt pop

A

biomechancial orthotics often fail in these pt bc they lack DF
* take away their compensatory pronation thru MTJ –> makes it worse

before giving an orthotic, make sure have TC DF

108
Q

ankle equinus

what orthotic might you consider and in what patient

A

heel lift

for temporary use in pts who are very reactive and uncomfortable

once they make gains w other interventions, take it out

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