K&B II Pathological Gait

a direct result of main impairment

what is a "primary" gait pathology?

issue at an adjacent joint

what is a "secondary" gait pathology?

accomodation for an impairment

what is a "compensatory" gait pathology?

weak DF MMT < 3/5

impaired motor control (PF overactive)

PF contracture

ankle pain/joint effusion

what is a primary cause for forefoot contact @ the ankle (IC)?

knee flexion contracture/hypomobility or impaired motor control

what is a secondary cause for forefoot contact @ the ankle (IC)?

for a shorter limb or to avoid heel pain

what is a compensatory cause for forefoot contact @ the ankle (IC)?

weak DF

PF contracture

impaired motor control (abnormal PF activity)

what is a primary cause for flatfoot contact AND/OR abbreviated heel contact @ the ankle (IC)?

inadequate knee extension in terminal swing

knee flexion contracture

impaired motor control (abnormal hamstring activity)

what is a secondary cause for flatfoot contact AND/OR abbreviated heel contact @ the ankle (IC)?

to reduce or avoid the effects of the heel rocker DUE to weak quads (quads cannot eccentrically control knee flexion)

what is a compensatory cause for flatfoot contact AND/OR abbreviated heel contact @ the ankle (IC)?

weak DFs

impaired motor control (abnormal PF activity)

PF contracture/hypomobility

ankle pain/joint effusion

what is a primary cause for inadequate DF @ the ankle (IC)?

weak DF (MMT <3/5)

what is a primary cause for foot slap @ the ankle (LR)?

abbreviated or absent heel rocker

what is a primary cause for inadequate PF @ the ankle (LR)?

the heel rises before opposite toe off

what qualifies as "EARLY" heel off?

skeletal deformity

impaired motor control (over activity of PF)

PF contracture/hypomobility

what is a primary cause for early heel off @ the ankle (MS)?

due to excess knee flexion

what is a secondary cause for early heel off @ the ankle (MS)?

voluntary PF to accommodate for a short reference limb

what is a compensatory cause for early heel off @ the ankle (MS)?

skeletal deformity

impaired motor control (PF spasticity)

PF contracture (rigid)

what is a primary cause for inadequate dorsiflexion @ the ankle (MS/TS)?

to avoid ankle rocker secondary to weak plantar flexors (PF do not want to have to do eccentric work as tibia rotates forward)

what is a compensatory cause for inadequate dorsiflexion @ the ankle (MS/TS)?

weak PFs

what is a primary cause for excessive dorsiflexion @ the ankle (MS/TS)?

excessive hip and/or knee flexion

what is a secondary cause for excessive dorsiflexion @ the ankle (MS/TS)?

to lower the CL limb for initial contact

what is a compensatory cause for excessive dorsiflexion @ the ankle (MS/TS)?

weak PFs (<4/5), or excessive ankle DF

what is a primary cause for no heel off @ the ankle (TS)?

forefoot pain, to inadequate toe extension, to knee hyperextension (lack of tibial advancement)

what is a secondary cause for no heel off @ the ankle (TS)?

weak DF (MMT <3/5), PF contracture/hypomobility, impaired motor control (PF activity), potential bony deformity

what is a primary cause for inadequate dorsiflexion @ the ankle (ALL SWING)?

excess ankle PF with prolonged forefoot weight bearing of the CL stance limb during referance limb swing limb advancement

what is contralateral vault?

a longer swing limb, inadequate knee flexion in initial swing, inadequate DF in mid swing

what is a compensatory cause for contralateral vault @ the ankle (ALL SWING)?

impaired motor control (decreased knee flexion from abnormal rec fem/knee extensor activity)

tibiofemoral/patellofemoral pain

excess CL knee flexion

what is a secondary cause for toe drag @ the ankle (ISw)?

inadequate DF, weak DF (MMT <3/5)

what is a primary cause for toe drag @ the ankle (MSw)?

inadequate hip flexion, excessive CL knee flexion

what is a secondary cause for toe drag @ the ankle (MSw)?

