Gait Pathology

1. In order to identify pathological gait deviations, the clinician must compare normal gait patterns and joint positions to the picture the patient presents. This is best learned segmentally, starting with the _______ and ____ and then proceeding to the _____, ____, _____ and _____. ankle and toes and then proceeding to the knees, hips, pelvis and trunk.

2. After performing a gait analysis, identify the major problems that prevent the accomplishment of the three functional tasks, _________________, ____________, and _________________. Weight Acceptance Single Limb Support Swing Limb Advancement 3. Which box Indicates that the deviation significantly impacts the mechanics of walking. (Major Deviation) a. Light Gray Box b. White Box c. Dark Gray Box 4. Which box indicates that either the deviation does not occur during that phase, or that position would not be considered abnormal. a. Light Gray Box b. White Box c. Dark Gray Box 5. Which box indicates that the deviation may occur in a phase, but it does not affect the accomplishment of the functional task. (Minor Deviation) a. Light Gray Box b. White Box c. Dark Gray Box

6. Identify the problem associated with the description of the deviation. Plantar flexion greater than normal for the specific phase. a. Foot-Flat Contact b. Excess Dorsiflexion c. Excess Plantar Flexion d. Drag e. No Heel Off c. Excess Plantar Flexion

7. Identify the ankle & foot problem associated with the description given. Initial contact with the ground made by the entire foot. a. Foot Slap b. Forefoot Contact c. No Heel Off d. Excess Inversion / Eversion e. Foot-Flat Contact e. Foot-Flat Contact

8. Identify the ankle & foot problem associated with the description given. Absence of heel rise during TSt or PSw. a. No Heel Off b. Forefoot Contact c. Heel Off d. Foot-Flat Contact e. Contralateral Vaulting a. No Heel Off

9. Identify the ankle & foot problem associated with the description given. Rising on the forefoot of the opposite stance limb during limb advancement of the reference leg. a. Contralateral Vaulting b. Excess Dorsiflexion c. Excess Inversion / Eversion d. Foot-Flat Contact e. Drag a. Contralateral Vaulting

10. Identify the ankle & foot problem associated with the description given. Inversion/eversion of the calcaneus or forefoot greater than normal for the specific phase. a. Forefoot Contact b. Drag c. Heel Off d. Excess Inversion / Eversion e. Excess Plantar Flexion d. Excess Inversion / Eversion

11. Identify the ankle & foot problem associated with the description given. Contact of the toes, forefoot or heel with the ground during SLA. a. Foot Slap b. Foot-Flat Contact c. No Heel Off d. Forefoot Contact e. Drag e. Drag

12. Identify the ankle & foot problem associated with the description given. Initial contact with the ground made by the forefoot. a. Excess Dorsiflexion b. Foot Slap c. Forefoot Contact d. Excess Plantar Flexion e. Heel Off c. Forefoot Contact 13. Identify the ankle & foot problem associated with the description given. Dorsiflexion greater than normal for the specific phase. a. Heel Off b. No Heel Off c. Foot-Flat Contact d. Foot Slap e. Excess Dorsiflexion e. Excess Dorsiflexion

14. Identify the ankle & foot problem associated with the description given. Uncontrolled plantar flexion at the ankle joint after heel contact, accompanied by a slapping sound a. Heel Off b. Foot-Flat Contact c. Excess Plantar Flexion d. Foot Slap e. Excess Dorsiflexion d. Foot Slap

15. Identify the ankle & foot problem associated with the description given. Heel not in contact with the ground during LR or MSt. a. Excess Dorsiflexion b. Heel Off c. Excess Plantar Flexion d. Measles e. Foot-Flat Contact b. Heel Off

16. Extension of the toes beyond neutral Up 17. Less metatarsalphalangeal extension than normal for the specific phase Inadequate Extension 18. Flexion of the distal interphalangeal joints and flexion or extension of the proximal interphalangeal joints Clawed / Hammered

