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Pathological Gait






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Pathological Gait. Excessive Plantarflexion. Causes Triceps surae contracture Triceps surae spasticity Pre-tibial weakness Voluntary/compensatory 2 0 weak quadriceps. Loading Response Deviations. FF contact sustained. FF contact  foot flat (rigid ankle)  knee hyperextension.
Pathological Gait

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Pathological gait l.jpgSlide 1

Pathological Gait

Excessive plantarflexion l.jpgSlide 2

Excessive Plantarflexion

Causes

  • Triceps surae contracture

  • Triceps surae spasticity

  • Pre-tibial weakness

  • Voluntary/compensatory 20 weak quadriceps

Loading response deviations l.jpgSlide 3

Loading Response Deviations

FF contact sustained

FF contact  foot flat (rigid ankle)  knee hyperextension

FF contact  rapid foot

flat (flexible ankle)

FF = fore foot

Midstance deviations l.jpgSlide 4

Midstance Deviations

Foot flat w/ restrained

tibia

Fwd. trunk lean, short contralateral step

Premature

heel rise

Terminal stance deviations l.jpgSlide 5

Terminal Stance Deviations

Pelvic obliquity  high on side of deviation

Excessive heel rise

Mid swing deviations l.jpgSlide 6

Mid Swing Deviations

Compensatory  hip and/or knee flexion

Toe Drag

Excessive dorsiflexion l.jpgSlide 7

Excessive Dorsiflexion

  • Weak triceps surae

  • Ankle joint fusion at neutral

  • Excessive knee flexion

Loading response deviations8 l.jpgSlide 8

Loading Response Deviations

Higher heel rocker

 knee    quad demand

Loading response deviations 2 0 rigid afo l.jpgSlide 9

Loading Response Deviations 20 Rigid AFO

Rigid AFO  knee and hip flexion

Terminal stance deviations10 l.jpgSlide 10

Terminal Stance Deviations

Prolonged heel contact

 knee  w/ heel rise

OR

Pre swing deviations l.jpgSlide 11

Pre Swing Deviations

Sustained heel contact   plantarflexion

Inadequate knee flexion excessive extension l.jpgSlide 12

Inadequate Knee Flexion / Excessive Extension

  • Quadriceps weakness

  • Pain

  • Quadriceps spasticity

  • Excessive ankle plantarflexion

Pre swing and initial swing l.jpgSlide 13

Pre Swing and Initial Swing

 ankle dorsiflexion w/

prolonged heel contact

Toe Drag

Midstance l.jpgSlide 14

Midstance

Retraction of tibia (soleus)

and femur (gluteus max)

when knee lacks

hyperextension range

Inadequate knee flexion 2 0 excessive plantarflexion l.jpgSlide 15

Inadequate knee flexion 20 excessive plantarflexion

Overall disruption of normal coordination

between the knee and ankle

Inadequate knee extension excessive knee flexion l.jpgSlide 16

Inadequate Knee Extension / Excessive Knee Flexion

Causes

  • Hamstring spasticity

  • Knee flexion contracture

  • Soleus weakness

  • Excessive ankle plantarflexion

Excessive knee flexion loading response l.jpgSlide 17

Excessive Knee Flexion - Loading Response

Resulting in  ankle dorsiflexion

Excessive knee flexion midswing l.jpgSlide 18

Excessive Knee Flexion - Midswing

As a compensation for

 ankle plantarflexion

Inadequate knee extension midstance and terminal stance l.jpgSlide 19

Inadequate Knee Extension – Midstance and Terminal Stance

Accompanied w/  ankle dorsiflexion   limb

and body advancement

Inadequate knee extension terminal swing l.jpgSlide 20

Inadequate Knee Extension – Terminal Swing

Loss of terminal reach

Inadequate hip extension excessive hip flexion l.jpgSlide 21

Inadequate Hip Extension – Excessive Hip Flexion

  • Hip flexion contracture

  • Iliotibial band contracture

  • Hip flexor spasticity

  • Pain

  • Voluntary/Compensatory

Inadequate hip extension tst l.jpgSlide 22

Inadequate Hip Extension – TSt

Contracture

 step length and

body advancement

Excessive hip flexion msw l.jpgSlide 23

Excessive Hip Flexion - MSw

Compensation for 

ankle plantarflexion

Inadequate hip flexion l.jpgSlide 24

Inadequate Hip Flexion

  • Hip flexor weakness

  • Hip joint arthrodesis

Inadequate hip flexion tsw l.jpgSlide 25

Inadequate Hip Flexion - TSw

Rapid hip /

Rapid hip 

Compensation for weak quadriceps that

cannot extend the knee (flaccid knee)

Compensations for inadequate hip flexion psw isw l.jpgSlide 26

Compensations for Inadequate Hip Flexion – PSw/ISw

Compensatory posterior

pelvic tilt

Compensations for inadequate hip flexion psw isw27 l.jpgSlide 27

Compensations for Inadequate Hip Flexion – PSw/ISw

Voluntary excessive (magnitude &

velocity) knee flexion

Excessive hip adduction l.jpgSlide 28

Excessive Hip Adduction

Causes:

  • Ipsilateral abductor weakness

  • Adduction contracture or spasticity

  • Using adductors as hip flexors

  • Contralateral hip abduction contracture

Deviations l.jpgSlide 29

Deviations

Swing  “Scissor Gait”

Combined hip  & IR

Deviations30 l.jpgSlide 30

Deviations

20 adductor contracture

or spasticity

20 adductors used as hip flexors

20 glute med weakness

Excessive hip abduction l.jpgSlide 31

Excessive Hip Abduction

Causes

  • Ipsilateral abduction contracture

  • Contralateral adduction contracture

  • Scoliosis w/ pelvic obliquity

Deviations32 l.jpgSlide 32

Deviations

Compensation for

inadequate knee flexion

20 contralateral

abduction or ipsilateral

adduction contracture

Excessive hip external rotation l.jpgSlide 33

Excessive Hip External Rotation

Causes

  • Gluteus maximus overactivity

  • Excessive ankle plantarflexion

Excessive hip internal rotation l.jpgSlide 34

Excessive Hip Internal Rotation

Causes

  • Medial hamstring overactivity

  • Adductor overactivity

  • Anterior abductor overactivity

  • Quadriceps weakness


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