Pathology in Gait Flashcards
Why do clinicians assess gait?
- to discern whether the problem is from the skeletal, muscular or neurologic system
- to discern whether pain is attributing to the gait issue (antalgic gait)
What are the next clinical steps after performing the observational gait analysis?
Skeletal: less likely for PT interventions to adapt or change skeletal system. Orthotics, gait adaptation or assisted devices are necessary (offer a variety of places for freedom of choice)
When a pt has painful acute and chronic skeletal issues who would you as a PT refer them to?
the orthopedics
How does the skeletal system contribute to gait?
It sets the framework for movement and gait.
1. supports body against gravity
2. supports body when standing
3. works together as a level system
How do you discern skeletal gait problems?
- skeletal length in lower limbs (leg length discrepancy in 10% of pop)
- Limbs move in predictable but abnormal pattern (consistent gait deviation)
- Observe and perform standing alignment, ROM, and various limb alignment assessments
What are two common skeletal gait abnormalities?
- leg length discrepancy
- foot progression angle (intoe v outtoe)
In which plane is it easiest to spot limb discrepancy?
-frontal view (rear view may be better to see unequal heights)
How much discrepancy is too much?
- over 2 cm
What may cause limb length discrepancy?
- the culprit can be tibia or femur
- previous broken bone
- bone infections, juvenile arthritis or arthropathies
How to assess standing posture?
- is scoliosis present?
- pelvis/shoulder height
How to measure supine leg length?
- tape measure (ASIS to medial malleolus)
- hook lying (w/ straight edge)
How to measure pain assessment?
- LBP
- hip or knee
(Orthodist for shoe lift)
What is an internal foot progression angle?
when the toe point inward (IR)
What is an external foot progression angle?
when the toe points outward (ER)
What is a normal foot progression angle?
13-15 degrees in adults
What are skeletal issues that lead towards out toe gait?
Caused by skeletal issues
- pronation (1st common)
- external tibial torsion (2nd common)
- passive hip IR
What can cause the feet to externally rotate while the patella faces forward?
- a collapsed midfoot (pronation)
- abnormal foot progression angle
In which population is in toe gait most common?
- in children up to 4 (toe walking)
- typically children grow out of posture
In toe gait can be caused by…
- Femoral anteversion
- Tibial Torsion
- In toe posture in the foot (club foot)
What is femoral anteversion?
excessive rotation of the hip (>15 degrees)
How do you check for femoral anteversion?
Position pt in prone, bend knees, and move them out laterally.
If hip IR is greater than 50 degrees femoral anteversion is usually present.
What is tibial torsion?
rotation of the tibial relative to the femur
What are some exams to assess foot progression angles?
- Walking assessment
- Standing assessment
- Femoral anteversion
- Tibial torsion
- Foot or forefoot in toeing (prone)
Can PT’s improve skeletal issues?
No
How do you assess pronation during gait?
- The line along the achilles tendon to the calcaneus should be straight
Overpronation results in…
- ineffective push off
- abnormal/increased pressure in medial knee
- creates IR of tibia
- over pronation can be seen moving up the chain
Describe the center of pressure through the gait cycle
inner toe to lateral midfoot, to mid heel (S)
Gait deficits steaming from neurologic diagnoses
CVA/Stroke/TBI: creates synergistic pattern in limbs