19. ANKLE & FOOT- Problem: Forefoot or Flat-foot Contact Task: Weight Acceptance (WA) Most Likely Causes: a. Secondary to excess knee flexion in TSw b. Compensatory for weak quadriceps to avoid normal LR c. Secondary to excess plantar flexion in TSw d. Heel pain Significance: a. Poor position for heel rocker b. Decreases forward momentum of the tibia c. Decreases shock absorption by limiting knee flexion (forefoot contact) 20. ANKLE & FOOT- Problem: Foot Slap Task: Weight Acceptance (WA) Most Likely Causes: a. Weak pretibials Significance: a. Decreases forward momentum of the tibia b. Decreases shock absorption by limiting knee flexion 21. ANKLE & FOOT- Problem: Excess Plantar Flexion Task: Weight Acceptance (WA) Most Likely Causes: a. Plantar flexion contracture Significance: a. Poor position for heel rocker

22. ANKLE & FOOT- Problem: Excess Plantar Flexion Task: Single Limb Support (SLS) Most Likely Causes: a. Plantar flexor hypertonicity b. Weak quadriceps c. Impaired proprioception d. Ankle pain Significance: a. Decreases shock absorption by limiting knee flexion (W A) b. Decreases forward progression of the tibia over the ankle and forefoot

23. ANKLE & FOOT- Problem: Excess Plantar Flexion Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Weak pretibials b. Plantar flexion contracture c. Plantar flexor hypertonicity d. Lack of selective dorsiflexion control (TSw) Significance: a. Interferes with foot clearance b. Interferes with foot position for IC

24. ANKLE & FOOT- Problem: Excess Dorsiflexion Task: Weight Acceptance (WA) Most Likely Causes: a. Secondary to excess hip or knee flexion Significance: a. Increases the demand on the hip and knee extensors b. Decreases limb stability 25. ANKLE & FOOT- Problem: Excess Dorsiflexion Task: Single Limb Support (SLS) Most Likely Causes: a. Weak calf b. Secondary to excess hip and knee flexion c. Intentional to lower the opposite limb for contact (TSt) d. Excess midfoot dorsiflexion secondary to limited ankle mobility Significance: a. Increases the demand on the hip and knee extensors b. Interferes with heel rise and decreases step length of the opposite limb (TSt)

26. ANKLE & FOOT- Problem: Excess Inversion Task: Weight Acceptance (WA), Single Limb Support (SLS), Swing Limb Advancement (SLA) Most Likely Causes: a. Tibialis anterior, tibialis posterior, or soleus overactivity b. Varus contracture c. Plantar flexion contracture (SLS) d. Weak peroneals e. Lack of selective motor control of the pretibials f. Variations in skeletal alignment resulting in a high arch g. Internal tibial torsion Significance: a. Poor position for W A b. Rigid foot resulting in decreased shock absorption c. Decreases stability in SLS d. Decreased foot clearance in SLA

27. ANKLE & FOOT- Problem: Excess Eversion Task: Weight Acceptance (WA), Single Limb Support (SLS), Swing Limb Advancement (SLA) Most Likely Causes: a. Weak tibialis posterior (WA & SLS), soleus (SLS) b. Plantar flexion contracture (SLS) c. Valgus deformity d. Referred from the knee or hip joint e. Variations in skeletal alignment resulting in a low arch f. Weak tibialis anterior g. Peroneal hypertonicity Significance: a. Rotary strain on midfoot and knee b. Interferes with rigid lever for forefoot rocker c. Can be used to gain dorsiflexion range when ankle mobilty is limited 28. ANKLE & FOOT- Problem: Heel Off Task: Weight Acceptance (WA), Single Limb Support (SLS) Most Likely Causes: a. Secondary to excess plantar flexion b. Heel pain c. Secondary to excess knee flexion Significance: a. Decreases the base of support due to smaller weight bearing surface b. Increases pressure on the MT heads

29. ANKLE & FOOT- Problem: No Heel Off Task: Single Limb Support (SLS), Swing Limb Advancement (SLA) Most Likely Causes: a. Weak calf b. Ankle or metatarsal head pain c. Secondary to inadequate extension of the toes d. Secondary to excess dorsiflexion Significance: a. Interferes with progression over the forefoot b. Decreases step length of the opposite limb c. Results in limited knee flexion inSLA 30. ANKLE & FOOT- Problem: Drag Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Secondary to limited hip flexion, limited knee flexion or excess plantar flexion b. Impaired proprioception Significance: a. May result in loss of balance b. Interferes with limb advancement c. May cause injury to toes

