Mitchell L. Goldflies, M.D.. Overview ï‚‍ Introduction ï‚‍ Stance ï‚‍ Swing ï‚‍ Normal and Abnormal Gait

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Text of Mitchell L. Goldflies, M.D.. Overview ï‚‍ Introduction ï‚‍ Stance...

  • Slide 1
  • Mitchell L. Goldflies, M.D.
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  • Overview Introduction Stance Swing Normal and Abnormal Gait
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  • Introduction
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  • Stance 60 % of gait cycle Foot is in contact with ground Conversion of potential energy into kinetic energy During stance phase hip extends and pelvis rotates backward gradually
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  • Stance 5 phases: Contact Loading Midstance Terminal Preswing
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  • Stance
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  • Stance - Contact Length of stance phase: Begin contact of the heel to the ground End remainder of the foot contacts the ground
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  • Stance - Contact Objective of stance phase: Forward progression Shock absorption Adaption to terrain Preparation for loading phase
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  • Stance - Contact At initial ground contact: Knee extended Hip flexed Ankle neutral Foot pronating at subtalar joint Leg internally rotating
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  • Stance - Contact At forefoot contact: Knee flexes Ankle plantarflexes STJ pronates
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  • Stance - Contact Muscles: Long extensors decelerate plantarflexion Tibialis posterior decelerates pronation Gastrocnemius decelerates internal tibial rotation
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  • Stance - Contact
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  • Stance Loading Objective: Initial double-limb support Body weight is transferred onto the stance limb
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  • Stance Loading Body: Knee flexes 15 Ankle plantarflexes15 Muscles: Pretibials shock absorbers during this phase
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  • Stance - Midstance Objective: Limb and trunk stability Progression over stationary foot Body: Knee/hip begin extension STJ neutral
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  • Stance - Midstance Muscles: Tibialis posterior/soleus start to supinate STJ Peroneus longus stabilizes first ray Triceps surae decelerate forward displacement of tibia and plantarflex ankle joint
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  • Stance - Terminal Objective: Forward progression Foot becomes rigid lever
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  • Stance - Terminal Body: Knee flexes Ankle plantar flexes STJ supinates, rapidly First ray plantarflexes 1 st MPJ dorsiflexes toe-off through tip of hallux
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  • Stance - Terminal Muscles: Soleus and tibialis posterior assist heel lift Peroneus longus stabilizes first ray FHL, FHB, AbH, AdH stabilize hallux EHL dorsiflexes hallux
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  • Stance - Preswing Objective: Forward progression Foot becomes rigid lever 30 60% of gait cycle Second period of double limb support
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  • Stance - Preswing
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  • Body: Knee flexes Ankle plantar flexes Subtalar joint rapidly supinates First ray plantarflexes 1 st MPJ dorsiflexes
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  • Stance - Preswing Muscles: Soleus and tibialis posterior assist heel lift Peroneus longus stabilizes first ray FHL, FHB, AbH, AdH stabilize hallux EHL dorsiflexes hallux
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  • Swing Objective: Forward progression Ground clearance
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  • Swing Body: Hip continues to flex Knee extends from flexed position Ankle dorsiflexes STJ slightly pronated at toe-off
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  • Swing Muscles Long extensors dorsiflex foot for toe clearance Tibialis anterior dorsiflexes the first ray
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  • Swing Phases Initial swing: Begins at toe off and continues until maximum knee flexion (60) Mid swing: Maximum knee flexion until tibia is vertical/perpendicular to the ground Terminal swing: Beings when tibia is vertical and ends at initial contact
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  • Swing Contraction of quadriceps before toe off Helps to initial leg forward swing Prevents heel from rising to high in the posterior direction Hamstrings become active before heel strike Decelerate forward swing of leg Controls heel position at foot strike
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  • Gait Analysis Assessment procedures required to properly asses gait: Weight acceptance initial contact/loading response Stance midstance/terminal stance Forward progression terminal stance/preswing Swing initial swing/midswing/terminal swing
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  • Gait Analysis
