Primary Care - Gait & Limp

Question 1

Normal gait cycle

Answer 1

Heel strike
Foot flat
Mid-stance
Heel off
Toe off
Swing

Question 2

Heel strike -gait cycle

Answer 2

Initial contact of the heel with the floor

Question 3

Foot flat - gait cycle

Answer 3

Weight is transferred onto this leg

Question 4

Mid -stance -gait cycle

Answer 4

The weight is aligned and balanced on this leg

Question 5

Heel off -gait cycle

Answer 5

The heel lifts off the floor as the foot rises but the toes remain in contact with floor

Question 6

Toe off -gait cycle

Answer 6

As the foot continues to rise, the toes lift off the floor

Question 7

Swing - gait cycle

Answer 7

The foot swings forward and comes back into contact with the floor with a heel strike (and the gait cycle repeats)

Question 8

Hemiplegic gait

Answer 8

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

Question 9

Clinical features associated with a hemiplegic gait incl

Answer 9

Increased tone with clasp-knife soasticity 
Hypereflexia with or without clonus 
Upgoing plantars (+ve babinski)
Reduced lower 
Sensory deficit

Question 10

Sensory deficit in hemiplegic gait

Answer 10

The pattern of sensory loss depends of the site of the lesion in the nervous system

Question 11

Causes of hemiplegic gait

Answer 11

Unilateral cerebral lesion - stroke, space-occupying lesion (SSL), trauma, MS
Hemisection of the spinal cord - trauma

Question 12

Clinical findings in diplegic gait

Answer 12

Similar to those in hemiplegic gait but are bilateral in nature. Spasticity is typically worse in the lower limbs compared to the upper limbs

Question 13

Diplegic gait

Answer 13

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

Question 14

Clinical features associated with a diplegic gait

Answer 14

Increased tone with clasp -knife spasticity
Hyperreflexia with or without clonus
Upgoing plantars (+ve babinski)
Reduced power
Sensory deficit 
Wasting and fasciculation

Question 15

Sensory deficit - diplegic gait

Answer 15

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

Question 16

Causes of diplegic gait

Answer 16

Spinal cord lesion (sensation usually affected) - prolapsed IVD, spinal spondylosis, spinal turnour, transverse myelitis, spinal infarcts, syringomyelia, hereditary spastic paraperesis

Question 17

Features of Parkisonion gait

Answer 17

Imitation 
Step length 
Arm swing 
Posture 
Tremor
Turning

Question 18

Imitation - Parkinsonian gait

Answer 18

Typicallly slow to start walking due to failure of gait ignition and hesitancy

Question 19

Step length - Parkisonian gait

Answer 19

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)

Question 20

Arm swing - Parkisonian gait

Answer 20

Reduced arms swing on one or both sides

Question 21

Posture - Parkisonian gait

Answer 21

Flexed trunk and neck causing a stooped appearance

Question 22

Tremor - Parkisonian gait

Answer 22

Restimg tremor can be observed when the pt is distracted by walking

Question 23

Turning - Parkisonian gait

Answer 23

Impaired balance on turning or hesitancy i common due to postural instability

Question 24

Ataxic gait

Answer 24

Typically broad-based and associated with midline cerebellar disease, vestibular disease or loss of proprioception (sensory ataxia)

Question 25

Clinical features associated w/ sensory ataxia

Answer 25

+ve Romberg's sign Impaired proprioception Impaired vibration sensation Absence of other cerebellar signs (e.g. dsymetria, nystagmus, dysarthria)

Question 26

Clinical features associated w/ vestibular ataxia

Answer 26

Vertigo Nausea Vomiting

Question 27

Myopathic gait

Answer 27

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

Question 28

Causes of myopathic gait

Answer 28

``` Systemic disease e.g. Hyperthyroidism Hypothyroidism Cushing's syndrome Acromegaly PMR polymyositis Dermatomyositis ```

Question 29

Antalgic gait

Answer 29

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

Question 30

Causes of myopathic gait

Answer 30

OA Infl joint disease Lower limb fracture Nerve entrapment e.g sciatica