Lecture 8: Pathological Human Gait

Primary Deviations

The actual physical pathologies that result in impaired ambulation:

• Motor deficits

• Sensory deficits

• Deformity

• Pain

Motor Deficits

Inability to properly control motor function

Depressed motor function

• Neuromuscular weakness, destruction or loss of innervation

• ex. upper & lower motor neuron lesions, Guillain-Barré, CP, MS, etc.

Excessive motor function

• clonus, spasticity

• ex. upper motor neuron lesions, CP, CVA, etc

Sensory deficits

Inability to receive proper neuromuscular signals

Depressed limb awareness - ex. CVA, head injury, etc.

Depressed proprioception - ex. upper motor neuron lesions, etc.

Depressed tactile sensation - ex. CVA, head injury, MS, etc.

Deformity

Physical alteration from normal form

Contractures - Muscular, ligamentous, or capsular

Bone deformity - Change in bone shape, bony restriction to ROM ex. arthritis, Blount’s, Paget’s, etc.

Ligamentous laxity - joint instability, ex. trauma, CP, etc

Pain

Physical discomfort that alters gait

Joint pain - ex. arthritis, trauma, etc.

Bone pain - ex. Legg-Calve-Perthes, Paget’s, osteomyelitis, etc.

Soft tissue pain - ex. burns, scars, sprains, etc.

Compensatory Deviation Defined

The method of accommodating for a primary deviation so that the effects of the primary deviation on gait are diminished

ex. - Muscular weakness of the dorsiflexors is a primary deviation (motor deficit). To prevent falling because of an inability to achieve toe clearance during swing phase, a compensatory deviation would be steppage gait

Common Compensatory Deviations

1. Effectively long/short limb

2. Steppage gait

3. Lateral trunk bending

4. Hip hiking

5. Circumduction

6. Wide/narrow base of support

7. Excessive medial foot contact

8. Anterior/Posterior trunk bending

9. Lordosis

10. Hyperextended knee

11. Excessive knee flexion

12. Inadequate dorsiflexion control

13. Insufficient push-off

14. Vaulting

Causes of effectively long limb

1. weak swing knee flexors

2. weak swing hip flexors

3. dorsiflexion weakness

4. knee extension contracture

5. spastic knee extensors

6. plantarflexion contracture

7. coxa valga

Causes of effectively short limb

1. bony shortening

2. knee flexion contracture

3. coxa vara

4. genu varum

5. genu valgum

6. genu recurvatum

Steppage gait

excessive hip and knee flexion during swing phase aid in the ability to clear the toe.

During terminal swing the knee is forcefully extended and at initial contact the forefoot contacts first.

Loading response follows rapidly which results in a “slapping of the foot”

Primary deviations that cause compensatory Steppage gait

Weak dorsiflexors

Lateral Trunk Bending

Occurs during single limb support of stance phase with the subject leaning toward the stance limb to clear a relatively longer swing limb.

Primary deviations that cause compensatory Lateral Trunk Bending

weak stance hip abductors

stance hip dislocation (deformity)

stance coxa vara (short stance leg)

others: stance hip pain (less motion & less force), short stance limb, long swing limb, instability (wide base), high medial orthotic wall

Hip hiking

Occurs during swing phase with the swing limb elevating at the hip to clear the foot.

Primary deviations that cause compensatory Hip Hiking

Long swing limb (not usually enough to shorten the swing limb from ankle lengthening)

Short stance limb

Circumduction

Occurs during swing phase where the swing limb arcs laterally using swing hip abduction to clear the foot

Primary deviations that cause compensatory circumduction

Long swing limb

Wide base of support

Can occur during swing and stance phase but is most visible during stance. May also have lateral trunk bending associated with wide base of support.

Primary deviations that cause compensatory wide base of support

Hip abduction contracture, instability due to fear, proprioception deficit, generalized hip weakness, genu valgum, leg length discrepancy (long leg is held laterally to shorten it), perineal orthosis pain.

Narrow Base of Support

Can occur during swing and stance phase but is more visible during stance

Primary deviations that cause compensatory narrow base of support

Spastic hip adduction

Genu varum

Hip orthosis adducted

Excessive Medial Foot Contact