Gait Deviations

What are primary gait deviations?

Gait deviations directly caused by an impairment

What are examples of causes of primary gait deviations?

• Deformity

• Weakness

• Impaired motor control

• Pain

What are secondary gait deviations?

Deviations caused by

• abnormal posture or

• abnormal movement at an adjacent joint

What are examples of secondary gait deviations?

• Forefoot contact at IC due to inadequate knee extension during TSw

• Excessive DF during MSt due to a knee flexion contracture (primary issue)

What are compensatory gait deviations?

Deviations that accommodate for an impairment rather than being a direct result of it

What are examples of a compensatory gait deviations?

• Ipsilateral trunk lean during stance to compensate for weak hip abductors

• Excessive hip flexion during MSw to compensate for weak DFs

What types of disorders can cause compensatory gait deviations?

• Musculoskeletal (MSK)

• Central Nervous System (CNS) disorders

What causes toe drag during initial swing?

Insufficient knee flexion to clear the foot

What causes toe drag during mid-swing

Insufficient DF to clear the toes

How does the medial longitudinal arch behave during the gait cycle?

It flattens during LR,

and rises again during late MSt into TSt

What happens to the medial arch during loading response (LR)?

It flattens as body weight is accepted

What muscle controls the lowering of the medial arch during LR?

posterior tibialis

How does the posterior tibialis act during LR?

Eccentrically, to control the lowering of the medial arch

What happens to the medial arch during late mid-stance to terminal stance?

It rises to prepare for push-off

How does the posterior tibialis act during late mid-stance to terminal stance?

Concentric contraction to raise the medial arch

How does an AFO help prevent genu recurvatum during stance phase?

By fixing the foot in DF, which encourages knee flexion

What effect does dorsiflexion from an AFO have on knee motion?

It promotes knee flexion during stance phase

How does an AFO influence the heel rocker?

It accentuates the heel rocker action,

which naturally promotes knee flexion

During which phases of gait does the AFO help maintain knee flexion?

Mid-stance and terminal stance

Hip during Loading Response (LR)

Impairment: Gluteus maximus weakness
Deviation/Compensation: Gluteus maximus gait — trunk leans backward to lock hip into extension

Hip during Mid-Stance (MSt)

Impairment: Gluteus medius weakness of the stance leg
Deviation/Compensation: Trendelenburg gait — contralateral pelvis drops

Hip during Mid-Stance (MSt)

Impairment: Gluteus medius weakness
Deviation/Compensation: Compensatory Trendelenburg gait — trunk leans over stance limb to prevent pelvic drop

Hip during Mid-Stance (MSt)

Impairment: Pain in the stance limb
Deviation/Compensation: Antalgic gait — reduced stance time on painful leg, shortened opposite step length

• ant = against

• -algic = pain

Ex: Jandro quickly shifts weight off the painful R leg, so the L leg swings earlier, making the L step shorter

Hip during Mid-Stance (MSt) — Deviation/Compensation

Impairment:

• Skeletal deformity

• Hip hypomobility

• Adduction contractures

• Abnormal adductor muscle activity

Deviation/Compensation: Scissoring gait — thighs cross midline and may touch

Hip during Terminal Stance (TSt)

Impairment:

• Hip flexion contracture

• Joint hypomobility

• Pain or

• Joint effusion
  

Deviation/Compensation: Excessive Backward Rotation of the pelvis during TSt

Hip during Swing Phase

Impairment: Inadequate hip flexion or DF
Deviation/Compensation: Circumduction — swing leg moves laterally in a circular motion to clear the foot

Hip during Mid-Swing (MSw)

Impairment:

• Inadequate knee flexion

• Insufficient DF

• Longer swing limb

• Flexed stance knee
  

Deviation/Compensation: Steppage gait — excessive hip flexion resembling marching

Knee during Initial Contact (IC)

Impairment: Quadriceps weakness or spasticity (often upper motor neuron lesion)
Deviation/Compensation: Extensor thrust — knee suddenly jerks into extension

Knee during Loading Response (LR)

Impairment: Quadriceps weakness
Deviation/Compensation: Quadriceps gait — trunk leans forward to shift LoG anterior to knee, creating external extension moment

Knee during Loading Response (LR)

Impairment: Skeletal deformity or ligament instability
Deviation/Compensation: Thrust — sudden uncontrolled varus or valgus movement on weight acceptance

• Varus Thrust in photo

Knee during Mid-Stance (MSt)

Impairment: Quadriceps weakness, tight PFS or hamstrings
Deviation/Compensation: Genu recurvatum — knee hyperextension

Knee during Mid-Stance (MSt)

Impairment:

• Knee flexion contracture

• hamstring tightness or spasticity
  

Deviation/Compensation: Crouch gait — knee remains excessively flexed

Knee during Initial Swing (ISw)

Impairment:

• Knee extension contracture

• Spasticity of knee extensors

Deviation/Compensation: Inadequate knee flexion causing toe drag

Knee during Mid-Swing (MSw)

Impairment:

• Impaired motor control of hip/knee flexors,

• Inadequate ankle DFs

• Short stance limb

Deviation/Compensation: Excessive knee flexion during MSw

Knee during Terminal Swing (TSw)v

Impairment:

• Knee flexion contracture

• Hamstring overactivity

• Joint pain/effusion
  

Deviation/Compensation: Inadequate knee extension causing instability in the next stance phase

Ankle & Foot during Initial Contact (IC)

Impairment:

• DF weakness

• PF contracture

• talocrural joint hypomobility

• impaired motor control
  

Deviation/Compensation: Foot flat — initial contact on forefoot or whole foot instead of just the heel

Ankle & Foot during Loading Response (LR)

Impairment: DF weakness
Deviation/Compensation:

Foot slap — forefoot rapidly plantarflexes uncontrollably

Ankle & Foot during Mid-Stance (MSt)

Impairment:

• PF contracture

• skeletal deformity

• joint hypomobility

• impaired PF control

Deviation/Compensation: Early heel off on stance leg

Ankle & Foot during Mid-Stance (MSt)

Impairment:

• Inadequate knee flexion

• insufficient DF

• longer swing limb
  

Deviation/Compensation: Vaulting — premature heel rise on the unaffected limb to give the affected foot extra clearance and avoid tripping

Ankle & Foot during Terminal Stance (TSt)

Impairment:

• Hindfoot valgus deformity

• foot invertor weakness (Tibialis Ant + Post)
  

Deviation/Compensation: Excessive pronation

Ankle & Foot during Pre-Swing (PSw)

Impairment: Inadequate Hallux MTP extension
Deviation/Compensation:

• Reduced push-off force

• impaired toe rocker

• shortened contralateral step length

Ankle & Foot during Initial Swing (ISw)

Impairment: Inadequate knee flexion
Deviation/Compensation:

• Toe drag — toes fail to clear the ground; compensates with:

  • vaulting (premature heel rise on opposite limb) AND

  • circumduction (lateral circular motion of swing leg) to clear foot

not sure if its the best pic →

Ankle & Foot during Mid-Swing (MSw)

Impairment:

• DF weakness

• deep fibular nerve injury

• Pes Equinus (PF contracture) deformity
  

Deviation/Compensation:

• Foot drop — ankle remains plantarflexed, compromising toe clearance and increasing fall risk;

• Compensates with hip hiking or circumduction to clear the foot

Ankle & Foot during Mid-Swing (MSw)

Impairment: DF weakness
Deviation/Compensation:

Hip hiking or circumduction to clear the foot