Walking & gaits: clinical

Question 1

What is a Trendelenburg gait? What does it mean?

Answer 1

when the pelvis drops towards the side of the RAISED limb

signifies that the ABductor muscles on the STANDING limb are greatly weakened / paralysed

Question 2

If a person had trendelenberg gait, and their pelvis dropped on their left side when their left leg is lifted, what is the cause? what is it due to?

Answer 2

the ABductors on the right side are the cause (aren’t contracting)
due to a leision of the ‘superior gluteal nerve’ which innervates the ABductors

Question 3

During walking, how does the gait present? what causes the gait?

Answer 3

weakness in the ABductor muscles causes the gait
the pelvis drops to 1 side, the trunk lurches to the opposite side to try and balance the pelvic level
e.g. pelvis drops to left, body moves to right

Question 4

What happens once the trunk has lurched to the opposite side? What is this called?

Answer 4

the trunk whips the pelvis back to the centre
the trunk often over compensates due to the momentum being too great for the abdominals, causing the trunk to be leaned slightly past the centre on the opposite side
called Trendelenberg gait

Question 5

What causes foot drop?

Answer 5

damage to common or deep fibular nerve

Question 6

How can damage to common fibular nerve lead to foot drop?

Answer 6

common fibular nerve (L5, S1, S2) made of superficial and deep fibular nerve
common fibular nerve wraps around the head of the fibula, so any blunt trauma or fracture here can lead to foot drop

Question 7

How can damage to deep fibular nerve lead to foot drop?

Answer 7

the deep fibular nerve (L4, L5) innervates muscles of anterior leg
these muscles dorsiflex the foot - required in swing phase to clear toes off ground

Question 8

Describe what happens when deep fibular nerve (L4, L5) is damaged

Answer 8

the foot cannot be dorsiflexed, and drags along the ground

patient may suddenly evert foot to try and clear toes from the ground - called ‘eversion flick’

Question 9

What is antalgic gait?

Answer 9

gait that results from pain upon weight-bearing

characterised by shortened STANCE phase - commonly seen in patients which chronic musculoskeletal pain

Question 10

Which muscles contract to prevent the pelvis dropping towards the raised leg during the lift & swing phase? what can cause the drop?

Answer 10

ABductor muscles (gluteus medius, minimus & tensor fasciae latae) prevent the pelvis dropping towards towards the raised leg from gravity