Gait Deviations for PTA

Hip hiking during Swing

-Compensation for weak DF's -compensation for weak knee flexors -compensation for extensor synergy pattern

Circumduction during Swing

-Compensation for weak hip flexors -compensation for weak DF's -compensation for weak HS

Hyperextension in Stance

-Compensation for weak quadriceps -PF Contracture

Excessive flexion with Swing

-Flexor Withdrawal Reflex -Lower extremity flexor synergy

No Toe Off

-Forefoot/toe pain -Weak PF's -Weak toe flexors -Insufficient PF ROM

Exaggerated knee flexion at Terminal Stance

-Knee flexion contracture -hip flexion contracture

Exaggerated hip flexion during Swing

-LE flexor synergy -compensation for insufficient ankle DF

Toe Down instead of Heel Strike

-PF spasticity -PF contracture -Weak DF's -DF paralysis -Leg Length Discrepancy -Hindfoot pain

Clawing of Toes

-Toe flexor spasticity -Positive Support Reflex

Insufficient flexion at Initial Contact

-Weak hip flexors -hip flexor paralysis -hip extensor spasticity -insufficient flexion ROM

Exaggerated knee flexion at contact

-Weak quads -Quads paralysis -HS spasticity -Insufficient extension ROM

Weak Quadriceps

-With quad weakness, the pt may lean the body forward over the Quads at the early part of stance phase, as WBing is being shifted onto the stance leg. -By leaning forward at the hip, the COG is shifted forward at the hip, and the line of force now falls in front of the Knee. This forces knee backwards into extension. -One can also use hip extensors and plantar flexors in a closed-chain action to pull knee into extension at heel strike(Initial Contact). -One can also physically push on the anterior thigh during stance phase, holding knee in extension.

Insufficient hip extension at stance

-insufficient hip extension ROM -hip flexion contracture -LE flexor synergy

Insufficient flexion with swing

-knee effusion -quadriceps extension spasticity -PF spasticity -Insufficient flexion ROM

Steppage gait

A gait pattern in which the feat and toes are lifted through hip and knee flexion to excessive heights, usually secondary to DF weakness. -Foot slaps on Initial Contact with the ground secondary to decreased control.

Trendelenburg(Gluteus Medius)

A gait pattern that denotes Gluteus Medius weakness. -Excessive lateral trunk flexion and weight shifting over the stance leg.

Spastic gait

A gait pattern with stiff movement. -toes seeming to catch and drag -legs held together, and hip and knee joints slightly flexed. -Commonly seen in Spastic Paraplegia

Cerebellar Gait

A staggering gait pattern seen in Cerebellar disease.

Steppage Gait

As a result of Drop Foot, the knee will need to be lifted higher for the dropped foot to clear the foot.

Circumduction gait

Characterized by a circular motion to advance the leg during Swing Phase. -May be used to compensate for insufficient hip or knee flexion or DF.

Equine gait

Characterized by high steps. -Usually involves excessive activity of the gastrocnemius.

Waddling Gait

Commonly seen with muscular and other types of dystrophies, because there is diffuse weakness of many muscle groups. -Pt stands with the shoulder behind hips, much like a person with Paraplegia would balance resting on the Iliofemoral ligament of the hips. -There is an increase in lumbar lordosis, pelvic instability, and Trendelenburg gait. -Little or no reciprocal pelvis and trunk rotation occur. To swing the leg forward, the entire side of the body must swing forward.

Ataxic Gait

Gait pattern characterized by staggering or unsteadiness. -Usually wide base of support and movement are exaggerated. -Cerebellar pathology

Scissor gait

Gait pattern in which legs cross midline upon advancement.

Hemiplegic gait

Gait pattern in which patient abducts the paralyzed limb, swinging it around, and bring it forward so that foot comes to the ground in front of them.

Parkinsonian gait

Gait pattern marked by increased forward flexion of the trunk and knees. -Gait is shuffled with quick and small steps. -Festination may occur

Festinating gait

Gait pattern where a patient walks on toes as though pushed. -Starts slowly, increases and may continue until the patient grasps an object in order to stop.

Vaulting gait

Gait pattern where the Swing leg advances to compensate through the combination of elevation of the pelvis and plantar flexion of the stance leg.

Flat Foot

If there is insufficient strength to move the ankle into dorsiflexion at the beginning of stance phase, the foot will land with a fairly flat foot.

Equinus Gait

If there is no ankle dorsiflexion, the toes will strike first at Heel strike.

Antalgic gait

Protective gait pattern where the stance time is decreased to avoid weight bearing on the involved side due to pain. -typically associated with a rapid and shorter swing phase of the uninvolved limb. -causes of antalgic gait include disease(usually bone or joint), joint inflammation, or injuries to muscles , tendons, and/or ligaments.

Gluteus Medius Gait(Trendelenburg Gait)

Pt shifts trunk over affected side during Stance Phase. ex: The left Gluteus Medius or hip abductor, is weak causing two things to happen: 1.) The body leans over the left leg during that leg's stance phase and 2.) the right side of pelvis drops when the right leg leaves the ground and begins swing phase. Shifting the trunk over the affected side is an attempt to reduce the amount of strength required by the Glute Med to stabilize the pelvis.

Gluteus Maximus Gait

The trunk quickly shifts posteriorly at heel strike(Initial contact). This will shift the body's center of gravity posteriorly over the Gluteus Maximus. Sometimes referred to as a Rocking horse gait.

Weak Hamstrings

Two things may happen: -During stance phase, the knee will go into hyperextension(Genu Recurvatum Gait) -Without the HS to slow the forward swing of the lower leg during Deceleration(Terminal Swing) part of swing phase, The knee will snap into extension

Foot Slap

Weak Ankle Dorsiflexors may not be able to support body weight after heel strike and will thus move toward Foot Flat(Loading Response) as they ineffectively eccentrically contract.

Foot Slap

Weak DF's or DF paralysis

Drop Foot

With the dorsiflexors not being able to slow the descent of the foot, the foot slaps into PF as more weight is put on the leg. During Swing Phase, they may not be able to dorsiflex ankle. Gravity will cause the foot to fall into PF when it is off the ground.