Module 5 Abnormal Gait 3B: Pathological - PowerPoint Presentation

Slide1

Module 5 Abnormal Gait

3B: Pathological

Differences:

Foot

and

Ankle Deviations

References

Perry, J and

Burnfield

, J. (2010).

Gait Analysis: Normal and Pathological Function 2

nd

edition.

Ch 9.

Hsu, JD; Michael, JW and Fisk, JR. (2008)

Atlas of Orthoses and Assistive Devices, 4

th

edition

. Ch 5,

pgs

67 to 74

.

Agenda - Pathological Gait: Ankle and Foot Variations

1. Floor Contact VariationsA. Forefoot ContactB. Delayed Heel ContactC. Foot Flat ContactD. Low HeelE. Foot Slap2. Ankle VariationsA. Excess PlantarflexionB. Excess DorsiflexionC. Prolonged Heel OnlyD. Premature Heel-Off

3. Subtalar Joint Variations

A. Excess Inversion

B. Excess Eversion

4. Toe Variations

A. Excess Toe Extension

B. Limited Toe Extension

C. Clawed Toes

1. Floor Contact Variations

A. Forefoot ContactDisrupts: heel rocker, forward progression of tibia and shock absorption of kneeCaused by: Three common resulting loading patterns:

1. Floor Contact Variations

B. Delayed Heel ContactDisrupts: heel rocker and forward progressionCommonly caused by yielding elastic PF contracture or spasticityTherefore assessment of PF tightness vs. contracture is imperativeDelayed Heel Contact Video

1. Floor Contact Deviations

C. Foot Flat ContactDisrupts: heel rocker and forward progressionCaused by:Video of Pediatric Foot Flat Contact Left Limb

1. Floor Contact Variations, continued

D. Low HeelDisrupts: heel rocker and forward progressionCaused by:Very difficult to observe clinically

1. Floor Contact Variations Foot Slap

E. Foot SlapDisrupts: heel rocker, forward progression and shock absorptionCaused by:

2. Ankle Variations

A. Excessive Plantar Flexion = “inadequate DF”Disrupts: rockers during stance and toe clearance and limb advancement during swingFocus now on just Mid Stance and Mid Swing

Pathological Gait

Variations observed during Stance

Variations observed during Swing

Observations made coronally and

sagittally

2. Ankle Variations Excessive Dorsiflexion

B. Excessive Dorsiflexion = “inadequate PF”Disrupts: controlled forward progression of tibiaEarly Stance and Later Stance:Accentuates heel rocker – causes more demand on quadsDuring pre-swing, shortens limb – causes reduced pelvis supportLimits toe rocker

2. Ankle Variations Heel

C. Prolonged Heel OnlyInfrequent findingDisrupts: stability and forward progression

D. Premature Heel-OffDisrupts: heel and ankle rockers and associated forward progressionDifficult to see in later part of Stance

2. Ankle Variations

E. No Heel Off/Delayed Heel Off

Disrupts forefoot

and toe

rockers

Reduces forward progression

Shortens contralateral step length

Limits Pre-Swing knee flexion

2. Ankle Variations, continued

F. DragDisrupts: forward progression and foot clearance

G. Contralateral Vaulting

Decreases contralateral stance stability

and increases

calf muscle demand

Initial, mid-

and terminal

Swing

3. Subtalar Variations

A. Excess Inversion = excessive lateral foot contactA.k.a. “varus”Swing = difficulty with clearanceStance = rigid foot less able to absorb shock

3. Subtalar Variations Excess Eversion

B. Excess Eversion = excessive medial foot contactA.k.a. “valgus”WA = increases rotary stress on ankle and kneeSLS = prevents achieving rigid forefoot for forward progressionUsually result of total weakness of invertors vs. excessive peroneals

4. Toe Variations

A. Excess Toe ExtensionDuring WA = may reflect increased use of long toe extensors if Tibialis Anterior is weakDuring SLA, may assist with foot clearance

B. Limited Toe ExtensionDisrupts: forefoot and toe rockersReduces contra-lateral step length

4. Toe Variations

C. Clawed ToesDisrupts: forefoot and toe rockersReduces contra-lateral step length

So, what do you see?Focus on Ankle and Foot Variations

Foot/Ankle Complex Sagittal Plane Motion

The End

Pedorthic Program of Study

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