Session 5 ILOs - The Lower Limb 3

Question 1

Describe the symptoms and signs of compartment syndrome

Answer 1

Signs and symptoms:

• Shiny skin
• Paraesthesia
• Swelling
• Poorly localised pain but worse when muscle is passively stretched

Question 2

Describe the short and long-term consequences if compartment syndrome is not adequately
treated

Answer 2

If left untreated, compartment syndrome can cause ischemia of the lower limb and may lead to muscle contractures resulting in deformity and functional impairment. Additionally, nerve damage may cause weakness or paralysis of the affected muscles and a dysfunctional painful extremity

Question 3

Define gait

Answer 3

Gait is the mechanism by which the body is transported using coordinated movements of the major lower limb joints. It’s an energy efficient interaction of the musculoskeletal and neurological systems.

Question 4

Describe the phases of the gait cycle

Answer 4

The gait cycle is the period of time from initial contact to next initial contact on the same side.

Stance phase (60% of time) and the swing phase (40% of time)

Stance phase:
1 - Initial contact (heel strike)
2 - Loading response
3 - Mid-stance (flat foot)
4 - Terminal stance (heel off)
5 - Pre-swing (toe off)

Swing phase:
6 - Initial swing
7 - Mid-swing
8 - Terminal swing

Question 5

Define step, stride and cadence

Answer 5

Step: distance from initial contact of right to initial contact of left

Stride: distance from initial contact of right to next initial contact of right

Cadence: number of steps per minute

Question 6

Describe the differences between walking and running

Answer 6

Walking has two double support phases, where both limbs are in contact with the ground

Running has two double float phases, where both limbs are NOT in contact with the ground

In running, the swing phase is greater than the stance phase.

Question 7

Identify the muscles used in normal gait

Answer 7

Anterior compartment muscles (tibialis anterior) - carries out dorsiflexion and stops foot from slapping the floor

Posterior compartment muscles (gastrocnemius and soleus) - carry out plantarflexion and lifts the heel off the floor and helps with the swing phase

Question 8

Describe some common gait abnormalities:

• Antalgic gait
• Trendelenburg gait
• Hemiplegic gait
• Diplegic gait
• High-steppage gait
• Parkinsonian gait
• Ataxic gait

Answer 8

Antalgic gait (limp):

• Caused by a painful leg
• Short stance phase (for affected leg)
• Short swing phase (for unaffected leg)

Trendelenburg gait:

• Caused by weak hip abductor muscles (pain, nerve damage, surgical trauma)
• Pelvis drops on unaffected side
• Torso swings over affected side to compensate

Hemiplegic gait:

• Caused by hemi brain injury (stroke, cerebral palsy, trauma)
• Flexed upper limb
• Extended lower limb
• Short step (on unaffected leg)
• Circumduction of affected leg

Diplegic gait (generally cerebral palsy):

• Scissoring walk, crossing of legs
• Tight muscle groups (psoas, adductors, hamstring, calf)
• Ankles are plantar flexed

High-steppage gait:

• Caused by a foot drop (from sciatica, common perineal n. palsy, neuromuscular disorders)
• Toes hang down and excessive hip flexion on affected side
• Foot slap

Parkinsonian gait (from Parkinson’s):

• Hard to initiate movement
• Shuffling movement with a short step
• Forward flexed and no arm swing

Ataxic gait (drunk):

• Cerebellar disorders (inherited, sensory and intoxication/drunkness)
• Reeling motion with arms balancing
• Drunk appearance