ASSTECH - COMMON GAIT DEVIATIONS ASSOCIATED WITH ORTHOTIC DEVICE ISSUES

Gait Cycle - Stance

• Period when the reference limb is in contact with the ground, is comprised of the following five phases: initial contact, loading response, mid stance, terminal stance, and pre-swing

Gait Cycle - Swing

• The period when the limb is off the ground

• Comprised of the following three phases: initial swing, mid swing, and terminal swing

Gait Cycle

• Has eight phases

• Consists of stance and swing

• Review PPT

[EARLY STANCE]

Foot Slap; Fore foot slaps the ground

Orthotic Causes:

• Inadequate dorsiflexion assist

• Inadequate plantarflexion stop

Anatomical Causes:

• Weak dorsiflexors

[EARLY STANCE]

Toe first; tiptoe posture may or may not be maintained throughout stance

Orthotic Causes:

• Inadequate heel lift

• Inadequate dorsiflexion assist

• Inadequate plantarflexion stop

• Inadequate relief of heel pain

Anatomical Causes:

• Short LE

• Pes equinus

• Extensor spasticity

• Heel pain

[EARLY STANCE]

Flat foot contact; entire foot contracts ground initially

Orthotic Causes:

• Inadequate traction from sole

• Requires walking aid (e.g cane)

• Inadequate dorsiflexion stop

Anatomical Causes:

• Poor balance

• Pes calcaneus

[EARLY STANCE]

Excessive medial (or lateral) foot contact; medial (or lateral) border contacts floor

Orthotic Causes:

• Transverse plane malalignment\

Anatomical Causes:

• Weak invertors (evertors)

• Pes valgus (varus)

• Genu valgum (varum)

[EARLY STANCE]

Excessive knee flexion; knee collapses when foot contacts the groun

Orthotic Causes:

• Inadequate knee lock

• Inadequate dorsiflexion stop

• Plantarflexion restriction (stop)

• Inadequate contralateral shoe lift

Anatomical Causes:

• Weak quads

• Short contralateral LE

• Knee pain

• Knee and/or hip flexion contracture

• Flexor synergy

• Pes calcaneus

[EARLY STANCE]

Hyperextended knee; knee hyperextends as weigh it transferred to LE

Orthotic Causes:

• Genu recurvatum inadequately controlled by plantarflexion stop

• Excessively concave (deep) calf band

• Pes equinus uncompensated by contralateral shoe lift

• Inadequate knee lock

Anatomical Causes:

• Weak quads

• Lax knee ligaments

• Extensor syngergy

• Pes equinus

• Shor contralateral LE

• Contralateral knee and/or hip flexion contracture

[EARLY STANCE]

Anterior trunk bending; patient leans forwards as wight is transferred to LE

Orthotic Causes:

• Inadequate knee lock

Anatomical Causes:

• Weak quads

• Hip flexion contracture

• Knee flexion contracture

[EARLY STANCE]

Posterior trunk bending; patient leans backwards as weight is transferred to LE

Orthotic Causes:

• Inadequate hip lock

• Knee lock

Anatomical Causes:

• Weak gluteus maximus

• Knee ankylosis

[EARLY STANCE]

Lateral trunk bending; patient leans towards stance leg as weigh is transferred to LE

Orthotic Causes:

• Excessive heigh of medial upright KAFO

• Excessive abduction of hi joint of HKAFO

• Requires walking aid

• Insufficient shoe lift

Anatomical Causes:

• Weak GMeds

• Abduction contracture

• Dislocated hip

• Hip pain

• Poor balance

• Short leg

[EARLY STANCE]

Wide walking base: Heel centers more than 4 in (10cm) apart

Orthotic Causes:

• Excessive heigh of medial upright KAFO

• Excessive abduction of hi joint of HKAFO

• Insufficient shoe lift on contralateral shoe

• Knee lock

• Requires walking aid (cane)

Anatomical Causes:

• Abduction contracture

• Poor balance

• Short contralateral LE

[EARLY STANCE]

Internal (or external) rotation: LE internally (or externally) rotated

Orthotic Causes:

• Uprights incorrectly aligned in transverse plane

• Requires orthotic control (eg. rotation control straps, pelvic band)

Anatomical Causes:

• IR or ER hip rotators spastic

• External or internal hip rotators weak

• Anteversion or retroversion

• Weak quadriceps external rotation

[LATE STANCE]

Inadequate transition; delayed or absent transfer of weight over the forefoot

Orthotic Causes:

• Plantarflexion stop

• Inadequate dorsiflexion stop

Anatomical Causes:

• Weak PFs

• Achilles tendon sprain or rupture

• Pes calcaneus

• Forefoot pain

[SWING PHASE]

Toe drag; Toes maintain contact with ground

Orthotic Causes:

• Inadequate DF ssists

• Inadequate PF stop

Anatomical Causes:

• Weaks DFs

• Plantarflecor spasticity

• Pes equinus

• Weak hip flexors

[SWING PHASE]

Circumduction LE swings outwards in a semicircular arc

Orthotic Causes:

• Knee lock

• Inadequate DF ssists

• Inadequate PF stop

Anatomical Causes:

• Weak hip flexors

• Extensor synergy

• Knee and/or ankle ankylosis

• Weak DFs

• Pes equinus

[SWING PHASE]

Hip hiking: LE elevated at pelvis to enable the limb to swing forward

Orthotic Causes:

• Knee lock

• Inadequate DF ssists

• Inadequate PF stop

Anatomical Causes:

• Short contralateral LE

• Contralateral knee and/or hip flexion contracture

• Weak hip flexors

• Extensor synergy

• Kne and/or ankle ankylosis

• Weak DFs

• Peq equinus

[SWING PHASE]

Vaulting: exaggerated plantarfexion of contralateral LE to enable the limb to swing forward

Orthotic Causes:

• Knee lock

• Inadequate DF ssists

• Inadequate PF stop

Anatomical Causes:

• Weak hi flexors

• Extensor spasticity

• Pes equinus

• Short contralateral LE

• Contralateral knee and/or hip flexion contracture

• Knee and/or ankle ankylosis

• Weak DFs