Gait Pathology

1. In order to identify pathological gait deviations, the clinician must compare normal gait patterns and joint positions to the picture the patient presents. This is best learned segmentally, starting with the _______ and ____ and then proceeding to the _____, ____, _____ and _____.

ankle and toes and then proceeding to the knees, hips, pelvis and trunk.

2. After performing a gait analysis, identify the major problems that prevent the accomplishment of the three functional tasks, _________________, ____________, and _________________.

Weight AcceptanceSingle Limb Support Swing Limb Advancement

3. Which box Indicates that the deviation significantlyimpacts the mechanics of walking. (Major Deviation)a. Light Gray Boxb. White Boxc. Dark Gray Box

4. Which box indicates that either the deviation does not occur during that phase, or that position would not be considered abnormal.a. Light Gray Boxb. White Boxc. Dark Gray Box

5. Which box indicates that the deviation may occur in aphase, but it does not affect the accomplishment of the functionaltask. (Minor Deviation)a. Light Gray Boxb. White Boxc. Dark Gray Box

6. Identify the problem associated with the description of the deviation. Plantar flexion greater than normal for the specific phase.a. Foot-Flat Contact b. Excess Dorsiflexionc. Excess Plantar Flexiond. Drage. No Heel Off

c. Excess Plantar Flexion

7. Identify the ankle & foot problem associated with the description given.Initial contact with the ground made by the entire foot.a. Foot Slapb. Forefoot Contact c. No Heel Offd. Excess Inversion / Eversione. Foot-Flat Contact

e. Foot-Flat Contact

8. Identify the ankle & foot problem associated with the description given. Absence of heel rise during TSt or PSw.a. No Heel Offb. Forefoot Contact c. Heel Offd. Foot-Flat Contact e. Contralateral Vaulting

a. No Heel Off

9. Identify the ankle & foot problem associated with the description given.Rising on the forefoot of the opposite stance limb during limb advancement of the reference leg.a. Contralateral Vaultingb. Excess Dorsiflexionc. Excess Inversion / Eversiond. Foot-Flat Contact e. Drag

a. Contralateral Vaulting

10. Identify the ankle & foot problem associated with the description given.Inversion/eversion of the calcaneus or forefoot greater than normal for the specific phase.a. Forefoot Contact b. Dragc. Heel Offd. Excess Inversion / Eversione. Excess Plantar Flexion

d. Excess Inversion / Eversion

11. Identify the ankle & foot problem associated with the description given.Contact of the toes, forefoot or heel with the ground during SLA.a. Foot Slapb. Foot-Flat Contact c. No Heel Offd. Forefoot Contact e. Drag

e. Drag

12. Identify the ankle & foot problem associated with the description given.Initial contact with the ground made by the forefoot.a. Excess Dorsiflexionb. Foot Slapc. Forefoot Contact d. Excess Plantar Flexione. Heel Off

c. Forefoot Contact

13. Identify the ankle & foot problem associated with the description given.Dorsiflexion greater than normal for the specific phase.a. Heel Offb. No Heel Offc. Foot-Flat Contact d. Foot Slape. Excess Dorsiflexion

e. Excess Dorsiflexion

14. Identify the ankle & foot problem associated with the description given.Uncontrolled plantar flexion at the ankle joint after heel contact, accompanied by a slapping sounda. Heel Offb. Foot-Flat Contact c. Excess Plantar Flexiond. Foot Slape. Excess Dorsiflexion

d. Foot Slap

15. Identify the ankle & foot problem associated with the description given.Heel not in contact with the ground during LR or MSt.a. Excess Dorsiflexionb. Heel Offc. Excess Plantar Flexiond. Measlese. Foot-Flat Contact

b. Heel Off

16. Extension of the toes beyond neutralUp

17. Less metatarsalphalangeal extension than normal for the specific phaseInadequate Extension

18. Flexion of the distal interphalangeal joints and flexion or extension of the proximal interphalangeal jointsClawed / Hammered