skeletal deformity, impaired motor control of inverters, OR equinovarus contracture/hypomobility

what is a primary cause for excessive inversion @ the calcaneus (during STANCE)?

genu varum or hip rotational deformities

what is a secondary cause for excessive inversion @ the calcaneus (during STANCE)?

same as stance or flaccid paralysis of dorsiflexors

what is a primary cause for excessive inversion @ the calcaneus (during SWING)?

skeletal deformity or weak inverters in LR

what is a primary cause for excessive eversion aka pes planus @ the calcaneus (during stance)?

forefoot varus, genu valgus, or hip rotational deformities specifically decreased ER

what is a secondary cause for excessive eversion aka pes planus @ the calcaneus (during stance)?

from limited DF ROM to preserve forward progression (becoming pes planus by dropping midfoot down to get more DF )

what is a compensatory cause for excessive eversion aka pes planus @ the calcaneus (during stance)?

skeletal deformity, toe flexion contracture, impaired motor control (hyperactivity of FDL/FHL), weak intrinsic muscles

what is a primary cause for excessive interphalangeal flexion @ the toes (during mid/terminal stance)?

weak soleus/gastroc to increase plantar flexor force to control tibial advancement

what is a compensatory cause for excessive interphalangeal flexion @ the toes (during mid/terminal stance)?

skeletal deformity (stiffness, overstretched or OA) or impaired motor control (abnormal FDL/FHL)

what is a primary cause for inadequate MTP extension @ the toes (during terminal stance/preswing)?

to avoid forefoot pain or no heel off

what is a secondary cause for inadequate MTP extension @ the toes (during terminal stance/preswing)?

knee flexion contracture/hypomobility, impaired motor control (abnormal knee flexor activity), knee pain or joint effusion

what is a primary cause for inadequate extension aka crouch gait @ the knee (during IC)?

excess DF posture or excess hip flexion posture

what is a secondary cause for inadequate extension aka crouch gait @ the knee (during IC)?

weak quads (needed for knee flexion eccentric control), impaired motor control (over active quads making knee go into extension), impaired proprioception, tibiofemoral or patellofemoral pain, skeletal deformity

what is a primary cause for inadequate flexion @ the knee (during LR)?

due to PF posture, abnormal PF activity, forefoot or flatfoot contact

what is a secondary cause for inadequate flexion @ the knee (during LR)?

for ACL deficiency

what is a compensatory cause for inadequate flexion @ the knee (during LR)?

weak quadriceps, impaired motor control (abnormal quadriceps activity), impaired proprioception

what is a primary cause for hyperextension/knee thrust @ the knee (during LR to terminal stance)?

due to PF posture

what is a secondary cause for hyperextension/knee thrust @ the knee (during LR to terminal stance)?

to increase limb stability with weak quadriceps and plantarflexors

what is a compensatory cause for hyperextension/knee thrust @ the knee (during LR to terminal stance)?

impaired proprioception and motor control

what is a primary cause for wobbling @ the knee (during LR to terminal stance)?

skeletal deformity, ligamentous laxity/joint instability, degenerative joint changes (OA)

what is a primary cause for varus aka bow leg @ the knee (during LR to terminal stance)?

hindfoot varus deformity or forefoot valgus deformity

what is a secondary cause for varus aka bow leg @ the knee (during LR to terminal stance)?

skeletal deformity, ligamentous laxity/joint instability, degenerative joint changes (RA)

what is a primary cause for valgus aka knock knee @ the knee (during LR to terminal stance)?

hindfoot valgus deformity, forefoot varus deformity, ipsilateral trunk lean

what is a secondary cause for valgus aka knock knee @ the knee (during LR to terminal stance)?

skeletal deformity, ligamentous laxity/joint instability

what is a primary cause for varus/valgus thrust @ the knee (during LR to terminal stance)?

impaired motor control (abnormal rec fem/knee extensor activity), tibiofemoral and/or patellofemoral pain, skeletal deformity

what is a primary cause for inadequate flexion aka stiff legged gait @ the knee (during pre and initial swing)?

