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Gait biomechanics

Joints of foot - biomechanics during gait

How would you measure the angle of gait? The angle of gait is defined as the angle formed between the longitudinal axis of foot and the line of progression. 5-10 degrees of external rotation is normal.
Derfine base of gait Base of gait is the distance between heel strike of one foot and the heel strike of the other, horizontally.
What are the two main divisions/parts of the gait cycle, and what % of the cycle does each occupy? Swing phase (40%) and Stance phase (60%)
How is a gait cycle defined? One gait cycle is defined as floor contact of the heel to the following heel contact of the same limb.
Stance phase is... Stance phase is the part of the gait cycle during which the foot makes contact with the ground.
Swing phase is... Swing phase is that period of gait during which the foot does not touch the ground, and is swung forwards.
What is "double support" ? Double support is a period of bilateral foot contact with the floor. Double support occurs twice during stance phase (at start and end of stance phase).
What are the phases of the gait cycle? Heel strike/Contact Forefoot Loading Midstance Heel Lift Propulsion Toe Off Acceleration Midswing Deceleration
Cadence is... Cadence, or step-rate, is the number of steps per minute when a person walks.
What is the average cadence? The average cadence is 101-122 steps per minute.
What effect does increasing cadence have on time spent in double support? Increasing cadence --> decreases time in double support.
Stride length is... Stride length is defined as the distance between two consecutive contacts of the same foot.
What is a "step"? A step is the period from heel strike of one limb to heel strike of the other limb.
True or False: a stride consists of two steps True: there are two steps in one stride
What position is the STJ in at initial Heel Strike/Contact ? At initial Heel Strike/Contact the Subtalar Joint is slightly SUPINATED.
During Midstance, what is the position of the Subtalar Joint? Until the very end of midstance, the STJ is almost fully pronated. At the end of midstance, the STJ supinates in preparation for heel lift and start of propulsion phase.
What is the function of the midtarsal joint during gait? The midtarsal joint (a) acts as a shock absorber on contact and (b) as a rigid lever for propulsion
What are the joint axes of the midtarsal joint ? MTJ Longitudinal (Off Sagittal=9, off Transverse=15) MTJ Oblique (off Sagittal=57, off Transverse=52)
When the STJ is pronated, does this allow more or less MTJ movement? STJ pronation "unlocks" the MTJ and allows more movement in the MTJ.
How does the MTJ behave during propulsion in gait? In propulsion, the MTJ needs to become a rigid lever, which it can only do if the STJ supinates, thus "locking" the MTJ.
What joints make up the MTJ? The MTJ comprises two joints: the Talo/Navicular joint and the Calcaneo/Cuboid joint
What is the normal ROM of the MTJ? The normal MTJ ROM is 15 Eversion and 30 Inversion A minimum of 6 degrees of MTJ inversion is required to that the STJ can pronate fully during gait.
Explain the difference between Open and Closed chain motion. In Open chain motion, the distal segment is free i.e. non-weightbearing. In Closed Chain motion the distal segment is weighbearing.
Normal ankle joint ROM is? Ankle joint DF=10 min, PF=50
Normal STJ ROM is? Normal STJ ROM is Eversion=10, Inversion=20
Normal MTJ ROM is? Normal MTJ ROM is Eversion=15, Inversion=30
In what plane of motion is STJ motion measured? STJ motion is triplanar, however STJ motion is assessed only in the FRONTAL plane.
About what MTJ axis does frontal plane motion occur? Frontal plane motion of the MTJ occurs around the LONGITUDINAL AXIS.
How many axes of motion does the MTJ have? The MTJ has 2 axes of motion: the longitudinal and oblique axes.
What bones make up the first ray? 1st ray = medial cuneiform & 1st Met
What first ray movement is "normal"? It is normal to see the 1st ray DF and PF equally 1cm each way.
When assessing 1st ray movement, what reference point should be used? Use the 2nd Met Head as a reference point for assessing 1st Ray movement.
What joint ROM is normal at the !st MTPJ? 1st MTPJ ROM should be at least 70 DF. PF is usually around 40 degrees.
What are the reference points for 1st MTPJ motion assessment? A line bisecting the medial aspect of the 1st Met shaft, and a line bisecting the proximal phalanx.
