ABNORMAL GAIT (Antalgic (Painful) Gait,Hemiparetic Gait,Gluteus Medius (Trendelenburg’s) Gait,Equinus Gait,Ataxic Gait,Arthrogenic (Stiff Hip or Knee) Gait,Antalgic (Painful) Gait)

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ABNORMAL GAIT (Antalgic (Painful) Gait,Hemiparetic Gait,Gluteus Medius (Trendelenburg's) Gait,Equinus Gait,Ataxic Gait,Arthrogenic (Stiff Hip or Knee) Gait,Antalgic (Painful) Gait)

Antalgic (Painful) Gait

 

The antalgic or painful gait is self-protective and is the result of injury to the pelvis, hip, knee, ankle, or foot.The stance phase on the AFFECTED leg is shorter than that on the nonaffected leg, because the patient attempts to remove weight from the affected leg as quickly as possible; therefore, the amount of time on each leg should be noted. The swing phase of the uninvolved leg is decreased. The result is a shorter step length on the uninvolved side, decreased walking velocity, and decreased cadence.28 In addition, the painful region is often supported by one hand, if it is within reach, and the other arm, acting as a counterbalance, is outstretched. If a painful hip is causing the problem, the patient also shifts the body weight over the painful hip. This shift decreases the pull of the abductor muscles, which decreases the pressure on the femoral head, from more than two times the body weight to approximately body weight, owing to vertical of angular placement of the load over thehip. Flynn and Widmann47 have outlined some of the causes ofa painful limp in children

 

Arthrogenic (Stiff Hip or Knee) Gait

The arthrogenic gait results from stiffness, laxity, or deformity, and it may be painful or pain free. If the knee or hip is fused or the knee has recently been removed from a cylinder cast, the pelvis must be elevated by exaggerated plantar flexion of the opposite ankle and circumduction of the stiff leg (circumducted gait) to provide toe clearance. The patient with this gait lifts the entire leg higher than normal to clear the ground because of a stiff hip or knee The arc of movement helps to decrease the elevation needed to "clear" the affected leg. Because of the loss of flexibility in the hip, knee, or both, the gait lengths are different for the two legs. When the stiff limb is bearing weight, the gait length is usually smaller.

 

Ataxic Gait

If the patient has poor sensation or lacks muscle coordination, there is a tendency toward poor balance and a broad base . The gait of a person with cerebellar ataxia includes a lurch or stagger, and all movements are exaggerated. The feet of an individual contracture often results in increased lumbar lordosis and extension of the trunk combined with knee flexion to get the foot on the ground. With a knee flexion contracture, the patient demonstrates excessive ankle dorsiflexion from late swing phase to early stance phase on the uninvolved leg and early heel rise on the involved side in terminal stance. Plantar flexion contracture at the ankle results in knee hyperextension (midstance of affected leg) and forward bending of the trunk with hip flexion (midstance to terminal stance of affected leg). Heel rise on the affected leg also occursearlier.28

 

Equinus Gait

This childhood gait is seen with talipes equinovarus(club foot) . Weight bearing is primarily on the dorsolateral or lateral edge of the foot, depending on the degree of deformity. The weight-bearing phase on the affected limb is decreased, and a limp is present. The pelvis and femur are laterally rotated to partially compensate for tibial and foot medial rotation

Gluteus Maximus Gait

If the gluteus maximus muscle, which is a primary hip extensor, is weak, the patient thrusts the thorax posteriorly at initial contact (heel strike) to maintain hip extension of the stance leg. The resulting gait involves a characteristic backward lurch of the trunk

Gluteus Medius (Trendelenburg's) Gait

If the hip abductor muscles (gluteus medius and minimus) are weak, the stabilizing effect of these muscles during stance phase is lost, and the patient exhibits an excessive lateral list in which the thorax is thrust later ally to keep the center of gravity over the stance leg . A positive Trendelenburg's sign is also exhibited (i.e., the contralateral side droops because the ipsilateral hip abductors do not stabilize or prevent the droop). If there is bilateral weakness of the gluteus medius muscles, the gait shows accentuated side-toside movement, resulting in a "wobbling" gait or "chorus girl swing." This gait may also be seen in patients with congenital dislocation of the hip and coxa vara

Hemiplegic or Hemiparetic Gait

The patient with hemiplegic or herniparetic gait swings the paraplegic leg outward and ahead in a circle (circumduction) or pushes it ahead . In addition, the affected upper limb is carried across the trunk for balance. This is sometimes referred to as a neurogenic or flaccid gait.

 

Parkinsonian Gait

The neck, trunk, and knees of a patient with parkinsonian gait are flexed. The gait is characterized by shuffling or short rapid steps (marche apetits pas) at times. The arms are held stiffly and do not have their normal associative movement . During the gait, the patient may lean forward and walk progressively faster as though unable to stop (festination

Plantar Flexor Gait

If the plantar flexor muscles are unable to perform their function, ankle and knee stability are greatly affected.Loss of the plantar flexors results in decrease or absence of push-off. The stance phase is less, and there is a shorter step length on the unaffected side.28

Psoatic Limp

The psoatic limp is seen in patients with conditions affecting the hip, such as Legg-Calve-Perthes disease. The patient demonstrates a difficulty in swing-through, and the limp may be accompanied by exaggerated trunk and pelvic movement.28 The limp may be caused by weakness or reflex inhibition of the psoas major muscle. Classic manifestations of this limp are lateral rotation, flexion, and adduction of the hip . The patient exaggerates movement of the pelvis and trunk to help move the thigh into flexion.

Scissors Gait

This gait is the result of spastic paralysis of the hip adductor muscles, which causes the knees to be drawn together so that the legs can be swung forward only with great effort . This is seen in spastic paraplegics and may be referred to as a neurogenic or spastic gait.

Short leg Gait

If one leg is shorter than the other or there is a deformity in one of the bones of the leg, the p'!tient demonstrates a lateral shift to the affected side, and the pelvis tilts down on the affected side, creating a limp . The patient may also supinate the foot on the affected side to try to "lengthen" the limb. The joints of the unaffected limb may demonstrate exaggerated flexion, or hip hiking may occur during the swing phase to allow the foot to clear the ground.28 The weight-bearing period may be the same for the two legs. With proper footwear, the gait may appear normal. This gait may also be termed painless osteogenic gait.

 

ABNORMAL GAIT (Antalgic (Painful) Gait,Hemiparetic Gait,Gluteus Medius (Trendelenburg's) Gait,Equinus Gait,Ataxic Gait,Arthrogenic (Stiff Hip or Knee) Gait,Antalgic (Painful) Gait)

 

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