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Normal Gait Patterns Have Two Major Periods: 1. Double Limb Support: a) weight loading b) weight unloading 2. Single Limb Support: a) stance phase of ipsilateral side b) swing phase of contralateral side
DOUBLE LIMB SUPPORT WEIGHT UNLOADING: Phases: Trailing foot is rolling off floor when heel rises when 1st MTP rolls off floor Pre-Swing Max. plantarflexion (20 o) Flexes to approx. 40o Flexes to approx. 0o (neutral) Less anterior rotation Begin anterior elevation Aligned towards wt. loading leg
Terminal Stance Heel rise Full extension Max. extension (20o) Relative anterior rotation Posterior depression Aligned between legs
Weight is transferred to contralateral leg Initial Contact: Loading Response: when heel contacts floor when sole of foot contacts floor
Initial Contact Neutral Knee extended Flexed 25o Level Aligned between legs
Loading Response Plantarflexes 10o Knee flexes 15o Stable 25o flexion Relative abduction Lateral drop to swing leg Aligned towards wt. bearing leg
Body is aligned over the stationary foot Contralateral leg is off the floor
(Initial Mid-Stance, Mid-Stance, Late Mid-Stance) Initial Mid-Stance Slight plantarflexion Slight flexion Flexed, Relative adduction Late Mid-Stance Max. dorsiflexion (10 o) Extended Extended, Relative adduction
10o
Lateral drop to swing leg, externally rotated Toward stance leg Away from stance leg Trunk rises in an arc over the stationary foot
Leg shortens via hip and knee bend to simplify floor clearance Initial Swing: big toe leaves ground Mid-Swing: contralateral leg is at high point mid-stance Terminal Swing: leg reaching forward for next floor contact Initial Swing Plantarflexed Max. flexion (60 o) Flexion, Relative abduction Mid-Swing Neutral Flexion Max, flexion (25 o) Max. abduction (10o) Terminal Swing Neutral Max. extension (0o) Flexion, Relative abducted
Lateral drop to swing leg, medial rotated Aligned over stance leg
Pathway of Center of Gravity Sagittal Plane: Rhythmical up and down motion Highest point: Over extended single leg (MSt) Lowest point: Double limb support (PSw/LR) Vertical displacement of 4-5 cm. (sinusoidal wave) Frontal Plane: Rhythmical side-to-side motion Most lateral point: Mid-Stance C. O. G. swings laterally in as arc over the stationary foot Lateral displacement of 4-5 cm. (sinusoidal wave)
References: Greenman PE. Clinical aspects of sacroiliac function in walking. Manual Medicine. 1990;5:125130. Koerner I. Observation of Human Gait. Edmonton, Alberta, Canada: University of Alberta; 1986. Observational Gait Analysis. Downey, CA: Rancho Los Amigos Research and Education Institute; 1993. Perry J. Gait Analysis. Normal and Pathological Function. Thorofare, NJ: Slack; 1992.
Talonavicular
Subtalar Ankle
Knee
Hip
Common Lower Extremity Musculoskeletal Impairments Associated With Gait Deviations Joint ROM/Muscle Length Deficits
1st MTP Dorsiflexion Talocalcaneal Eversion Talocrural Dorsiflexion Tibiofemoral Extension Tibiofemoral Flexion Patellofemoral Medial Glide Hip Extension
Joint Hypermobility/Instability
Calcaneocuboid/Oblique MTJA Talonavicular/Longitudinal MTJA
1 Foot Capsule Disorders "Midtarsal Joint Capsulitis" ICD-9-CM: 845.11 Sprain of tarsometatarsal joint
Diagnostic Criteria History: Arch area pain - medial or lateral Pain worse with single limb support phase of gait Recent strain or repetitive use Pain at end range of one or more of the following accessory movement tests (dorsal glide or plantar glide of the distal bone on a stabilized proximal bone): Lateral Foot Calcaneus Cuboid Navicular/3rd Cuneiform Cuboid
Physical Exam:
Talus - Navicular Accessory Movement Test Cues: Patient sits on edge of table to allow knee flexion Proximal forearm rests on tibia, index finger metacarpal (MCP) stabilizes dorsal surface of talus, PIP and DIP stabilize talus using sustentaculum tali of calcaneus Distal index finger MCP provides the planter glide and PIP and DIP provide the dorsal glide of the navicular Alter forearm/upper extremity angle to align force with the "treatment plane" (move the navicular with a glide parallel to the plane of the talonavicular joint) Determine symptom response, available motion, and end feel