Gait Deviations

forward trunk lean

• compensation for weak quads (decreases flexor movement of knee)

• hip flexor contractures

• weak lumbar or hip extensors

• hypomobile anterior joint capsule

decreased hip extension

• tight hip flexors

• decreased joint mobility

• weak glutes

• decreased step length

glute max gait/backward trunk lean

• trunk shifts posteriorly during IC to try and offset forward momentum, less muscle strength required to maintain hip in extension during stance

trendelenurg gait

hip drop contralateral side (trunk lean, hip hike)

weak glute med

knee hyperextensions

• quad weakness

• hamstring weakness

• increased tone of quads

• compensation for PF contracture or spasticity

decreased knee extension

• quad weakness

• knee joint hypomobility

• hamstring contracture

• strategy to avoid heel strike

• decreased step length

excessive genu valgum

• knees face each other, widen BoS

• excessive foot pronation, glute med weakness, excessive femoral adduction

excessive genu varum

• knees face outward

• degenerative changes, pain, bony deformity

excessive PF during gait

• toe lands at IC

• hypomobility of talocrural joint

increased DF

tight tib ant, weak gastroc , hypomobility, contracture tib ant

heel walking during gait

equinovarus gait

• ankle PF and subtalar inversion

• walk on lateral foot

foot drop

• DF weakness caused by paralysis of common peroneal nerve

• slap with hitting ground

excessive supination

• excessive lateral contact of foot during stance

• hypomobility subtalar joint, spastic invertors, weak evertors, genu varum

excessive pronation

• excessive medial contact of foot during stance with valgus position of foot

  • subtalar hypomobility, post tib weakness

inadequate push off

seen during transition from stance phase to swing phase

weak PF, tight DF, hypomobile talocrural

excessive anterior pelvic tilt

• lumbar lordosis & low back pain

• normal = 10-30*

• weak hip extensors, hip felxion contracture, abdominal weakness, limited hip extenstion ROM

posterior pelvic tilt

• tight hamstrings

• hip flexor weakness

• low back pain

• limited lumbar extension ROM

anatomical LLD

legs are actually different lengths as confirmed with x ray or tape measurements

functional LLD

leg lengths are equal on xray but appear longer due to weakness, tightness, compensation

circumduction

during swing phase to compensate for a leg that is too long to clear swing, clears leg by swinging out in circular pattern

hip hiking

during swing phase to compensate for a leg that is too long to clear in swing, performs by activating lateral trunk musculature

steppage gait

too long leg; consists of exaggerated hip and knee flexion to compensate for excess PF at ankle

vaulting

patient will rise up on stance phase toe to clear contralateral leg for swing phase

waddling gait

• someone trying to regain balance

• contralateral hip ABD weakness

• limited hip or knee flexion

  • pain with arthritis

antalgic gait

compensatory gait adopted to remove or decrease discomfort caused by pain in lower leg, pelvis, lumbar spine

• decreased duration of stance phase on affected

• lack of weight shift laterally over stance limb to keep weight off involved

• decrease in stance phase in affected will result in decrease in swing phase of uninvolved limb thuse shortened step length

hemiplegic gait

• spastic pattern, hip in extension, adduction & medial rotation

• knee in extension

• ankle in drop foot with PF and inversion, present during both stance and swing phases

• spastic muscles wont allow hip and knee to flex to clear floor

  • often circumduction usually with no reciprocal arm swing

ataxic gait

• defined as presence of abnormal and uncoordinated movements

  • variability of stride length and width

cerebellar ataxia

due to involvement of cerebellar structures, sensory normal, little to no improvement with visualization

sensory ataxia

involvement of structures along or interruption of ML pathway, sensory impaired, visually reliant

festinating gait

• parkinsons disease, other basal ganglia diseases

• rigidity = flex forward

• displaces COG anteriorly

• shuffle steps, walk faster

wide BOS

• more lateral movements of trunk

• indicate imbalance or fear of falling

• decreased proprioception, cerebellar ataxia

narrow BOS

• adduction deformity of hip

• increased hip ADD during swing causing limb to cross over stance limb for contact

• commonly observed in CP, valgus deformity of knee is common compensation