Lecture 16
Pathological Gait - Laboratory
Ankle Deviations
Excessive plantarflexion
IC
LR
MSt
 Low heel contact or forefoot contact  Reduced or loss of heel
rocker
 Foot drop
 Forefoot contact sustained (CP)
 Forefoot contact  foot flat
 Premature heel rise (vigorous walker)
 Knee hyperextension (CVA, incomplete SCI, CP, head trauma)
 Forward Trunk lean and anterior pelvic tilt
TSt
 Increased heel rise  increased/prolonged pelvis height
(vigorous walker)
ISw
 No impact unless excessive
MSw
 Toe drag  increased hip flexion / circumduction / lateral trunk
lean / vaulting
TSw
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 Usually no impact unless coupled with inadequate knee
extension
Causes:
1. Weakness of pretibial muscles
2. Plantarflexion contracture
3. Soleus/gastroc spasticity
4. Secondary to quadriceps weakness to protect from knee
hyperextension by reducing the heel rocker
Excessive Dorsiflexion
IC
 Rare  exaggerated heel rocker
LR
 Increased heel rocker  accelerated tibial advancement 
increased knee flexion
MSt
TSt
 Accelerated tibial advancement and/or excessive dorsiflexion 
greater demand on quadriceps to control knee flexion
 Prolonged heel contact
 Excessive knee flexion
PSw
 Loss of plantarflexion
 Sustained heel contact
Swing - Does not usually cause a problem
Causes:
1. Triceps surae weakness
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2. Ankle locked at neutral secondary to fusion or orthosis
Foot/Ankle Dysfunctions
Equinovarus
 Secondary to plantarflexor (soleus, TP, FHL, FDL)over activity
 Either premature or prolonged
Valgus / Planovalgus
 Secondary to total inverter weakness (flaccid or spastic) as
opposed to peroneal overactivity
 Can be coupled with the collapse of the arch (ligamentous
laxity)
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Knee Deviations
Inadequate flexion
LR
 Limited is usually secondary to knee joint pathology
 Absent knee flexion desirable with extreme quad weakness to
provide for stability
 Reduced shock absorption
PSw
 Ankle excessively dorsiflexed
 Heel contact prolonged
ISw
MSw
 Toe drag
 Decreased ability to advance the limb
 Toe drag
 Can occur with lack of hip flexion
Excessive Extension (during stance only)
 Extension thrust
 Excessive extensor force when knee lacks hyperextension
range
 Accompanied by premature ankle plantarflexion and
decreased hip flexion
 Hyperextension (recurvatum)
 Slow/passive or active/abrupt
 Can be secondary to strong hip extensor or soleus contraction
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Causes of Inadequate Knee Flexion / Excessive Knee Extension:
1. Quadriceps weakness  stance
2. Pain  stance and swing
3. Quadriceps spasticity  stance and swing
4. Exessive ankle plantarflexion  stance
5. Hip flexor weakness  swing
6. Extension contractures  capsular scarring or quadriceps
contracture – (need 60 deg of flexion)
Excessive Knee Flexion
LR
 Knee flexion > 25 degrees
 Excessive dorsiflexion
MSw
 Usually secondary to excessive hip flexion
 Not clinical concern
Inadequate Knee Extension
MSt and TSt
 Usually a continuation of excessive flexion during LR
TSw
 Limb not fully prepared for IC
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Causes:
1. Inappropriate hamstring activity  swing and stance
 Spasticity
 Voluntary secondary to glute max insufficiency
 Prolonged or premature
2. Knee flexion contracture swing and stance
 30 deg secondary to joint swelling
3. Triceps surae weakness  stance
 during MSt and TSt and is often associated with excessive
dorsiflexion and sustained heel contact
4. excessive plantarflexion - swing
 to avoid toe drag
 associated with excessive hip flexion
Coronal Gait Deviations in the Knee
 Varus (adduction)
 Valgus (abduction)
Causes:
Static - structural deformities
1. congenital or development deformities
2. traumatic deformities
Dynamic – secondary to disease process
1. OA – varus (medial tibial plateau)
2. RA - valgus
3. Paralytic Gait glute med weakness  lateral trunk lean
 valgus
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Hip Deviations
Inadequate Extension
MSt
TSt
 Forward trunk lean
 Lumbar lordosis – least stressful of 3 methods
 Flexed knee
 Lumbar lordosis via anterior pelvic tilt  loss of trailing limb
 decreased step length (contralateral limb)
Excessive flexion
PSw and ISw
 Usually a continuation of inadequate extension
 Rapid advancement of limb secondary to release of flexors
under tension  swing initiated prematurely
MSw
 Often reflected by posterior pelvic tilt
 Common substitution for excessive plantarflexion
Causes:
1.
2.
3.
4.
Hip Flexion contracture
Anterior ITB contracture
Hip Flexor spasticity
Pain – intra-articular pressures least at 30-40 deg of
flexion
5. Arthodesis –surgical or spontaneous
6. Voluntary flexion secondary to excessively plantarflexed
foot
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Inadequate Hip Flexion
ISw
 Failure to reach 15 deg flex  reduces limb advancement
MSw
 Continuation of ISw – little flexor action available
TSw, IC, LR
 No additional flexion since MSw  reduced step length
Causes:
1. Hip flexor weakness
2. Joint arthrodesis (rare)
Compensation for Hip Flexor Insufficiency:
1. posterior pelvic tilt with abdominals
2. circumduction
 hip hiking via quadratus lumborum
 forward pelvic rotation
 hip abduction
3. excessive/rapid knee flexion
4. contralateral vaulting
5. lateral lean to opposite side
Excessive Coronal Plane Motion
Excessive Adduction
Stance
 excessive medial angle of thigh (coxa vera) resulting in knee
valgus
 contralateral pelvis drop
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Swing
 scissor gait
*excessive adduction can be confused with excessive hip IR and flexion
 pseudo-Adduction
Causes:
1. ipsilateral abductor weakness
2. ipsilateral adduction contracture or spasticity
3. substitution of adductors(longus, brevis, gracilis) as hip flexors
(weak iliacus)
4. contralateral hip abduction contracture – tight lateral
musculature  scissor gait
Excessive Abduction
Stance – wider base of support – requires more energy
Causes:
1. ipsilateral hip abduction contracture
2. ipsilateral short leg – only if severe
3. ipsilateral voluntary abduction – during circumduction
(abduction, pelvic rotation, and hiking)
4. contralateral hip adduction contracture
5. scoliosis with pelvic obliquity
Excessive Transverse Rotation (10 degrees 5/5)
 can be secondary to hip motion or pelvic/trunk motion
Causes of excessive external rotation:
1. glute max overactivity
2. excessive plantarflexion (equinus) often during later stance
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Causes of excessive internal rotation:
1. medial hamstring overactivity during swing
2. adductor overactivity
3. anterior abductor overactivity (TFL and anterior glute medius)
4. quadriceps weakness
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