19. ANKLE & FOOT- Problem: Forefoot or Flat-foot ContactTask: Weight Acceptance (WA)Most Likely Causes: a. Secondary to excess knee flexion in TSwb. Compensatory for weak quadriceps to avoid normal LRc. Secondary to excess plantar flexion in TSwd. Heel painSignificance:a. Poor position for heel rockerb. Decreases forward momentum of the tibiac. Decreases shock absorption by limiting knee flexion (forefoot contact)

20. ANKLE & FOOT- Problem: Foot Slap Task: Weight Acceptance (WA)Most Likely Causes: a. Weak pretibials Significance:a. Decreases forward momentum of the tibiab. Decreases shock absorption by limiting knee flexion

21. ANKLE & FOOT- Problem: Excess Plantar FlexionTask: Weight Acceptance (WA)Most Likely Causes: a. Plantar flexion contractureSignificance:a. Poor position for heel rocker

22. ANKLE & FOOT- Problem: Excess Plantar FlexionTask: Single Limb Support (SLS)Most Likely Causes: a. Plantar flexor hypertonicityb. Weak quadricepsc. Impaired proprioceptiond. Ankle painSignificance:a. Decreases shock absorption by limiting knee flexion (W A)b. Decreases forward progression of the tibia over the ankle and forefoot

23. ANKLE & FOOT- Problem: Excess Plantar FlexionTask: Swing Limb Advancement (SLA)Most Likely Causes: a. Weak pretibialsb. Plantar flexion contracturec. Plantar flexor hypertonicityd. Lack of selective dorsiflexioncontrol (TSw)Significance:a. Interferes with foot clearance b. Interferes with foot position for IC

24. ANKLE & FOOT- Problem: Excess DorsiflexionTask: Weight Acceptance (WA)Most Likely Causes: a. Secondary to excess hip or knee flexionSignificance:a. Increases the demand on the hip and knee extensorsb. Decreases limb stability

25. ANKLE & FOOT- Problem: Excess DorsiflexionTask: Single Limb Support (SLS)Most Likely Causes: a. Weak calfb. Secondary to excess hip and knee flexionc. Intentional to lower the opposite limb for contact (TSt)d. Excess midfoot dorsiflexion secondary to limited ankle mobilitySignificance:a. Increases the demand on the hip and knee extensorsb. Interferes with heel rise and decreases step length of the opposite limb (TSt)

26. ANKLE & FOOT- Problem: Excess InversionTask: Weight Acceptance (WA), Single Limb Support (SLS), Swing Limb Advancement (SLA)Most Likely Causes: a. Tibialis anterior, tibialis posterior, or soleus overactivityb. Varus contracturec. Plantar flexion contracture (SLS)d. Weak peroneals e. Lack of selective motor control of the pretibialsf. Variations in skeletal alignment resulting in a high archg. Internal tibial torsion

Significance:a. Poor position for W Ab. Rigid foot resulting in decreased shock absorptionc. Decreases stability in SLSd. Decreased foot clearance in SLA

27. ANKLE & FOOT- Problem: Excess EversionTask: Weight Acceptance (WA), Single Limb Support (SLS), Swing Limb Advancement (SLA)Most Likely Causes: a. Weak tibialis posterior (WA & SLS), soleus (SLS)b. Plantar flexion contracture (SLS)c. Valgus deformityd. Referred from the knee or hip jointe. Variations in skeletal alignment resulting in a low archf. Weak tibialis anteriorg. Peroneal hypertonicitySignificance:a. Rotary strain on midfoot and knee b. Interferes with rigid lever for forefoot rockerc. Can be used to gain dorsiflexion range when ankle mobilty is limited

28. ANKLE & FOOT- Problem: Heel OffTask: Weight Acceptance (WA), Single Limb Support (SLS) Most Likely Causes: a. Secondary to excess plantar flexionb. Heel pain c. Secondary to excess knee flexion Significance:a. Decreases the base of support due to smaller weight bearing surface b. Increases pressure on the MT heads

29. ANKLE & FOOT- Problem: No Heel OffTask: Single Limb Support (SLS), Swing Limb Advancement (SLA)Most Likely Causes: a. Weak calf b. Ankle or metatarsal head painc. Secondary to inadequate extension of the toesd. Secondary to excess dorsiflexionSignificance:a. Interferes with progression over the forefootb. Decreases step length of the opposite limbc. Results in limited knee flexion inSLA