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  • Normal Gait Used to describe patterns that have been generalized across sex, age, genetic predisposition, and anthropometric variables Duration of stance/swing phases are the same for each limb
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  • Normal Gait Maximizes center of gravity through: Knee motion Knee flexion after heel strike Pelvic rotation Pelvic tilt Lateral displacement of pelvis Foot and ankle motion
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  • Normal Gait
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  • Abnormal Gait Consequence of: Pain Weakness Difference in limb length
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  • Abnormal Gait
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  • Antalgic gait Pain common cause of limp Shortened stance phase on affected side In stance phase - with pain in hip joint, trunk motion toward painful side
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  • Abnormal Gait Dorsiflexor gait pattern Swing phase difficulty in clearing toes
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  • Abnormal Gait Gluteus maximus gait pattern Contracts at moment of heel-strike Slows trunks forward motion by stopping flexion of hip and initiating extension Weak gluteus maximus cause trunk to lurch forward at heel strike on weaker side, which interrupts forward motion
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  • Abnormal Gait Gluteus maximus gait pattern
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  • Abnormal Gait Gluteus medius gait pattern Characterized by Trendelenberg gait pattern Stance - opposite side of pelvis tilts downward during toward weaker side resulting from a weakened medius
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  • Abnormal Gait Gluteus medius gait pattern
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  • Abnormal Gait Gluteus medius gait pattern Trunk lurches toward weakened side to compensate Center of gravity shifts to fulcrum on weaker side, which shortens the moment arm from the center of gravity to hip joint, therefore reducing effort required of hip abductors
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  • Abnormal Gait Gluteus medius gait pattern
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  • Abnormal Gait Paralyzed quadriceps gait pattern Gait may appear normal when walking on level surface with a paralyzed quadriceps Quads not necessary for knee joint stability at full extension
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  • Abnormal Gait Paralyzed quadriceps gait pattern Those with paralyzed quads will be unable to run and experience difficulty on rough/inclined surfaces or stairs Long leg knee brace might be needed to support knee joint in full extension Triceps gait pattern
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  • Discussion
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  • Conclusion
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  • Questions?
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  • References Goldflies, M.L, Andriacchi, T.P., and Galante, J.O. The Relationship Between Varus Deformity and Moments at the Knee During Gait and the Changes at the knee after High Tibial Osteotomy. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981. Andriacchi, T.P., Goldflies, M.L, Galante, J.O. and Stern, D.S. Moments Exerted on the Lower Extremities During Running. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981. Andriacchi, T.P., Goldflies, M.L, Galante, J.O. Normal Variation in Joint Moments During Level Walking, 1980.
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  • References http://moon.ouhsc.edu/dthompso/GAIT/TERMS.HTM http://moon.ouhsc.edu/dthompso/GAIT/TERMS.HTM http://www.drpribut.com/sports/spgait.html http://www.drpribut.com/sports/spgait.html http://www.emedicine.com/pmr/topic225.htm http://www.emedicine.com/pmr/topic225.htm http://www.latrobe.edu.au/podiatry/Thegaitcycle.html http://www.latrobe.edu.au/podiatry/Thegaitcycle.html http://www.oandp.org/jpo/library/1993_02_039.asp http://www.oandp.org/jpo/library/1993_02_039.asp http://www.oandp.org/jpo/library/1997_02_049.asp http://www.oandp.org/jpo/library/1997_02_049.asp
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  • References http://www.wheelessonline.com/ortho/gait http://www.wheelessonline.com/ortho/gait http://www.wheelessonline.com/ortho/stance_phase_of_gait http://www.wheelessonline.com/ortho/stance_phase_of_gait http://www.wheelessonline.com/ortho/swing_phase_of_gait http://www.wheelessonline.com/ortho/swing_phase_of_gait
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  • Image Sources http://www.newscientist.com/blog/shortsharpscience/2007_0 5_01_archive.html http://www.newscientist.com/blog/shortsharpscience/2007_0 5_01_archive.html www.foot-fixer.com/contactus.html www.foot-fixer.com/contactus.html http://www.northcoastfootcare.com/footcare-info/foot- problems.html http://www.northcoastfootcare.com/footcare-info/foot- problems.html web.techwalking.com:462/gait_lab.html web.techwalking.com:462/gait_lab.html http://www.stepfamilytalk.com/walk-a-little-slower-daddy/ http://www.stepfamilytalk.com/walk-a-little-slower-daddy/ http://www.nature.com/nrn/journal/v3/n10/fig_tab/nrn939_F1. html http://www.nature.com/nrn/journal/v3/n10/fig_tab/nrn939_F1. html
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  • Image Sources