inadequate hip flexion, inadequate hip extension in terminal stance, no heel off in terminal stance

what is a secondary cause for inadequate flexion aka stiff legged gait @ the knee (during pre and initial swing)?

any factor that causes stance limb knee flexion of the CL limb

what is a primary cause for excess contralateral flexion @ the knee (from pre to terminal swing)?

to intentionally lower the shorter reference swing limb to the ground for initial contact

what is a secondary cause for excess contralateral flexion @ the knee (from pre to terminal swing)?

impaired motor control due to abnormal hip/knee flexor activity

what is a primary cause for excess flexion @ the knee (during all of swing)?

to assure toe clearance

what is a compensatory cause for excess flexion @ the knee (during all of swing)?

weak quadriceps, knee flexion contracture/hypomobility, impaired motor control (abnormal knee flexor activity), knee pain, or joint effusion

what is a primary cause for inadequate extension @ the knee (during mid and terminal swing)?

to ensure knee extension in terminal swing in preparation for initial contact when the quads are weak

what is a primary cause for extensor thrust @ the knee (during mid and terminal swing)?

hip flexion contracture/hypomobility, joint arthrodesis, impaired motor control abnormal hip flexor muscle activity, hip pain or hip joint effusion

what is a primary cause for excess flexion/inadequate extension aka crouched gait @ the thigh (from IC through rest of stance)?

due to excess knee flexion or excess DF posture

what is a secondary cause for excess flexion/inadequate extension aka crouched gait @ the thigh (from IC through rest of stance)?

skeletal deformity (excessive femoral anteversion), impaired motor control (abnormal medial rotator muscle activity, adductor longus and brevis, medial hamstrings) or medial rotation contracture/hypomobility

what is a primary cause for medial rotation @ the thigh (from mid stance through the end of swing)?

skeletal deformity (femoral retroversion) or lateral rotation contracture/hypomobility

what is a primary cause for lateral rotation @ the thigh (in mid and terminal stance)?

to progress center of mass forward when DF ROM is limited

what is a compensatory cause for lateral rotation @ the thigh (in mid and terminal stance)?

skeletal deformity

what is a primary cause for abduction @ the thigh (in mid and terminal stance)?

due to a pelvic obliquity, CL pelvic hike, spinal deformity (scoliosis), or increase BOS for stability

what is a secondary cause for abduction @ the thigh (in mid and terminal stance)?

to clear a longer swing limb (true leg length discrepancy) or to clear a functionally longer swing limb (inadequate hip or knee flexion, inadequate DF)

what is a compensatory cause for abduction @ the thigh (in mid and terminal stance)?

skeletal deformity, adduction contracture/hypomobility, impaired motor control (abnormal adductor muscle activity)

what is a primary cause for adduction aka scissoring gait @ the thigh (from mid stance through the end of swing)?

due to pelvic obliquity, CL pelvic drop, or spinal deformity

what is a secondary cause for adduction aka scissoring gait @ the thigh (from mid stance through the end of swing)?

weak hip flexors or impaired motor control (abnormal hamstring activity)

what is a primary cause for inadequate flexion @ the thigh (from pre swing through the end of swing)?

due to toe drag or to decrease demand on hip extensor in preparation for IC and LR

what is a secondary cause for inadequate flexion @ the thigh (from pre swing through the end of swing)?

inadequate knee flexion in initial swing for toe clearance, for inadequate ankle dorsiflexion in mid swing for toe clearance, for a longer swing limb, for CL knee flexion (functionally shortens the stance limb)

what is a compensatory cause for excess flexion aka steppage gait @ the thigh (from pre swing through the end of swing)?

to advance limb using hip adductors when hip flexors are weak

what is a compensatory cause for lateral rotation @ the thigh (from pre swing through the end of swing)?

to advance limb and clear foot when hip flexion, knee flexion, and/or ankle DF are inadequate

what is a compensatory cause for circumduction @ the thigh (from pre swing through the end of swing)?

