click below
click below
Normal Size Small Size show me how
Gait Deviations
Common gait deviations in LE
Deviation | Description | Possible Causes | Analysis |
---|---|---|---|
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 |