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Pathological Gait

Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

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Page 1: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Pathological Gait

Page 2: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Plantarflexion

Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 20 weak

quadriceps

Page 3: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Loading Response Deviations

FF contact rapid foot flat (flexible ankle)

FF contact sustained

FF contact foot flat (rigid ankle) knee hyperextension

FF = fore foot

Page 4: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Midstance Deviations

Prematureheel rise

Foot flat w/ restrainedtibia

Fwd. trunk lean, short contralateral step

Page 5: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Terminal Stance Deviations

Excessive heel rise

Pelvic obliquity high on side of deviation

Page 6: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Mid Swing Deviations

Toe DragCompensatory hip and/or knee flexion

Page 7: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Dorsiflexion Weak triceps surae

Ankle joint fusion at neutral

Excessive knee flexion

Page 8: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Loading Response Deviations

Higher heel rocker knee quad demand

Page 9: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Loading Response Deviations 20 Rigid AFO

Rigid AFO knee and hip flexion

Page 10: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Terminal Stance Deviations

Prolonged heel contact

OR knee w/ heel rise

Page 11: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Pre Swing Deviations

Sustained heel contact plantarflexion

Page 12: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Knee Flexion / Excessive Extension Quadriceps weakness Pain Quadriceps spasticity Excessive ankle plantarflexion

Page 13: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Pre Swing and Initial Swing

ankle dorsiflexion w/prolonged heel contact

Toe Drag

Page 14: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Midstance

when knee lackshyperextension range

Retraction of tibia (soleus)and femur (gluteus max)

Page 15: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate knee flexion 20 excessive plantarflexion

Overall disruption of normal coordinationbetween the knee and ankle

Page 16: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Knee Extension / Excessive Knee Flexion

Causes Hamstring spasticity Knee flexion contracture Soleus weakness Excessive ankle plantarflexion

Page 17: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Knee Flexion - Loading Response

Resulting in ankle dorsiflexion

Page 18: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Knee Flexion - Midswing

As a compensation for ankle plantarflexion

Page 19: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Knee Extension – Midstance and Terminal Stance

Accompanied w/ ankle dorsiflexion limband body advancement

Page 20: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Knee Extension – Terminal Swing

Loss of terminal reach

Page 21: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Hip Extension – Excessive Hip Flexion Hip flexion contracture Iliotibial band contracture Hip flexor spasticity Pain Voluntary/Compensatory

Page 22: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Hip Extension – TSt

step length and body advancement

Contracture

Page 23: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Hip Flexion - MSw

Compensation for ankle plantarflexion

Page 24: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Hip Flexion Hip flexor weakness

Hip joint arthrodesis

Page 25: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Inadequate Hip Flexion - TSw

Compensation for weak quadriceps that cannot extend the knee (flaccid knee)

Rapid hip Rapid hip /

Page 26: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Compensations for Inadequate Hip Flexion – PSw/ISw

Compensatory posteriorpelvic tilt

Page 27: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Compensations for Inadequate Hip Flexion – PSw/ISw

Voluntary excessive (magnitude &velocity) knee flexion

Page 28: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Hip Adduction

Causes: Ipsilateral abductor weakness Adduction contracture or spasticity Using adductors as hip flexors Contralateral hip abduction

contracture

Page 29: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Deviations

Swing “Scissor Gait” Combined hip & IR

Page 30: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Deviations

20 glute med weakness20 adductor contractureor spasticity

20 adductors used as hip flexors

Page 31: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Hip Abduction

Causes Ipsilateral abduction contracture Contralateral adduction

contracture Scoliosis w/ pelvic obliquity

Page 32: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Deviations

20 contralateral abduction or ipsilateraladduction contracture

Compensation for inadequate knee flexion

Page 33: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Hip External Rotation

Causes Gluteus maximus overactivity Excessive ankle plantarflexion

Page 34: Pathological Gait. Excessive Plantarflexion Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak

Excessive Hip Internal Rotation

Causes Medial hamstring overactivity Adductor overactivity Anterior abductor overactivity Quadriceps weakness