weak hip abductors, impaired motor control (abnormal adductor muscle activity), adduction contracture ALL ON REFERENCE LIMB

what is a primary cause for CL drop > 5 deg aka Trendelenburg @ the pelvis (in mid and terminal stance)?

skeletal deformity or pelvic obliquity

what is a secondary cause for CL drop > 5 deg aka Trendelenburg @ the pelvis (in mid and terminal stance)?

for a short CL leg (leg length discrepancy)

what is a compensatory cause for CL drop > 5 deg aka Trendelenburg @ the pelvis (in mid and terminal stance)?

hip flexion contracture/hypomobility, impaired motor control (abnormal hip flexor muscle activity), or weak hip extensor and/or abs

what is a primary cause for excess anterior tilt @ the pelvis (in mid and terminal stance)?

due to forward trunk lean

what is a secondary cause for excess anterior tilt @ the pelvis (in mid and terminal stance)?

impaired motor control (abnormal activity of trunk, pelvis, and hip muscles)

what is a primary cause for inadequate forward rotation @ the pelvis (in mid and terminal stance)?

to inadequate CL backward rotation

what is a secondary cause for inadequate forward rotation @ the pelvis (in mid and terminal stance)?

to decrease demand on weak hip extensors during loading response

what is a compensatory cause for inadequate forward rotation @ the pelvis (in mid and terminal stance)?

to excess CL backward rotation

what is a secondary cause for excessive forward rotation @ the pelvis (in mid and terminal stance)?

to advance limb when hip flexors are weak

what is a compensatory cause for excessive forward rotation @ the pelvis (in mid and terminal stance)?

impaired motor control (inability to perform selective activation of trunk, pelvis, hip, and/or plantar flexor muscles)

what is a primary cause for excess backward rotation aka retracted pelvis @ the pelvis (in mid and terminal stance)?

to CL excess forward rotation

what is a secondary cause for excess backward rotation aka retracted pelvis @ the pelvis (in mid and terminal stance)?

for a trailing limb with limited thigh extension in terminal stance (hip flexion contracture), for a trailing limb when there is no heel off in teal stance (weak plantar flexors)

what is a compensatory cause for excess backward rotation aka retracted pelvis @ the pelvis (in mid and terminal stance)?

impaired motor control (inability to perform selective activation of trunk, pelvis, hip, and/or plantar flexor muscles)

what is a primary cause for inadequate backward rotation @ the pelvis (in mid and terminal stance)?

to CL inadequate forward rotation

what is a secondary cause for inadequate backward rotation @ the pelvis (in mid and terminal stance)?

weak CL hip abductors, impaired motor control (abnormal contralateral adductor muscle activity), CL adduction contracture

what is a primary cause for ipsilateral drop > 5 deg @ the pelvis (from pre swing through terminal swing)?

due to skeletal deformity or pelvic obliquity

what is a secondary cause for ipsilateral drop > 5 deg @ the pelvis (from pre swing through terminal swing)?

for a shorter reference limb (leg length discrepancy)

what is a compensatory cause for ipsilateral drop > 5 deg @ the pelvis (from pre swing through terminal swing)?

for toe clearance when there is inadequate knee flexion in pre and initial swing or inadequate hip flexion and ankle DF in mid swing

what is a compensatory cause for hike @ the pelvis (from pre swing through terminal swing)?

hamstring tightness/contracture, impaired motor control (abnormal hamstring muscle activity)

what is a primary cause for excess posterior tilt @ the pelvis (from pre swing through terminal swing)?

due to backward trunk lean

what is a secondary cause for excess posterior tilt @ the pelvis (from pre swing through terminal swing)?

to advance the limb when hip flexors are weak

what is a compensatory cause for excess posterior tilt @ the pelvis (from pre swing through terminal swing)?

skeletal deformity, impaired postural control (inadequate hip/spine extensor muscle activity)

what is a primary cause for forward lean @ the trunk (from mid stance terminal swing)?

due to pelvic anterior tilt posture, from using an assistive device, or to excess hip flexion

what is a secondary cause for forward lean @ the trunk (from mid stance terminal swing)?