Gait Deviations Associated with Lower Leg and Foot Pain Syndromes

Original Editor - Stacy Schiurring based on the course by Damien Howell

Top Contributors - Stacy Schiurring, Jess Bell, Kim Jackson and Lucinda hampton  

Introduction

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.

ADD REVIEW OF ANKLE/FOOT ANATOMY, photo for reference

Gait Deviations

Gait Deviation	Expected Movement Pattern	Deviant Movement Pattern	Secondary Signs Associated with Deviant Movement
Late heel off or 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. Can occur due to an anatomically longer leg	Hyperextension of the knee during terminal stance Hyperflexion of the knee during terminal stance A decrease in the up and down motion of centre of mass The appearance of a "geriatric gait"
Early heel off or premature heel rise	(Same as above)	The heel of the trailing foot leaves the ground just prior to the leading foot heel strike. Bouncy gait Toe walker Can occur due to an anatomically short leg	Hyperextension of the knee during terminal stance Hyperflexion of the knee during terminal stance An increase in the up and down motion of centre of mass Loud 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.	Increased angle of foot relative to the ground Loud foot strike Visible vibration of treadmill during treadmill walking Calf muscle or lower leg appear to "shimmy" Increased knee extension or hyperextension, particularly at heel strike Increased hip extension in terminal stance Foot may cross midline Slow walking cadence, less than 120 steps/min; slow running cadence, less than 180 steps/min.
Toe out	During walking when viewed from front or behind, the foot is 5-10 degrees out form the line of progression. It is common to see two of the lateral toes when viewed from behind.	Greater than 10 degrees of toe out relative to the line of progression. When viewed from behind during ambulation, more than two of the lateral toes are visible. There is an asymmetry in the degree of toe out between the person's lower extremities. Will occur with hallux limitus or first MTP joint osteoartirits Can occur due to an anatomically short leg	Laterally oriented patella Popliteal skin crease is oblique from superomedial to anterolateral When viewed from behind, the lateral malleolus is visible but the medial malleolus is not
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. Or when there is an asymmetry in the degree of toe in between the person's lower extremities. Will occur with hallux limitus or first MTP joint osteoartirits Can occur due to an anatomically longer leg	Popliteal skin crease is oblique from superolateral to inferomedial Medially oriented patella When viewed from behind, medial malleolus is visible but the lateral malleolus is not
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.	Loud single or double sounds with the same foot strike Slow cadence with a long stride length Increased angle of foot relative to the ground (increased PF) with a prolonged heel only period during stance The heel stays on the ground longer in early stance phase
Heel whip	This is the one gait deviation that occurs between the transition from stance to swing phase. During walking when viewed from behind, it is expected to see a 5-10 degree rotation of the heel and foot in the transverse plane as the foot comes off the ground.	If the heel whip angle of rotation is greater than 10 degrees. Also deviant is the heel whip is greater on one side compared to the other side. Can occur due to an anatomically long leg Likely related to muscle imbalances at the hip	Oblique popliteal skin crease No daylight between the knees The foot crossing the midline of the body Signs of excessive wear on shoe bottom under the metatarsal heads where shear or twisting force occurs
Excessive pronation	A bisected calcaneus or shoe heel counter is perpendicular relative to the ground. When viewed from behind: can view two or fewer of the lateral toes the navicular bone is not visible

Pain Syndromes Associated with Gait Deviations

Gait Deviation	Associated Pain and Pain Syndromes
Late heel off or prolonged heel contact	Anterior groin pain Hip pain Acetabular labral injuries Anterior knee pain Patellofemoral arthralgia Anterior ankle pain Ankle impingement Achilles pain (Achilles is relatively long due to tendon lengthening procedure or a tendon rupture) Plantar heel pain syndrome
Early heel off or premature heel rise	Anterior knee pain Patellofemoral arthralgia Achilles pain (Achilles is relatively short) Ankle pain Plantar heel pain syndrome Metatarsalgia Forefoot pain
Stride length too long	Back pain Anterior groin pain Acetabular labral injury Anterior and or lateral knee pain IT band syndrome Patellofemoral arthralgia Medial tibial stress syndrome Stress fractures Achilles pain Plantar heel pain syndrome
Toe out	Hip osteoarthritis Knee osteoarthritis Gait pattern can become habitual status post total joint replacements Patellofemoral arthralgia Medial tibial stress syndrome Tibial stress fracture Achilles pain Plantar heel pain syndrome Metatarsalgia
Loud foot strike	IT band syndrome Medial tibial stress syndrome Stress fracture Plantar heel pain syndrome
Heel whip	Gluetal tendinopathy Anterior and or lateral knee pain Patellofemoral arthralgia IT band syndrome Medial tibial stress syndrome Tibial stress fracture Metatarsalgia Hallux valgus

Resources

• bulleted list
• x

or

1. numbered list
2. x