Gait Impairments

mechanisms associated with gait dysfunction

• pain (antalgic gait)

• musculoskeletal impairments

• sensort impairments

• CNS impairments

• different conditions can result in similar gait deviations

pain (antalgic gait)

caused by joint pathologies or joint pathologies

musculoskeletal impairments

• muscle weakness, poor endurance

• congenital or injury related

  • leg length discrepancy

  • pes cavus/planus

  • joint contracture

CNS impairments associated with gait

CVA, parkinsons, cerebral palsy

result of gait with pain/antalgic gait

• decreased stance time on painful side

• decreased contralateral step length

• on the unaffected side there is a decreased stride and decreased step length

• decreased step length on affected side

gait analysis observations

• observe from multiple view points (anterior/posterior and lateral)

• start big picture with trunk, step lengths …

• focus on suspected region and look proximal to distal

hip abductors common compensations

• lateral trunk lean towards the weak side (this decreases hip ABD moment arm)

• decreased stance time

• decreased contralateral step length (if the right side is weak, there is a shorter step length)

trendelenburg compensations

swinging his foot out to the side (circumducting) to clear it or bending the hip/knee to shorten the limb

hip extensor common compensations

• posterior trunk lean towards weak side

  • this gives the appropriate angle to maintain typical gait

• decreased contralateral step length (step length is shorter on the opposite side of the lean backwards)

knee extension compensations

• landing on more of a flat foot

• knee may buckle because GRF wants to drive into more flexion

  • to keep GRF in front of the knee, the person may lean forward

knee buckling compensation

the adductor longus and distal part of the adductor magnus pull the leg into hyper extension at the knee to compensate (plantarflexors (soleus) also helps with hyperextension)

quadriceps avoidance gait

• less likely to put weight through the leg (isometric contraction of quads and hamstrings)

• very common post ACL or knee surgery

common compensations of quadriceps avoidance gait

• heel isnt going down to stay in plantarflexion (keeping the leg bent)

• stepping to other foot (not further in front of the other foot)

both of those lead to decreased:

• stance on affected side

• step length on contralateral side

weak ankle dorsiflexors in swing phase

• common compensation

  • do more knee flexion to clear toes (and hip flexion)

  • do circumduction to swing leg around instead of lifting toes

weak ankle dorsiflexors in stance phase

• foot slap would happen

• if there is an impairment during both the swing and stance phase there is a bigger impairment

  • more isolated weakness if only during foot slap

what is foot slap

rapid ankle plantar flexion

• the louder the slap the weaker the muscles

what part of the foot will touch first if there is excessive hip/knee flexion

forefoot/toes

knee flexion contracture

unable to fully extend knee (stuck in flexion)

common knee flexion contracture compensations

• initial contact on ipsilateral side with forefoot/toes

• decreased ipsilateral step length

• excessive hip or knee flexion on contralateral side

  • this type of contracture makes you shorter so you need to make the other leg shorter by flexing it so it can clear

knee extension contracture

lacking knee flexion (stuck in extension)

common knee extension contracture

• ipsilateral limb circumduction

• contralateral limb vaulting

ankle plantarflexion contracture

ankle lacking dorsiflexion (stuck in plantar flexion)

common ankle plantarflexion contracture compensations

• forward trunk lean

• ipsilateral knee hyperextension

• early ipsilateral heel off

• decreased contralateral step length

• ipsilateral limb circumduction

at initial contact/loading response what causes a posterior trunk lean to the right side

weak R hip extensors

at initial contact/loading response what causes lacking adequate R knee extension

• weak R extensors

• decreased ROM

at initial contact/loading response what causes buckling of the right knee

weak R knee extensor muscles

at initial contact/loading response what causes R foot slap

weak R dorsiflexors

at initial contact/loading response what causes initial contact w R forefoot/toes

• decreased knee extension ROM

• decreased ankle DF ROM

• weak R DF muscles

at midstance what causes hyper extension of the R knee

• weak R knee extensor muscles

• decreased ankle DF ROM

at midstance what causes R side trendelenburg/compensated trendelenburg

• weak R hip ABD muscles

at midstance what causes excessive R foot pronation

• R forefoot valgus

• R knee valgus

• R leg length is shorter

at terminal stance/pre swing what causes decreased right hip extension

decreased right hip extension ROM

at terminal stance/pre swing what causes early right heel rise

• decreased DF ROM

• decreased R knee extension ROM

at terminal stance/pre swing what causes decreased right push off

• weak R PF muscles

• excessive R foot pronation

• decreased big toe extension ROM

• weak great flexor hallucis longus muscle

at initial swing and mid swing what causes decreased right hip flexion

weak right hip flexors

at initial swing and mid swing what causes right foot/toe drag

• weak R DF muscles

• decreased ankle DF ROM

• weak knee or hip flexors

at initial swing and mid swing what causes increased hip + knee flexion

• weak R DF muscles

• decreased R ankle DF ROM

at initial swing and mid swing what causes R hip hiking

• R leg longer than left

• weak R hip flexor

• decreased knee flexion ROM

at initial swing and mid swing what causes R leg circumduction

• R leg longer than left

• weak R hip flexor

• decreased knee flexion ROM

what causes decreased R step length at terminal swing

• decreased L great toe extension ROM

• decreased L ankle DF ROM

• decreased left hip extension ROM

• weak PF muscles

• decreased hip flexion ROM or weak R hip flexor muscles

• decreased R knee extension ROM or weak R knee extensors