30. ANKLE & FOOT- Problem: DragTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Secondary to limited hip flexion, limited knee flexion or excess plantar flexionb. Impaired proprioceptionSignificance:a. May result in loss of balanceb. Interferes with limb advancementc. May cause injury to toes

31. ANKLE & FOOT- Problem: Contralateral VaultingTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Compensatory for limited flexion of the swing limbb. Compensatory for longer swing limb Significance:a. Increases the demand on the calf muscles

32. TOES - Problem: UpTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Compensatory for weak tibialis anterior or insufficient dorsiflexionb. Toe extensor hypertonicity Significance:a. May help with foot clearance b. May cause skin irritation or callouses on the dorsum of the toes from rubbing against the shoe

33. TOES - Problem: Inadequate ExtensionTask: Single Limb Support (SLS), Swing Limb Advancement (SLA)Most Likely Causes:a. Limited toe extension range of motion including hallux valgus, or hallux rigidus b. Toe flexor hypertonicityc. Forefoot paind. Secondary to no heel off Significance:a. Interferes with forward progressionb. Decreases step length of the opposite limb

34. TOES - Problem: Clawed / HammeredTask: Single Limb Support (SLS) Most Likely Causes:a. Toe flexor or extensor hypertonicity b. Imbalance of the long toe extensors and intrinsic foot muscles c. Compensatory for weak plantar flexorsSignificance:a. Interferes with forward progressionb. Decreases step length of the opposite limb

35. Identify the knee problem associated with the description given.Alternating flexion and extension of the knee occurring during a single phase.a. Excess Flexionb. Wobblesc. Extension Thrustd. Varus/Valgus b. Wobbles

36. Identify the knee problem associated with the description given.Forceful motion of the knee towards extension

a. Limited Flexionb. Excess Flexionc. Excess Contralateral Flexiond. Extension Thrust

d. Extension Thrust

37. Identify the knee problem associated with the description given.Knee flexion greater than normal during LR, MSt or TSt of the opposite limb; this occurs during SLA of the reference limba. Excess Contralateral Flexionb. Wobblesc. Varus/Valgusd. Limited Flexion

a. Excess Contralateral Flexion

38. Identify the knee problem associated with the description given.Lateral/medial angulation of the tibia relative to the femura. Wobblesb. Varus/Valgusc. Excess Flexiond. Excess Contralateral Flexion

b. Varus/Valgus

39. Identify the knee problem associated with the description given.Position of knee beyond neutral extensiona. Excess Flexionb. Limited Flexionc. Extension Thrustd. Hyperextends

d. Hyperextends

40. Identify the knee problem associated with the description given.Less than normal knee flexion for the specific phasea. Wobblesb. Varus/Valgusc. Limited Flexiond. Extension Thrust

c. Limited Flexion

41. Identify the knee problem associated with the description given.Greater than normal knee flexion for the specific phasea. Excess Flexionb. Limited Flexionc. Extension Thrustd. Wobbles.

a. Excess Flexion

42. KNEE - Problem: Limited FlexionTask: Weight Acceptance (WA) Most Likely Causes: a. Weak quadricepsb. Secondary to forefoot or foot- flat contact with a tight calfc. Knee paind. Quadriceps hypertonicitye. Impaired proprioception Significance:a. Decreases shock absorption b. Decreases forward momentum of the tibiac. Potential injury to the posterior capsule of the knee joint

43. KNEE - Problem: Limited FlexionTask: Swing Limb Advancement (SLA)Most Likely Causes: a. Secondary to excess hip flexion or no heel off in TSt b. Impaired motor control resulting in inability to rapidly flex the kneec. Knee paind. Knee extension contracturee. Extensor hypertonicity (plantar flexor and/or knee extensor)f. Limited thigh advancement secondary to hamstring hypertonicity or hip flexor weakness

Significance:a. Interferes with foot clearance (ISw)b. Decreased knee flexion in PSw usually results in decreased knee flexion in ISwc. Increases energy cost

