Gait Deviations Associated with Lower Leg and Foot Pain Syndromes: Difference between revisions
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For a review of the gait cycle, please review [[Gait Cycle|this article]]. For an overview of gait deviations, please review [[Gait Deviations|this article]]. To review common gait terminology and definitions, please review [[Gait Definitions|this article]]. | For a review of the gait cycle, please review [[Gait Cycle|this article]]. For an overview of gait deviations, please review [[Gait Deviations|this article]]. To review common gait terminology and definitions, please review [[Gait Definitions|this article]]. | ||
[[File:Gait cycle.jpg|center|1000x1000px]] | [[File:Gait cycle.jpg|center|1000x1000px]] | ||
== Anatomy Review == | == Anatomy Review == | ||
[[File:Bigstock_Image_-Anatomy_Bones_Of_The_Foot_-ID_404217734.jpg|alt=|right|450x450px]] | |||
The ankle is the part of the lower limb encompassing the distal portion of the leg and proximal portions of the foot. The ankle encompasses the [[Ankle Joint|ankle joint]], an articulation between the [[tibia]] and [[fibula]] of the leg and the [[talus]] of the foot. | The ankle is the part of the lower limb encompassing the distal portion of the leg and proximal portions of the foot. The ankle encompasses the [[Ankle Joint|ankle joint]], an articulation between the [[tibia]] and [[fibula]] of the leg and the [[talus]] of the foot. | ||
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{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
!Gait Deviation | !'''Gait Deviation''' | ||
!Expected Movement Pattern | !'''Expected Movement Pattern''' | ||
!Deviant Movement Pattern | !'''Deviant Movement Pattern''' | ||
!Secondary Signs Associated with Deviant Movement | !'''Secondary Signs Associated with Deviant Movement''' | ||
|- | |- | ||
|Late heel off | |'''Late heel off''' | ||
ie: prolonged heel contact | |||
|The heel of the trailing foot lifts off the ground just prior to the contact of the leading foot. | |The heel of the trailing foot lifts off the ground just prior to the contact of the leading foot. | ||
|The heel of the trailing foot stays on the ground beyond the moment of the leading foot heel strike. | |The heel of the trailing foot stays on the ground beyond the moment of the leading foot heel strike. | ||
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* The appearance of a "geriatric gait" | * The appearance of a "geriatric gait" | ||
|- | |- | ||
|Early heel off | |'''Early heel off''' | ||
ie: premature heel rise | |||
|(Same as above) | |(Same as above) | ||
|The heel of the trailing foot leaves the ground just prior to the leading foot heel strike. | |The heel of the trailing foot leaves the ground just prior to the leading foot heel strike. | ||
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* Loud heel strike | * Loud heel strike | ||
|- | |- | ||
|Stride length too long | |'''Stride length too long''' | ||
|During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is relatively short. | |During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is relatively short. | ||
|During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is too long. | |During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is too long. | ||
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* Slow walking cadence, less than 120 steps/min; slow running cadence, less than 180 steps/min. | * Slow walking cadence, less than 120 steps/min; slow running cadence, less than 180 steps/min. | ||
|- | |- | ||
|Toe out | |'''Toe out''' | ||
|During walking when viewed from front or behind, the foot is 5-10 degrees out form the line of progression. | |During walking when viewed from front or behind, the foot is 5-10 degrees out form the line of progression. | ||
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* When viewed from behind, the lateral malleolus is visible but the medial malleolus is not | * When viewed from behind, the lateral malleolus is visible but the medial malleolus is not | ||
|- | |- | ||
|Toe in | |'''Toe in''' | ||
|During walking when viewed from behind, should not be able to view the big toe. | |During walking when viewed from behind, should not be able to view the big toe. | ||
|The big toe is visible during walking when viewed from behind. | |The big toe is visible during walking when viewed from behind. | ||
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* When viewed from behind, medial malleolus is visible but the lateral malleolus is not | * When viewed from behind, medial malleolus is visible but the lateral malleolus is not | ||
|- | |- | ||
|Loud foot strike | |'''Loud foot strike''' | ||
|It is expected for foot strike to emit a sound. The sound is representative of the ground reaction force. | |It is expected for foot strike to emit a sound. The sound is representative of the ground reaction force. | ||
|If the sound of the foot strike is ''asymmetrical'' between the lower extremities, or between the non-painful and the painful side. | |If the sound of the foot strike is ''asymmetrical'' between the lower extremities, or between the non-painful and the painful side. | ||
