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Gait Deviations

Common gait deviations in LE

Deviation Description Possible CausesAnalysis
Initial contact - Foot flat Entire foot contacts the ground at heel strike Excessive fixed dorsiflexion flaccid or weak dorsiflexors neonatal/proprioceptive walking Check ROM of ankle; check for hyperextension at the knee and persistence of immature gait pattern
Initial contact - Excessive knee flexion Knee flexes or buckles rather than extends as foot hits the ground Painful knee; spasticity of knee flexors or weak quadriceps; short leg on contralateral side Check for pain at knee; tone of knee flexors; strength of knee extensors; leg length; anterior pelvic tilt
Initial contact to foot flat - Excessive hip flexion Flexion exceeding 30 degrees at the hip Hip and/or knee flexion contracture; knee flexion caused by weak soleus and quadriceps; hypertonicity of hip flexors Check hip and knee ROM and strength of soleus and quads; check tone of hip flexors
Initial contact to foot flat - Limited hip flexion Hip flexion does not reach 30 degrees Weakness of hip flexors; limited range of hip flexion; glut max weakness Check strength of hip flexors and extensors; analyze hip ROM
Midstance - Excessive position plantar flexion Tibia does not advance to neutral from 10 degrees of plantar flexion No eccentric contraction of plantar flexors due to flaccidity/weakness in plantar flexors; surgical overrelease, rupture, or contraction of achilles tendon Check for spastic or weak quads; hyoerextension at knee or hip; backward or forward leaning trunk; weakness or rupture of achilles tendon
Midstance - Heel lift in midstance Heel does not contact ground in midstance Spasticity of plantar flexors Check for spasticity in plantar flexors, quads, hip flexors, and adductors
Midstance - Excessive positional dorsiflexion Tibia advances too rapidly over the foot, creating a greater than normal amount of dorsiflexion Inability of plantar flexors to control tibial advance; knee or hip flexion contractures Test ankle muscles, knee and hip flexors, and trunk position
Midstance - Toe clawing Toes flex and "grab" floor Plantar grasp reflex not fully integrated; positive supporting reflexes; spastic toe flexors Check plantar grasp reflex, positive supporting reflexes, and ROM of toes
Initial contact- Foot slap At heel strike, forefoot slaps the ground Flaccid or weak dorsiflexors; atrophy of dorsiflexors Look for low muscle tone at ankle; Steppage gait in swing phase
Initial contact - Toes first Toes contact ground instead of heel; tip toe posture may stay throughout phase or heel may contact ground Leg length discrepancy; contracted heel cord; plantar flexion contracture; spasticity of plantar flexors; flaccidity of dorsiflexors; painful heel Compare leg length and look for hip and/or knee flexion contractures; analyze muscle tone and timing of plantar flexors; check pain in heel
Created by: jvlassov