Figure 12.13

Figure 12.14

Figure 12.18

Figure 12.19

Figure 12.20

Figure 12.24a

Figure 12.24b

Figure 12.25a

Figure 12.25b

Figure 12.25c

Figure 12.26a1

Figure 12.26a2

Figure 12.27a1

Figure 12.27a2

Figure 12.27b1

Figure 12.27b2

Figure 12.27c1

Figure 12.27c2

Figure 12.28

Figure 12.29a

Figure 12.29b

Figure 12.29c

Figure 12.29d

Accessory Motions Reciprocal trunk/upper-extremity motion: rotates opposite pelvis Thigh and leg rotations –From MSw, swing-limb thigh and leg begin and continue from medial rotation moving toward lateral rotation to be at neutral by HS –Move from medial to lateral rotation by HO –Total motion = ~9 

Accessory Motions: Talocrural and Subtalar Joints Talus accommodates leg medial rotation in WB dorsiflexion. Talus accommodates leg lateral rotation in WB plantar flexion. Subtalar joint: –In supination at HS; Pronates immediately –Pronation continues until between FF and MS  supination Pronation allows the foot joints to loosen to accommodate foot to ground and absorb shock. Supination causes joints to become taut  rigid lever  forward propulsion

Figure 12.15a

Figure 12.15b

Figure 12.15c

Figure 12.15d

Figure 12.16

Figure 12.22

Gait Analysis Listen for cadence. Do an overview before looking at specifics. Look at one segment at a time. Look at one extremity at a time. Make note of deviations.

Gait Observation Posture first: few clothes. Video is ideal. Treadmill is second-best option. Look at whole patient from all sides. Begin at one joint. Confirm findings with tests. Identify causes. Correct causes.

Anterior View Head position Amount of lateral pelvic tilt and hip adduction and abduction Excessive swaying of the trunk or pelvis Vertical displacement of the pelvis Arm swing Shoulder position (continued)

Anterior View (continued) Varus or valgus knee position Width of base of support Toe position—approximately 7° of lateral rotation (toe-out position) Abnormal movement of the lower extremity during swing phase in the frontal and transverse planes (e.g., circumduction) Rotation of the lower extremity—patella can be a useful landmark

Lateral View Amount of shoulder and trunk rotation Orientation of the trunk—anterior pelvic tilt of 10° considered normal Degree of hip extension Knee flexion and extension range of motion (ROM) (continued)

Lateral View (continued) Ankle dorsiflexion and plantar flexion ROM Stride length and step length Loading response Heel rise Toe-off Push-off

Posterior View Position of the calcaneus Same as the anterior view Toe positions Knee valgus and varus Circumduction of leg in swing Back motion Pelvis and shoulder rotations Arm swing

Put Your Observations Together Gait deviations are caused by deficiencies or pain. Your examination confirms the source of those deficiencies. The treatment plan is based on your findings of the causes of those deficiencies.

Identify Possible Causes of These Deviations Inadequate knee extension Foot slap Initial contact on forefoot Wide base of support Excessive hip and knee flexion Excessive knee extension (continued)

Identify Possible Causes of These Deviations Trendelenburg—pelvic drop Anterior trunk lean Increased lumbar lordosis Circumduction Antalgic gait—short stance time on involved with increased stance phase on uninvolved