Pathologic Gait Analysis Flashcards
Pathology in Observational Gait Analysis
Clinicians in physical rehab assess gait to:
* discern whether the problem is skeletal system, muscular, neurologic, or discern whether pain attributing to the gait issue
Next clinical steps after performing the observational gait analysis
- Skeletal: less likely from PT interventions adapt or change the skeletal system
- Orthotics, gait adaptation or assistive devices are necessary
- Painful acute and chronic skeletal issues refer to orthopedics
Skeletal System
sets the framework for movement and gait
1. Supports the body against the pull of gravity
2. Supports the body while standing
3. Works together as a level system
How to discern skeletal gait problems
- Skeletal length in lower limbs
* leg length disrepancy is common as only 10% of the population have equal leg lengths
* best seen from frontal view, rear view might be better as it is easier to view unequal height of pelvis (ex. left shoulder drop and right pelvis elevation) - Limbs move in a predictable but abnormal pattern- is there a conistent gait deviation
- Observe and perform standing alignment, ROM, various limb alignment assessments
Common Skeletal Gait Abnormalities
- Leg length discrepancy
- Foot progression angle: intoe and outtoe gait due to:
* hip
* knee
* ankle
How much leg length discrepancy is too much?
- Over 2 cm
- the culprit is the tibia or the femur
- Previous broken bone is a common reason
- Bone infections, juvenile arthritis or arthropathies
Keys to leg length (measure)
Measure:
1. Standing: posture assessment
* Scoliosis
* pelvis/shoulder height
2. Supine leg length
* tape measure (ASIS to medial malleous)
* hooklying (check for tibial length equal by looking if knees line up)
3. Pain assessment
* low back pain
* hip or knee
Orthotist or shoe lift or orthopedics
no mechanism of injury? consider this
Foot progression angle: out toe gait
- Normal foot progression angle in adults is 13-15 degrees, is estimated by the whole stance phase
- caused by skeletal issues
-external tibial torsion
-pronation
-hip internal rotation (passive)
In toe gait
common in children up to four years
* children will “grow out” of this posture
* There are pathologies in children and adults
Femoral anteversion
* excessive rotation of the hip >15 degrees in adolescents & adults (normal is 16 degrees, born with 40 degrees)
* suspect femoral anteversion: hip internal rotation is >50 degrees
Tibial torsion
* rotation of the tibia relative to the femur
In toe posture in foot
* unusual to have untreated club foot in US
* orthotics can assist
* intoe pattern
Exams to assess foot progression angle
- walking assessment
- standing assessment
- femoral anteversion: bilateral hip rotation in prone (>50 degrees IR)
- Tibial torsion: prone thigh foot angle, or sitting tibial torsion, standing assessment with patellar alignment
- foot or forefoot intoeing: prone
Caveat about rotational abnormalities
- Discern weather this is a skeletal, muscular, or neurologic issue
- Typically, this is a skeletal issue which are difficult for PTs to improve
- Orthotics may assist to ameliorate some deformities, but will not assist at the primary issue
Overpronation creates abnormal knee stress
Pronation
* creates IR of the tibia
* Increased forces during stance in the medial knee
* Reduces the efficiency during toe off
* medial knee OA is common
Neurologic gait deficits
- Numerous gait defects in persons with primary diagnosis
- Etiology in brain injury: synergistic pattern in limbs (hemiplegia). Primary cause is CVA.
CVA Gait pattern: identify involves limbs
Stance Phase
* Initial contact: achieves first rocker?
* Loading response
* Midstance: ankle, knee, hip position during walking
* Terminal stance/pre swing: trailing limb
Swing Phase
* Initial swing: push off, hip position
* midswing: knee position
* Terminal stance: ankle not in appropriate position for push off (toe off)
