Post on 04-Jun-2018
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Joe Godges DPT 1
Normal Gait Mechanics
Normal Gait Patterns Have Two Major Periods:
1. Double Limb Support: a) weight loading
b) weight unloading2. Single Limb Support: a) stance phase of ipsilateral side
b) swing phase of contralateral side
DOUBLE LIMB SUPPORT
WEIGHT UNLOADING: Trailing foot is rolling off floor
Phases: Terminal Stance: when heel risesPre-Swing: when 1st MTP rolls off floor
Joint Motions: Terminal Stance Pre-Swing
Ankle Heel rise Max. plantarflexion (20o)
Knee Full extension Flexes to approx. 40o
Hip Max. extension (20o) Flexes to approx. 0o (neutral)
Pelvis Relative anterior rotation Less anterior rotation
Posterior depression Begin anterior elevation
Trunk Aligned between legs Aligned towards wt. loading leg
WEIGHT LOADING: Weight is transferred to contralateral leg
Phases: Initial Contact: when heel contacts floor
Loading Response: when sole of foot contacts floor
Joint Motions Initial Contact Loading Response
Ankle Neutral Plantarflexes 10o
Knee Knee extended Knee flexes 15o
Hip Flexed 25o Stable 25o flexion
Relative abduction
Pelvis Level Lateral drop to swing legTrunk Aligned between legs Aligned towards wt. bearing leg
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Joe Godges DPT 2
SINGLE LIMB SUPPORT Body is aligned over the stationary foot
Contralateral leg is off the floor
STANCE PHASE: (Initial Mid-Stance,Mid-Stance, Late Mid-Stance)
Joint Motions Initial Mid-Stance Late Mid-Stance
Ankle Slight plantarflexion Max. dorsiflexion (10 o)
Knee Slight flexion Extended
Hip Flexed,
Relative adduction 10o
Extended,
Relative adduction
Pelvis Lateral drop to swing leg, externally rotated
Trunk Toward stance leg Away from stance leg
Trunk rises in an arc over the stationary foot
SWING PHASE: Leg shortens via hip and knee bend to simplify floor clearance
Sub Phases: 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
Joint Motions Initial Swing Mid-Swing Terminal Swing
Ankle Plantarflexed Neutral Neutral
Knee Max. flexion (60 o) Flexion Max. extension (0o)
Hip Flexion,
Relative abduction
Max, flexion (25 o)
Max. abduction (10o)
Flexion,
Relative abducted
Pelvis Lateral drop to swing leg, medial rotatedTrunk 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;5:125-
130.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.
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Joe Godges DPT 3
Critical Events During Gait
Joint Sagittal Plane Frontal Plane Transverse Plane
1
st
MTP 65
o
extension at PSw
Midtarsal:
Calcaneocuboid
Control of Abduction at TSt
PF of 1st Ray at TSt/PSw
(Peroneus Longus)
Oblique MT Jnt Axis stability
at TSt
Talonavicular Control of Eversion at MSt
(Tib Ant and Tib Post)
Longitudinal MT Jnt Axis
stability at TSt
Subtalar 4-6
o
eversion at IC/LR
Ankle 10o-20o DF at TSt
Control of DF (tibial
advancement) after
MSt
(Gastroc. and Soleus)
Knee Control of flexion at LR
(Quadriceps and VMO)
0o extension at TSt
60o flexion at ISw
Produce full ext. at TSw
Patellar Medial Glide
Hip Control of flexion at LR
(Hip extensors)
20o extension at TSt
Control of lateral pelvic tilt
at MSt
(Hip Abductors)
Common Lower Extremity Musculoskeletal Impairments Associated With Gait
Deviations
Joint ROM/Muscle Length
Deficits
Motor Control/Strength
Deficits
Joint Hypermobility/Instability
1st MTP Dorsiflexion Tibialis Anterior Calcaneocuboid/Oblique MTJA
Talocalcaneal Eversion Tibialis Posterior Talonavicular/Longitudinal MTJA
Talocrural Dorsiflexion Peroneus Longus
Tibiofemoral Extension Gastrocnemius/Soleus
Tibiofemoral Flexion Quadriceps/VMO
Patellofemoral Medial Glide Gluteus Medius/Minimus
Hip Extension Gluteus Maximus
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Joe Godges PT, Robert Klingman PT Loma Linda U DPT Program KPSoCal Ortho PT Residency
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 gaitRecent strain or repetitive use
Physical Exam: 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):
Medial Foot Lateral FootTalus - Navicular Calcaneus Cuboid
Navicular - 1st Cuneiform Navicular/3rd Cuneiform Cuboid
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
calcaneusDistal index finger MCP provides the planter glide and PIP and DIP provide thedorsal 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