observational gait analysis - peter · pdf fileevaluation of short leg palpate pelvic crest...
TRANSCRIPT
![Page 1: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/1.jpg)
Observational Gait Analysis
Identifying Key Events in the Gait Cycle
![Page 2: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/2.jpg)
Normal Gait Four objectives must be accomplished for normal gait to occur.1. Leg supports body weight without collapsing2. Balanced maintained (statically &
dynamically) during single support phase3. Swing leg advance to take over supporting
role4. Sufficient power for necessary limb
movements and trunk advancement
![Page 3: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/3.jpg)
Effectiveness Of Normal GaitDepends on free joint mobility & muscle action
Pathological conditions of:musclebonejointssensory nervous systemcentral motor control cardiopulmonary system
Alters mode and efficiency of gait
![Page 4: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/4.jpg)
During Normal Gait Cycle
Joints are:• free to move• possess optimal alignment• depends on…
– fibrous tissue mobility– articular cartilage smoothness
*Evaluated during static biomechanical examination-also examine: plantar lesions, soft tissue abnormalities
![Page 5: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/5.jpg)
Keep In Mind...
• Step• Stride• Cadence• Gait CycleAbnormal or subtle change in gait
– movement is forced due to weakness spasticity or deformity
or– movement is a compensation to correct for some other
problem which needs to be identified
![Page 6: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/6.jpg)
Requirements for Observational Gait Analysis
• Suitable site– straight, level walkway
(length & width)– line of progression– lighting
• Patient attire• Treadmill and video• Observe
– posterior, anterior, lateral– barefoot vs. wearing shoes– with & without orthotics
![Page 7: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/7.jpg)
Observational Gait AnalysisEvent: Head tilt at heel strikeNormal: Vertical PositionSignificance of Deviation• Tilts to short or long limb• Tilts towards the raised shoulder• Muscle tightness • Habit
![Page 8: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/8.jpg)
Observational Gait Analysis
Event: Shoulder position during stanceNormal: EqualSignificance of DeviationShoulder drop due to
– Scolosis– Short or long limb– Trauma– Occupational
![Page 9: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/9.jpg)
![Page 10: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/10.jpg)
Observational Gait AnalysisEvent: Arm swing during stanceNormal: Equal active arm swingSignificance of DeviationNo arm swing
– Need to stabilize the trunk– Tight erect posture
Unilateral arm swing– Greater arm swing on the side of
the short leg– Limitation of motion in the opposite hip– Occupational
![Page 11: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/11.jpg)
Evaluation of Short LegPalpate pelvic crest ASIS and PSIS • Level the pelvic crest with know
thickness of material under short side
![Page 12: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/12.jpg)
Observational Gait Analysis
Event: Pelvic hike in swingNormal: NoneSignificance of DeviationUsed to assist ground clearance if foot drop is present
![Page 13: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/13.jpg)
Observational Gait AnalysisEvent: Pelvic drop of opposite side during
stanceNormal: NoneSignificance of DeviationIf present:• Weak hip abductors• Tight hip adductors
![Page 14: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/14.jpg)
![Page 15: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/15.jpg)
Observational Gait Analysis
Event: Pelvic drop of same side in swing
Normal: NoneSignificance of DeviationIf present suspect:• Opposite side hip abductor
weakness• Loading a short limb• Scolosis
![Page 16: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/16.jpg)
Observational Gait Analysis
Event: External hip rotationNormal: Terminal stance and into swingSignificance of DeviationIncreased by:• Muscle problem – gluteus maximus• Foot fault contact – retroversion• Compensation• Excessive supination at contact
![Page 17: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/17.jpg)
Observational Gait Analysis
Event: Internal hip rotationNormal: Contact into midstanceSignificance of DeviationIncreased by:• Tight medial musculature• Foot contact fault – Anteversion• Compensation• Excessive pronation into propulsion
![Page 18: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/18.jpg)
Observational Gait AnalysisEvent: Knee extension in stanceNormal: Fully extends in midstanceSignificance of DeviationIf excessive consider:Compensation for equinus Weak quadricepsPain
![Page 19: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/19.jpg)
Observational Gait AnalysisEvent: Knee flexion in stanceNormal: After contact and
midswingSignificance of DeviationIf excessive in stance or swing:Hamstring contractureSoleus weakness (stance only)Quadriceps weakness (swing
only)
![Page 20: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/20.jpg)
Observational Gait AnalysisEvent: Transverse plane position
of knee at end of contactNormal: 3-5 internally rotatedSignificance of DeviationInternal:• Internal femoral torsion or position• Spastic or tight medial musculature
