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Common gait deviations in LE

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Possible Causes
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  


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Created by: jvlassov