Primary Care - Gait & Limp Flashcards
Normal gait cycle
Heel strike Foot flat Mid-stance Heel off Toe off Swing
Heel strike -gait cycle
Initial contact of the heel with the floor
Foot flat - gait cycle
Weight is transferred onto this leg
Mid -stance -gait cycle
The weight is aligned and balanced on this leg
Heel off -gait cycle
The heel lifts off the floor as the foot rises but the toes remain in contact with floor
Toe off -gait cycle
As the foot continues to rise, the toes lift off the floor
Swing - gait cycle
The foot swings forward and comes back into contact with the floor with a heel strike (and the gait cycle repeats)
Hemiplegic gait
Patients with hemiplegic exhibit spastic flexion of the upper limb & extension of the lower limb
Due to the extension of the lower limb (fixed ankle plantar flexion and knee extension) the leg is elongated meaning pts have to circumduct their leg to prevent their foot from dragging on the ground
Clinical features associated with a hemiplegic gait incl
Increased tone with clasp-knife soasticity Hypereflexia with or without clonus Upgoing plantars (+ve babinski) Reduced lower Sensory deficit
Sensory deficit in hemiplegic gait
The pattern of sensory loss depends of the site of the lesion in the nervous system
Causes of hemiplegic gait
Unilateral cerebral lesion - stroke, space-occupying lesion (SSL), trauma, MS
Hemisection of the spinal cord - trauma
Clinical findings in diplegic gait
Similar to those in hemiplegic gait but are bilateral in nature. Spasticity is typically worse in the lower limbs compared to the upper limbs
Diplegic gait
The hips and knees are flexed and abducted whilst the ankles are extended and internally rotated
The knees are forced together due to spasticity in the adductor muscles resulting in leg overlap when walking (aka scissoring)
In an attempt to overcome this adduction, the pt circumducts both legs during the swing phase
Clinical features associated with a diplegic gait
Increased tone with clasp -knife spasticity Hyperreflexia with or without clonus Upgoing plantars (+ve babinski) Reduced power Sensory deficit Wasting and fasciculation
Sensory deficit - diplegic gait
If diplegic gait is caused by spinal cord pathology, the ‘sensory level’ (i.e. Lowest dermatome level w/ normal sensation) correlates with the level of spinal card pathology
Causes of diplegic gait
Spinal cord lesion (sensation usually affected) - prolapsed IVD, spinal spondylosis, spinal turnour, transverse myelitis, spinal infarcts, syringomyelia, hereditary spastic paraperesis
Features of Parkisonion gait
Imitation Step length Arm swing Posture Tremor Turning
Imitation - Parkinsonian gait
Typicallly slow to start walking due to failure of gait ignition and hesitancy
Step length - Parkisonian gait
Reduced stride length with short steps is common (shuffling gait). Each step may get progressively smaller as the pt attempts to retain balance (festinant gait)
Arm swing - Parkisonian gait
Reduced arms swing on one or both sides
Posture - Parkisonian gait
Flexed trunk and neck causing a stooped appearance
Tremor - Parkisonian gait
Restimg tremor can be observed when the pt is distracted by walking
Turning - Parkisonian gait
Impaired balance on turning or hesitancy i common due to postural instability
Ataxic gait
Typically broad-based and associated with midline cerebellar disease, vestibular disease or loss of proprioception (sensory ataxia)
Clinical features associated w/ sensory ataxia
+ve Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dsymetria, nystagmus, dysarthria)
Clinical features associated w/ vestibular ataxia
Vertigo
Nausea
Vomiting
Myopathic gait
AKA waddling or tendelenburg gait
Hip abductor weakness results in an ability to stabilize the pelvis during the stance phase. As a result, the pelvis tilts downwards towards the unsupported side during the unsupported side during the swing phase
Causes of myopathic gait
Systemic disease e.g. Hyperthyroidism Hypothyroidism Cushing's syndrome Acromegaly PMR polymyositis Dermatomyositis
Antalgic gait
Abnormal gait pattern-which develops as a result of pain. Typically the stance phase is reduced on the affected leg resulting in a limping appearance
Causes of myopathic gait
OA
Infl joint disease
Lower limb fracture
Nerve entrapment e.g sciatica
