Module 5 Abnormal Gait 3 B Pathological Differences

Module 5 Abnormal Gait 3 B: Pathological Differences: Foot and Ankle Deviations

References § Perry, J and Burnfield, J. (2010). Gait Analysis: Normal and Pathological Function 2 nd edition. Ch 9. § Hsu, JD; Michael, JW and Fisk, JR. (2008) Atlas of Orthoses and Assistive Devices, 4 th edition. Ch 5, pgs 67 to 74.

Agenda - Pathological Gait: Ankle and Foot Variations • 1. Floor Contact Variations • • • A. B. C. D. E. Forefoot Contact Delayed Heel Contact Foot Flat Contact Low Heel Foot Slap • 2. Ankle Variations • • A. B. C. D. Excess Plantarflexion Excess Dorsiflexion Prolonged Heel Only Premature Heel-Off • 3. Subtalar Joint Variations • A. Excess Inversion • B. Excess Eversion • 4. Toe Variations • A. Excess Toe Extension • B. Limited Toe Extension • C. Clawed Toes

1. Floor Contact Variations • A. Forefoot Contact • Disrupts: heel rocker, forward progression of tibia and shock absorption of knee • Caused by: • Three common resulting loading patterns:

1. Floor Contact Variations • B. Delayed Heel Contact • Disrupts: heel rocker and forward progression • Commonly caused by yielding elastic PF contracture or spasticity • Therefore assessment of PF tightness vs. contracture is imperative • Delayed Heel Contact Video

1. Floor Contact Deviations • C. Foot Flat Contact • Disrupts: heel rocker and forward progression • Caused by: • Video of Pediatric Foot Flat Contact Left Limb

1. Floor Contact Variations, continued • D. Low Heel • Disrupts: heel rocker and forward progression • Caused by: • Very difficult to observe clinically

1. Floor Contact Variations Foot Slap • E. Foot Slap • Disrupts: heel rocker, forward progression and shock absorption • Caused by:

2. Ankle Variations • A. Excessive Plantar Flexion = “inadequate DF” • Disrupts: rockers during stance and toe clearance and limb advancement during swing • Focus now on just Mid Stance and Mid Swing

Pathological Gait • Variations observed during Stance • Variations observed during Swing • Observations made coronally and sagittally

2. Ankle Variations Excessive Dorsiflexion • B. Excessive Dorsiflexion = “inadequate PF” • Disrupts: controlled forward progression of tibia • Early Stance and Later Stance: • Accentuates heel rocker – causes more demand on quads • During pre-swing, shortens limb – causes reduced pelvis support • Limits toe rocker

2. Ankle Variations Heel • C. Prolonged Heel Only • Infrequent finding • Disrupts: stability and forward progression • D. Premature Heel-Off • Disrupts: heel and ankle rockers and associated forward progression • Difficult to see in later part of Stance

2. Ankle Variations • E. No Heel Off/Delayed Heel Off • • Disrupts forefoot and toe rockers Reduces forward progression Shortens contralateral step length Limits Pre-Swing knee flexion

2. Ankle Variations, continued • F. Drag • Disrupts: forward progression and foot clearance • G. Contralateral Vaulting • Decreases contralateral stance stability and increases calf muscle demand • Initial, mid- and terminal Swing

3. Subtalar Variations • A. Excess Inversion = excessive lateral foot contact • A. k. a. “varus” • Swing = difficulty with clearance • Stance = rigid foot less able to absorb shock

3. Subtalar Variations Excess Eversion • B. Excess Eversion = excessive medial foot contact • A. k. a. “valgus” • WA = increases rotary stress on ankle and knee • SLS = prevents achieving rigid forefoot forward progression • Usually result of total weakness of invertors vs. excessive peroneals

4. Toe Variations • A. Excess Toe Extension • During WA = may reflect increased use of long toe extensors if Tibialis Anterior is weak • During SLA, may assist with foot clearance • B. Limited Toe Extension • Disrupts: forefoot and toe rockers • Reduces contra-lateral step length

4. Toe Variations • C. Clawed Toes • Disrupts: forefoot and toe rockers • Reduces contra-lateral step length

So, what do you see? Focus on Ankle and Foot Variations

Foot/Ankle Complex Sagittal Plane Motion

The End

Pedorthic Program of Study This workforce product was funded by a grant awarded by the U. S. Department of Labor’s Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U. S. Department of Labor. The U. S. Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Produced 2016. HOPE Careers Consortium is a partnership of five institutions of higher education that is building exciting new programs that will provide valuable career education and training in the Orthotics, Prosthetics, and Pedorthics (O&P) sector. The five institutions are: Baker College— Flint, Michigan; Century College—White Bear Lake, Minnesota; Oklahoma State University Institute of Technology—Okmulgee, Oklahoma; Spokane Falls Community College—Spokane, Washington; and St. Petersburg College—St. Petersburg, Florida. Although the authoring institution of this educational resource has made every effort to ensure that the information presented is correct, the institution assumes no liability to any party for any loss, damage, or disruption caused by errors or omissions. Except where otherwise noted, this work by St. Petersburg College is licensed under the Creative Commons Attribution 4. 0 International License. To view a copy of this license, click on the following link: Creative Commons Licenses 4. 0.