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* The heel stays on the ground longer in early stance phase | * The heel stays on the ground longer in early stance phase | ||
|- | |- | ||
|Heel whip | |'''Heel whip''' | ||
|This is the one gait deviation that occurs between the transition from stance to swing phase. | |This is the one gait deviation that occurs between the transition from stance to swing phase. | ||
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* Signs of excessive wear on shoe bottom under the metatarsal heads where shear or twisting force occurs | * Signs of excessive wear on shoe bottom under the metatarsal heads where shear or twisting force occurs | ||
|- | |- | ||
|Excessive pronation | |'''Excessive pronation''' | ||
|A bisected calcaneus or shoe heel counter is perpendicular relative to the ground. | |A bisected calcaneus or shoe heel counter is perpendicular relative to the ground. | ||
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* Oblique popliteal skin crease | * Oblique popliteal skin crease | ||
|- | |- | ||
|Absent windlass effect | |'''Absent windlass effect''' | ||
ie: increased dorsiflexion of the first MTP joint | ie: increased dorsiflexion of the first MTP joint | ||
|During forefoot contact/terminal stance, there is normally 35-65 degrees of first MTP joint dorsiflexion. | |During forefoot contact/terminal stance, there is normally 35-65 degrees of first MTP joint dorsiflexion. | ||
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* Knee extension in terminal stance | * Knee extension in terminal stance | ||
|- | |- | ||
|Decreased dorsiflexion of the first MTP joint | |'''Decreased dorsiflexion of the first MTP joint''' | ||
|During forefoot contact/terminal stance when viewed from the side, there is normally 35-65 degrees of first MTP joint dorsiflexion. | |During forefoot contact/terminal stance when viewed from the side, there is normally 35-65 degrees of first MTP joint dorsiflexion. | ||
|During forefoot contact/terminal stance, there is less than 35 degrees of first MTP joint dorsiflexion. | |During forefoot contact/terminal stance, there is less than 35 degrees of first MTP joint dorsiflexion. | ||
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{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
!Gait Deviation | !'''Gait Deviation''' | ||
!Associated Pain | !'''Associated Pain''' | ||
and Pain Syndromes | '''and Pain Syndromes''' | ||
|- | |- | ||
|Late heel off | |'''Late heel off''' | ||
ie: prolonged heel contact | |||
| | | | ||
* Anterior groin pain | * Anterior groin pain | ||
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* Plantar heel pain syndrome | * Plantar heel pain syndrome | ||
|- | |- | ||
|Early heel off | |'''Early heel off''' | ||
ie: premature heel rise | |||
| | | | ||
* Anterior knee pain | * Anterior knee pain | ||
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* Forefoot pain | * Forefoot pain | ||
|- | |- | ||
|Stride length too long | |'''Stride length too long''' | ||
| | | | ||
* Back pain | * Back pain | ||
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* Plantar heel pain syndrome | * Plantar heel pain syndrome | ||
|- | |- | ||
|Toe out | |'''Toe out''' | ||
| | | | ||
* Hip osteoarthritis | * Hip osteoarthritis | ||
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* Metatarsalgia | * Metatarsalgia | ||
|- | |- | ||
|Loud foot strike | |'''Loud foot strike''' | ||
| | | | ||
* IT band syndrome | * IT band syndrome | ||
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* Plantar heel pain syndrome | * Plantar heel pain syndrome | ||
|- | |- | ||
|Heel whip | |'''Heel whip''' | ||
| | | | ||
* Gluetal tendinopathy | * Gluetal tendinopathy | ||
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* Hallux valgus | * Hallux valgus | ||
|- | |- | ||
|Excessive pronation | |'''Excessive pronation''' | ||
| | | | ||
* Gluteal tendinopathy | * Gluteal tendinopathy | ||
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* Hallux valgus | * Hallux valgus | ||
|- | |- | ||
|Absent windlass effect | |'''Absent windlass effect''' | ||
| | | | ||
* Plantar heel pain syndrome | * Plantar heel pain syndrome | ||
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* Metatarsalgia | * Metatarsalgia | ||
|- | |- | ||
|Decreased dorsiflexion of the first MTP joint | |'''Decreased dorsiflexion of the first MTP joint''' | ||
| | | | ||
* Plantar heel pain syndrome | * Plantar heel pain syndrome |
Revision as of 04:45, 29 May 2022
Top Contributors - Stacy Schiurring, Jess Bell, Kim Jackson and Lucinda hampton
Introduction[edit | edit source]
This article discusses gait deviations associated with pain syndromes in the lower leg and foot. While this information focuses on certain regions of the body, remember that the human body functions within a kinetic chain. No one movement is ever completely isolated and is without effect on another.