31. ANKLE & FOOT- Problem: Contralateral Vaulting Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Compensatory for limited flexion of the swing limb b. Compensatory for longer swing limb Significance: a. Increases the demand on the calf muscles

32. TOES - Problem: Up Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Compensatory for weak tibialis anterior or insufficient dorsiflexion b. Toe extensor hypertonicity Significance: a. May help with foot clearance b. May cause skin irritation or callouses on the dorsum of the toes from rubbing against the shoe

33. TOES - Problem: Inadequate Extension Task: Single Limb Support (SLS), Swing Limb Advancement (SLA) Most Likely Causes: a. Limited toe extension range of motion including hallux valgus, or hallux rigidus b. Toe flexor hypertonicity c. Forefoot pain d. Secondary to no heel off Significance: a. Interferes with forward progression b. Decreases step length of the opposite limb

34. TOES - Problem: Clawed / Hammered Task: Single Limb Support (SLS) Most Likely Causes: a. Toe flexor or extensor hypertonicity b. Imbalance of the long toe extensors and intrinsic foot muscles c. Compensatory for weak plantar flexors Significance: a. Interferes with forward progression b. Decreases step length of the opposite limb

35. Identify the knee problem associated with the description given. Alternating flexion and extension of the knee occurring during a single phase. a. Excess Flexion b. Wobbles c. Extension Thrust d. Varus/Valgus b. Wobbles

36. Identify the knee problem associated with the description given. Forceful motion of the knee towards extension a. Limited Flexion b. Excess Flexion c. Excess Contralateral Flexion d. Extension Thrust d. Extension Thrust

37. Identify the knee problem associated with the description given. Knee flexion greater than normal during LR, MSt or TSt of the opposite limb; this occurs during SLA of the reference limb a. Excess Contralateral Flexion b. Wobbles c. Varus/Valgus d. Limited Flexion a. Excess Contralateral Flexion

38. Identify the knee problem associated with the description given. Lateral/medial angulation of the tibia relative to the femur a. Wobbles b. Varus/Valgus c. Excess Flexion d. Excess Contralateral Flexion b. Varus/Valgus

39. Identify the knee problem associated with the description given. Position of knee beyond neutral extension a. Excess Flexion b. Limited Flexion c. Extension Thrust d. Hyperextends d. Hyperextends

40. Identify the knee problem associated with the description given. Less than normal knee flexion for the specific phase a. Wobbles b. Varus/Valgus c. Limited Flexion d. Extension Thrust c. Limited Flexion

41. Identify the knee problem associated with the description given. Greater than normal knee flexion for the specific phase a. Excess Flexion b. Limited Flexion c. Extension Thrust d. Wobbles. a. Excess Flexion

42. KNEE - Problem: Limited Flexion Task: Weight Acceptance (WA) Most Likely Causes: a. Weak quadriceps b. Secondary to forefoot or foot- flat contact with a tight calf c. Knee pain d. Quadriceps hypertonicity e. Impaired proprioception Significance: a. Decreases shock absorption b. Decreases forward momentum of the tibia c. Potential injury to the posterior capsule of the knee joint

43. KNEE - Problem: Limited Flexion Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Secondary to excess hip flexion or no heel off in TSt b. Impaired motor control resulting in inability to rapidly flex the knee c. Knee pain d. Knee extension contracture e. Extensor hypertonicity (plantar flexor and/or knee extensor) f. Limited thigh advancement secondary to hamstring hypertonicity or hip flexor weakness Significance: a. Interferes with foot clearance (ISw) b. Decreased knee flexion in PSw usually results in decreased knee flexion in ISw c. Increases energy cost

