COMMON GAIT DEVIATIONS ASSOCIATED WITH ORTHOTIC DEVICE ISSUES

LE Gait Deviations during Early Stance

1. Foot Slap

2. Toes first

3. Flat foot contact

4. Excessive medial / lateral contact

5. excessive knee flexion

6. hyperextended knee

Trunk Deviations during Early Stance

1. Anterior trunk bending

2. Posterior trunk bending

3. Lateral trunk bending

4. Wide walking base

5. Internal / External Rotation

Orthotic causes of Foot Slap

• inadequate dorsiflexion assist

• inadequate plantarflexion stop

Anatomical causes of foot slap

weak foot dorsiflexors

Orthotic causes of Toes First deviation

• inadequate heel lift

• inadequate dorsiflexion assist

• inadequate plantarflexion stop

• inadequate relief of pain

Anatomical causes of Toes first deviation

• Short LE

• Pes Equinus

• Extensor spasticity

• Heel pain

Orthotic causes of flat foot contact (entire foot contacts ground initially)

• inadequate traction from sole

• requires walking aid

• inadequate dorsiflexion stop

Anatomical causes of flat foot contact

• poor balance

• pes calcaneus

Orthotic causes of Excessive lateral/medial foot contact

• transverse plane malalignment

Anatomical causes of excessive medial / lateral foot contact

• weak inverters / evertors

• pes valgus (varus)

• Genu valgum (varum)

Orthotic causes of excessive knee flexion

• inadequate knee lock

• inadequate dorsiflexion stop

• plantarflexion restriction

• inadequate contralateral shoe lift

Anatomical causes of Excessive knee flexion

• weak quadriceps

• short contralateral LE

• knee pain

• knee and/or hip flexion contracture

• flexor synergy

• pes calcaneus

Orthotic Causes of Hyperextended knee

• genu recurvatum

• inadequately controlled by plantar flexion stop

• excessively concave (deep) calf band

• Pes equines uncompensated by contralateral shoe lift

• Inadequate knee lock

Anatomical causes of hyperextended knee

• weak quadriceps

• lax kene ligaments

• extensor synergy

• pes equinus

• short contralateral LE

• Short contralateral knee and/or hip flexion contracture

Orthotic Causes of Anterior trunk bending

inadequate knee lock

Anatomical causes of anterior trunk bending

• weak quadriceps

• hip flexion contracture

• knee flexion contracture

Orthotic causes of posterior trunk bending

• inadequate hip lock

• knee lock

Anatomical causes of posterior trunk bending

• weak gluteus maximus

• knee ankylosis

Orthotic causes of Lateral bending

• excessive height of medial upright if KAFO

• Excessive abduction of hip joint of HKAFO

• requires walking aid

• insufficient shoe lift

Anatomic causes ot lateral trunk bending

• weak gluteus medius

• abduction contracture

• dislocated hip

• hip pain

• poor balance

• short leg

Orthotic causes of wide walking base

• Excessive height of medial upright of KAFO

• Excessive abduction of hip joint of HKAFO

• Insufficient lift on contralateral shoe

• Knee lock

• Requires walking aid (e.g. cane)

Anatomical causes of wide walking base

• abduction contracture

• poor balance

• short contralateral LE

Wide walking base - heel centers more than ____ apart

4 inches / 10 cm apart

Orthotic causes of IR / ER LE

• uprights incorrectly aligned in transverse plane

• requires orthotic control

Anatomical causes of IR / ER LE

• internal or external hip rotators spastic or weak

• Anteversion / Retroversion

• Weak quadriceps: external rotation

Gait Deviations in the Late Stance

inadequate transition: delayed or absent transfer of weight over the forefoot

Gait deviations during Swing

1. Toe drag

2. Circumduction

3. Hip hiking

4. Vaulting

Exaggerated plantar flexion of contralateral LE to enable the limb to swing forward

Vaulting

LE swings outward in a semicircular arc

Circumduction

LE elevated at pelvis to enable the limb to swing forward

Hip hiking

Orthotic causes of Inadequate Transition (late stance)

• plantar flexion stop

• inadequate dorsiflexion stop

Anatomical causes of Inadequate transition (Late Stance)

• weak plantar flexors

• achilles tendon sprain or rupture

• pes calcaneus

• forefoot pain

Orthotic causes of toe drag

• inadequate dorsiflexion assist

• inadequate plantarflexion stop

Anatomical causes of toe drag

• weak dorsiflexors

• plantar flexor spasticity

• pes equinus

• weak hip flexors

Orthotic causes of Circumduction

• Knee lock

• inadequate dorsiflexion assist

• inadequate plantar flexion stop

Anatomical causes of Circumduction

• weak hip flexors

• extensor synergy

• knee and/or ankle ankylosis

• weak dorsiflexors

• pes equinus

Orthotic causes of hip hiking

• knee lock

• inadequate dorsiflexion assist

• inadequate plantar flexion stop

Anatomical causes of hip hiking

• short contralateral LE

• contralateral knee and/or hip flexion contracture

• weak hip flexors

• extensor synergy

• knee and/or ankle ankylosis

• weak dorsiflexors

• pes equinus

Orthotic causes of vaulting

• knee lock

• inadequate dorsiflexion assist

• inadequate plantarflexion stop

Anatomical causes of vaulting

• weak hip flexors

• extensor spasticity

• pes equinus

• short contralateral LE

• contralateral knee and/or hip flexion contracture

• knee and/or ankle ankylosis

• weak dorsiflexors