For a review of the gait cycle, please review this article. For an overview of gait deviations, please review this article. To review common gait terminology and definitions, please review this article.
Anatomy Review[edit | edit source]
The ankle is the part of the lower limb encompassing the distal portion of the leg and proximal portions of the foot. The ankle encompasses the ankle joint, an articulation between the tibia and fibula of the leg and the talus of the foot.
The foot is the part of the lower limb distal to the ankle joint. It is covered on its dorsal surface by loosely adherent skin and on its plantar surface by thick hairless skin that is tough and strongly adherent to the underlying plantar aponeurosis. The foot contains 26 small bones that are designed for weight bearing and force distribution. The bony alignment creates three arches the provide efficient weight distribution while avoiding compression of plantar neuro-vascular structures. The three arches, medial and lateral longitudinal and the transverse arch together create an architectural vault, which is one of the strongest load-bearing structures known to mankind.[1]
Please read the linked article for a more in-depth anatomical review of the Foot and ankle.
Gait Deviations[edit | edit source]
Gait Deviation | Expected Movement Pattern | Deviant Movement Pattern | Secondary Signs Associated with Deviant Movement |
---|---|---|---|
Late heel off
ie: prolonged heel contact |
The heel of the trailing foot lifts off the ground just prior to the contact of the leading foot. | The heel of the trailing foot stays on the ground beyond the moment of the leading foot heel strike.
|
|
Early heel off
ie: premature heel rise |
(Same as above) | The heel of the trailing foot leaves the ground just prior to the leading foot heel strike.
|
|
Stride length too long | During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is relatively short. | During walking when viewed from the side, the linear distance from the foot strike to the person's centre of mass is too long. |
|
Toe out | During walking when viewed from front or behind, the foot is 5-10 degrees out form the line of progression.
|
Greater than 10 degrees of toe out relative to the line of progression.
|
|
Toe in | During walking when viewed from behind, should not be able to view the big toe. | The big toe is visible during walking when viewed from behind.
|
|
Loud foot strike | It is expected for foot strike to emit a sound. The sound is representative of the ground reaction force. | If the sound of the foot strike is asymmetrical between the lower extremities, or between the non-painful and the painful side. |
|
Heel whip | This is the one gait deviation that occurs between the transition from stance to swing phase.
|
If the heel whip angle of rotation is greater than 10 degrees.
|
|
Excessive pronation | A bisected calcaneus or shoe heel counter is perpendicular relative to the ground.
|
When viewed from behind:
|
|
Absent windlass effect
ie: increased dorsiflexion of the first MTP joint |
During forefoot contact/terminal stance, there is normally 35-65 degrees of first MTP joint dorsiflexion.
|
|
|
Decreased dorsiflexion of the first MTP joint | During forefoot contact/terminal stance when viewed from the side, there is normally 35-65 degrees of first MTP joint dorsiflexion. | During forefoot contact/terminal stance, there is less than 35 degrees of first MTP joint dorsiflexion. |
|
Pain Syndromes Associated with Gait Deviations[edit | edit source]
Gait Deviation | Associated Pain
and Pain Syndromes |
---|---|
Late heel off
ie: prolonged heel contact |
|
Early heel off
ie: premature heel rise |
|
Stride length too long |
|
Toe out |
|
Loud foot strike |
|
Heel whip |
|
Excessive pronation |
|
Absent windlass effect |
|
Decreased dorsiflexion of the first MTP joint |
|
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ The Editors of Encyclopaedia Britannica. Foot. Available from: https://www.britannica.com/science/foot (accessed 28/05/2022).