What is "subtalar neutral"? STJ neutral = there is neither pronation nor supination occuring at the joint. (Root)
What minimum joint ROMs are required for normal gait? Normal gait requires 1st MTPJ DF of 70 and ankle DF of 10 degrees.
What movement occurs at the ankle joint? Ankle joint movement is mainly dorsiflexion/plantarflexion in the Sagittal plane, with some accompanying abduction/adduction.
Describe what bones are moving during closed chain ankle dorsiflexion In closed chain ankle dorsiflexion, the talus is fixed and the distal tibia internally rotates and moves forward over the talus.
Which bones are moving and how during open chain ankle plantarflexion? In open chain ankle joint plantarflexion, the talus is free and the tibia is fixed. Therefore the talus plantarflexes and adducts in relation to the fixed tibia.
What restricts ankle PROM? Passive ankle ROM is restricted by: Triceps Surae muscles, the Posterior TaloFibular ligament and Posterior Deltoid Ligament, and the wider anterior aspect of the talar trochlea.
What restricts passive ankle plantarflexion? Passive ankle plantarflexion is restricted by the posterior talar tubercule (bony) and the Anterior TaloFibular Ligament.
What movements occur at the STJ? STJ movements are supination and pronation.
Describe open chain subtalar pronation In open chain STJ pronation, the talus if fixed and the calcaneus moves freely. Motion consists of dorsiflexion (foot), abduction (foot) and eversion (calc)
Describe open chain STJ supination In open chain STJ supination, the talus is fixed and the calcaneus and foot move around it. Supination consists of plantarflexion, adduction and inversion (calcaneus).
Describe closed chain STJ supination. STJ supination is plantarflexion, adduction and inversion but in closed chain supination, the calcaneus is fixed, and the talus & leg move around it. Therefore, supination is achieved by: Talar Dorsiflexion and abduction Calcaneal inversion
Describe closed chain STJ pronation. STJ pronation is dorsiflexion, abduction and eversion. But in closed chain the calcaneus is blocjed by the grouns, so the talus must move instead. Thus in closed chain, spuination consists of: talar plantarflexion and adduction, with calcaneal eversion.
STJ inversion is restricted by which ligament? Cervical ligament restricts STJ inversion.
Which ligament restricts STJ eversion? STJ eversion is restricted by the interosseous ligament which lies within the Sinus Tarsi.
Describe the MTJ "locking mechanism" Excessive MTJ pronation is limited by calcaneal process of cuboid hitting the dorsal aspect of the calcaneus.
Escessive supination of the MTJ is restricted by what ? Excessive supination of the MTJ is resctricted by the Plantar Ligaments.
What is happening to the Plantar aponeurosis in a pronated foot in stance? The Plantar ligaments and fascia will be stretched when the foot pronates in stance.
In closed chain supination, describe what is happening to the plantar fascia and ligaments. In closed chain supination, the plantar ligaments and fascia are relaxed.
Explain how the STJ moves during the phases of gait. At contact the STJ is slightly supinated. During contact and through midstance it pronates. Just before propulsion the STJ supinates, then during swing it becomes slightly pronated then slightly supinated ready for Heel Strike again.
Explain how the ankle joint moves during gait. At Heel Strike the ankle is slightly DF, then PFxg during contact. It DFx thru midstance 'til the DF peak at heel lift, after which it PFx through propulsion. Peak PFxn occurs just after toe-off/end of propulsion. The ankle then DFx ready for Heel Strike.
What ligaments support the STJ? The STJ is supported by 5 ligaments: the Interosseous and Cervical Ligaments within the Sinus Tarsi; and three Talo-Calcaneal Ligaments (medial, lateral & posterior)
The STJ axis runs.... STJ axis runs Lateral, Posterior, Plantar --> Medial, Anterior, Dorsal
What are the axes of the STJ? The STJ axes lie 20 degrees from Sagittal and 42 degrees from Transverse
What are the joint axes of the MTJ? The Longitudinal MTJ lies 9 degrees from Sagittal and 15 degrees from Transverse
What are the joint axes of the ANKLE joint? The Ankle joint axes lie 25 degrees from Sagittal and 8 degrees from Frontal
Explain "Planal Dominance" The deviation of the joint axis from a cardinal plane determines which components of the joint movement will dominate in a given individual.