44. KNEE - Problem: Excess Flexion Task: Weight Acceptance (WA), Single Limb Support (SLS) Most Likely Causes: a. Knee flexion contracture b. Knee flexor hypertonicity c. Secondary to excess hip flexion d. Secondary to decreased contralateral limb stance stabilty (W A) e. Secondary to excess dorsiflexion f. Knee pain g. Intentional to lower the opposite limb (TSt) h. Secondary to posterior pelvic tilt with hip flexion contracture (SLS) Significance: a. Increases the demand on the plantar flexors, quadriceps, and hip extensors. b. Decreases limb stability 45. KNEE - Problem: Excess Flexion Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Knee flexion contracture b. Inability to selectively extend the knee while maintaining a flexed hip c. Weak quadriceps d. Hamstring hypertonicity e. Intentional to allow forefoot or footflat contact Significance: a. Decreases step length of the reference limb b. Interferes with heel first contact 46. KNEE - Problem: Wobbles Task: Weight Acceptance (WA), Single Limb Support (SLS) Most Likely Causes: a. Impaired proprioception b. Quadriceps hypertonicity c. Plantar flexor hypertonicity Significance: a. Decreases forward momentum b. Decreases limb stabilty and balance

47. KNEE - Problem: Hyperextends or Extension Trust Task: Weight Acceptance (WA) Most Likely Causes: a. Secondary to forefoot contact with excess plantar flexor tightness b. Weak quadriceps c. Impaired proprioception d. Quadriceps hypertonicity e. Intentional to increase limb stability Significance: a. Decreases shock absorption b. Decreases forward progression of the tibia c. Potential injury to the posterior structures of the knee joint 48. KNEE - Problem: Hyperextends or Extension Trust Task: Single Limb Support (SLS) Most Likely Causes: a. Secondary to excess plantar flexion b. Impaired proprioception c. Intentional to increase limb stabilty Significance: a. Decreases forward progression of the tibia b. Potential injury to the posterior elements of the knee joint 49. KNEE - Problem: Hyperextends or Extension Trust Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Impaired proprioception b. Intentional to extend the knee Significance: a. May assist in achieving maximum knee extension 50. KNEE - Problem: Varus / Valgus Task: Single Limb Support (SLS) Most Likely Causes: a. Joint or ligamentous instability b. Bony deformity c. Resulting from a dysfunctional subtalar joint d. Secondary to lateral trunk lean (valgus) Significance: a. Decreases limb stabilty b. Necessitates compensation proximal or distal to the knee c. May result in knee pain

51. KNEE - Problem: Excess Contralateral Flexion Task: Swing Limb Advancement (SLA) Most Likely Causes: a. Intentional to lower reference swing limb to the ground b. Secondary to excess knee flexion in SLS of the opposite limb Significance: a. Relatively lengthens the reference swing limb and interferes with foot clearance and limb advancement b. Increases the energy demand on the opposite stance limb 52. Identify the hip problem associated with the description given. A visible forward and then backward movement of the thigh during TSw. a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation c. Past Retract

53. Identify the hip problem associated with the description given. Considered a deviation if other than Neutral a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation d. Abduction

54. Identify the hip problem associated with the description given. Considered a deviation if the patella is facing laterally a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation e. External Rotation

55. Identify the hip problem associated with the description given. Less than normal hip extension for the specific phase a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation b. Inadequate Extension

56. Identify the hip problem associated with the description given. Considered a deviation if other than neutral a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation d. Abduction

57. Identify the hip problem associated with the description given. Considered a deviation if the patella is facing medially a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation g. Internal Rotation

58. Identify the hip problem associated with the description given. Less than normal hip flexion for the specific phase a. Limited Flexion b. Inadequate Extension c. Past Retract d. Abduction e. External Rotation f. Adduction g. Internal Rotation a. Limited Flexion

59. HIP (THIGH Vs. VERTICAL) - Problem: Limited Flexion Task: Weight Acceptance (WA) Most Likely Causes: a. Intentional to decrease the demand on the hip extensors b. Limited hip flexion achieved in TSw Significance: a. May disturb the normal LR by limiting knee flexion and ankle plantar flexion

HIP (THIGH Vs. VERTICAL)

Swing Limb Advancement (SLA) Weight Acceptance (WA) , Single Limb Support (SLS)