![Page 21: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/21.jpg)
Observational Gait Analysis
Event: Transverse plane position of knee at end of contact
Normal: 3-5° internally rotatedSignificance of DeviationExternal:• External femoral torsion or position• Spastic or tight lateral musculature
![Page 22: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/22.jpg)
Observational Gait AnalysisEvent: Frontal plane position
of the knee Normal: Vertical +/- 2°Significance of DeviationBow leg• Coxa valga- genu varum• Pediatric developmentalKnock Knee• Coxa vara- genu valgum• Pediatric developmental
![Page 23: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/23.jpg)
Observational Gait Analysis
Event: Frontal plane position of the tibiaNormal: Vertical +/- 2°Significance of Deviation• Tibial varum• Blount’s disease• Rickets
![Page 24: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/24.jpg)
Observational Gait AnalysisEvent: Frontal plane position of the calcaneus
at heel strikeNormal: 2 - 4° invertedSignificance of DeviationExcessive varus due to:• Tibia varum• Cavus foot type• Plantarflexed 1st ray• Narrow base of gait• Abducted gait angle
![Page 25: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/25.jpg)
Sounds of Heel Strike
Listen…pounding?If excessive pounding this will indicate
lack of shock absorptionLook for shock waves up the leg
![Page 26: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/26.jpg)
Observational Gait AnalysisEvent: Frontal plane position of the calcaneus at
heel strikeNormal: 2 - 4° invertedSignificance of DeviationVertical or valgus due to:• Genu valgum• Calcaneal valgum• Internal femoral torsion• Internal tibial torsion• Weak anterior group• Inability to resupinate
![Page 27: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/27.jpg)
Navicular Position- Sagittal View
• Pronation - talar head adducts against navicular, decreasing distance from ground
• Supination - talar head abducts, increasing distance from ground
• Can be related to Medial longitudinal arch angle
![Page 28: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/28.jpg)
Observational Gait Analysis
Event: Angle of gait during stance phaseNormal: 10-15 ° abductedSignificance of DeviationAbducted gait due to:
– External hip rotation– External tibial rotation– Fully compensated MTJ– Pronated foot at heel off
![Page 29: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/29.jpg)
Observational Gait Analysis
Event: Angle of gait during stance phaseNormal: 10-15 ° abductedSignificance of DeviationAdducted gait due to:
– Internal hip rotation– Internal tibial torsion– Tight medial hamstring– Metatarsus adductus
![Page 30: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/30.jpg)
Observational Gait Analysis
Event: Base of gait during the stance phase
Normal: 4” in width between subsequent heel strike
Significance of DeviationNarrow base due to:
– Tibia varum– Increase in cadence, running, and jogging
![Page 31: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/31.jpg)
Observational Gait AnalysisEvent: Base of gait during the stance
phaseNormal: 4” in width between subsequent heel
strikeSignificance of DeviationBroad base due to:
– Genu valgum– Instability of the trunk– Pediatric– Geriatric
![Page 32: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/32.jpg)
Observational Gait AnalysisMTJ
– Midstance & propulsion - key for foot stability
Metatarsal heads– FFL- anterior view - 5th met. head contacts first,
followed in sequence by the others– Propulsion - reverse - 5th leaves first
• 1st MPJ - lateral view - df TOE POSITION
– contact - dorsiflexion– midstance - plantargrade
![Page 33: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/33.jpg)
Observational Gait Analysis
Event: Time of heel liftNormal: 60-70% of stance phase, when
opposite limb has passed the support limb
Significance of DeviationPremature heel lift due to:
– Short or spastic posterior group, ankle block– Associated with the limited midtarsal ROM
![Page 34: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/34.jpg)
Observational Gait Analysis
Event: Time of heel liftNormal: 60-70% of stance phase,
when opposite limb has passed the support limb
Significance of DeviationDelayed heel lift due to:
– Moderate to severe MTJ compensation
– Short stride
![Page 35: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/35.jpg)
Observational Gait AnalysisEvent: Frontal plane motion of the foot to the
support surface during propulsionNormal: Lateral side of the foot raises
earlier than medial sideSignificance of DeviationInverted gait due to:
– Forefoot varus– Forefoot valgus– Rigid plantarflexed 1st ray– Functional hallux limitus– Adducted gait angle
![Page 36: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/36.jpg)
Observational Gait Analysis
Event: Frontal plane motion of the calcaneus at heel lift
Normal: Vertical moving into inversionSignificance of DeviationVertical or valgus
– Pronated STJ
![Page 37: Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot](https://reader035.vdocuments.mx/reader035/viewer/2022062302/5a78753e7f8b9a1f128b4647/html5/thumbnails/37.jpg)
Observational Gait AnalysisEvent: Direction of weight flow through
hallux at toe offNormal: moves through the long axis of the
halluxSignificance of DeviationMedial side of hallux due to:
– Pronated STJ and MTJ– Abducted gait– FHL– Hallux rigidus