44. KNEE - Problem: Excess FlexionTask: Weight Acceptance (WA), Single Limb Support (SLS) Most Likely Causes: a. Knee flexion contracture b. Knee flexor hypertonicityc. Secondary to excess hip flexiond. Secondary to decreased contralateral limb stance stabilty (W A)e. Secondary to excess dorsiflexionf. Knee paing. Intentional to lower the opposite limb (TSt)h. Secondary to posterior pelvic tilt with hip flexion contracture (SLS)Significance:a. Increases the demand on the plantar flexors, quadriceps, and hip extensors.b. Decreases limb stability

45. KNEE - Problem: Excess FlexionTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Knee flexion contractureb. Inability to selectively extend the knee while maintaining a flexed hipc. Weak quadricepsd. Hamstring hypertonicitye. Intentional to allow forefoot or footflat contactSignificance:a. Decreases step length of the reference limbb. Interferes with heel first contact

46. KNEE - Problem: WobblesTask: Weight Acceptance (WA), Single Limb Support (SLS)Most Likely Causes:a. Impaired proprioceptionb. Quadriceps hypertonicityc. Plantar flexor hypertonicitySignificance:a. Decreases forward momentumb. Decreases limb stabilty and balance

47. KNEE - Problem: Hyperextends or Extension TrustTask: Weight Acceptance (WA) Most Likely Causes:a. Secondary to forefoot contact with excess plantar flexor tightnessb. Weak quadricepsc. Impaired proprioceptiond. Quadriceps hypertonicitye. Intentional to increase limb stabilitySignificance:a. Decreases shock absorptionb. Decreases forward progression of the tibiac. Potential injury to the posterior structures of the knee joint

48. KNEE - Problem: Hyperextends or Extension TrustTask: Single Limb Support (SLS) Most Likely Causes:a. Secondary to excess plantar flexion b. Impaired proprioceptionc. Intentional to increase limb stabilty Significance:a. Decreases forward progression of the tibiab. Potential injury to the posterior elements of the knee joint

49. KNEE - Problem: Hyperextends or Extension TrustTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Impaired proprioceptionb. Intentional to extend the knee Significance:a. May assist in achieving maximum knee extension 50. KNEE - Problem: Varus / ValgusTask: Single Limb Support (SLS) Most Likely Causes:a. Joint or ligamentous instabilityb. Bony deformityc. Resulting from a dysfunctional subtalar jointd. Secondary to lateral trunk lean (valgus)Significance:a. Decreases limb stabilty b. Necessitates compensation proximal or distal to the kneec. May result in knee pain

51. KNEE - Problem: Excess Contralateral FlexionTask: Swing Limb Advancement (SLA)Most Likely Causes:a. Intentional to lower reference swing limb to the groundb. Secondary to excess knee flexion in SLS of the opposite limb Significance:a. Relatively lengthens the reference swing limb and interferes with foot clearance and limb advancementb. Increases the energy demand on the opposite stance limb

52. Identify the hip problem associated with the description given.A visible forward and then backward movement of the thigh during TSw.a. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

c. Past Retract

53. Identify the hip problem associated with the description given. Considered a deviation if other than Neutrala. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

d. Abduction

54. Identify the hip problem associated with the description given.Considered a deviation if the patella is facing laterallya. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

e. External Rotation

55. Identify the hip problem associated with the description given.Less than normal hip extension for the specific phasea. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

b. Inadequate Extension

56. Identify the hip problem associated with the description given.Considered a deviation if other than neutrala. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

d. Abduction

57. Identify the hip problem associated with the description given.Considered a deviation if the patella is facing mediallya. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

g. Internal Rotation

58. Identify the hip problem associated with the description given.Less than normal hip flexion for the specific phasea. Limited Flexionb. Inadequate Extensionc. Past Retractd. Abductione. External Rotationf. Adductiong. Internal Rotation

a. Limited Flexion

59. HIP (THIGH Vs. VERTICAL) - Problem: Limited FlexionTask: Weight Acceptance (WA) Most Likely Causes:a. Intentional to decrease the demand on the hip extensorsb. Limited hip flexion achieved in TSw Significance:a. May disturb the normal LR by limiting knee flexion and ankle plantar flexion

HIP (THIGH Vs. VERTICAL)

Swing Limb Advancement (SLA)

Weight Acceptance (WA) , Single Limb Support (SLS)