How many articular facets are involved in STJ motion? The STJ normally involves three articulations between the talus and calcaneus.
What is the theory thath explains the difference between closed and open chain motion at a joint? "An open kinetic chain motion at a given joint will produce an equal and opposite motion proximal to the joint when in the closed kinetic chain". (Valmassy)
How would you find "subtalar neutral" in clinic? Patient prone on couch. With one hand pincering the talar head, evert/invert the calcaneus to find the midway position. This is STJ neutral. Can also be found standing in which case it is called NCSP.
Define "Gait" Gait is "any period of locomotion characterised by periodds of loading and unloading the limbs" (Kirtley). "a method of locomotion involving the use of two legs alternately to provide both support and propulsion" (Whittle)
What are the three main tasks of gait? The three main tasks of gait are (1) Weight acceptance (2) Single Limb Support and (3) Limb Advancement
What tasks are achieved in the Loading Response phase of the gait cycle? The loading response phase involves weight acceptance (onto leading leg) and shock absorption (supporting leg).
How would double support and base of gait differ in someone with a balance problem? Balance problems often result in gait adaptations that increase time spent in double support, i.e. shorter step length, wide base of gait.
What supports the MLA in static stance? In static stance, the MLA is supported by ligaments i.e. (1) plantar aponeurosis (2) Spring Ligament (3) Interosseous ligaments (4) Long & Short Plantar Ligs.
What supports the MLA in movement? Dynamic support to the MLA is provided by MUSCLES. Flexor Hallucis Longus, Abductor Hallucis Brevis and Medial Head of Flexor Digitorum Brevis
Name 5 signs of excessive PRONATION Excessive pronation signs: 1) little or no MLA (2) Helbing's sign (bowing of Achilles tendon) (3) forefoot abducted on rearfoot (4) calcaneus everted (5) Talonavicular joint bulging (6) Creasing beneath lateral malleolus
Name 6 signs of excessive SUPINATION Excessive supination signs include (1) high/exaggerated MLA (2) Helbing's sign (bowed Achilles tendon) (3) Forefoot appears adducted on rearfoot (4) inverted calcaneus (5) rigid foot (6) concavity beneath medial malleolus
The MTJ oblique axis allows what movements? The oblique MTJ allows a great deal of sagittal and transverse plane movement.
Will a foot in RCSP that has an everted calcaneus allow a greater or lesser MTJ ROM? Because of the interdependence of the STJ and MTJs, a foot with an everted calcaneus (pronated) will allow increased MTJ motion.
A stride is defined as....? A stride is the period from initial heel strike of one foot to the next heel strike of the same foot.
What percentage of gait is stance phase? Stance occupies approximately 60% of gait.
The first ray is composed of which bones? The first ray bones are the medial cuneiform and the 1st metatarsal.
What bones make up the Lateral Column? The Lateral Column comprises the Calcaneus, Cuboid, lateral Cuneiform and Mets 4&5
When in the gait cycle is the STJ pronating? The STJ starts pronating after Heel Strike, reaching peak pronation during Contact phase. Pronation is reduced throughout Midstance and continues until max supination is achieved just prior to Propulsion. After propulsion, supination reduces and the joinn
What is the medial column? The medial column is the talus, navicular, all three cuneiforms and mets 1-3.
What is the function of the sesamoids? The sesamoids increase the lever arm of Flexor Hallucis Brevis in stabiliting the hallux.
What is the "forefoot" ? Forefoot = metatarsals + phalanges
What is the "midfoot"? Midfoot = Cuboid, Navicular and all three cuneiforms
What is the rearfoot? Rearfoot = Talus and Calcaneus
How does the STJ affect MTJ movement? When the STJ is pronated, this allows greater ROM at the MTJ. STJ unlocks the MTJ's longitudinal axis, enabling the foot to act as a rigid lever.
How does STJ movement enable adaptation to uneven terrain? STJ pronation allows more movement at the MTJ, which enables shock absorption and adaptation to uneven surfaces.
Created by: georgealbertjnr