Question

Gait Abnormalities:

1- Ankle Dorsiflexion Weakness

2- Knee Flexion Contracture

question: discuss the gait abnormalities separately as following:

(i) Their common etiologies

(ii) The "Normal" gait description

(iii) Their Pathological Presentation

(iv) Your recommendation to improve or correct the gait abnormalities including the justifications

You can include drawings if you think that will give a better representation.

Answer 1

Gait Abnormalities:

1- Ankle Dorsiflexion Weakness

(i) Their common etiologies - Hip and knee osteoarthritis are the two most common non-neurological etiology of gait disorders. Others include multiple sclerosis (MS), Meniere's disease, brain hemorrhage, brain tumor, PD, Spinal cord injury, myopathy, Chiari malformation (CM), Guillain-Barré syndrome, cerebral palsy (CP), gout, vit B-12 deficiency, obesity, chronic alcohol misuse, vertigo and stroke

(ii) The "Normal" gait description - Normal gait is the integrated action of  strength, sensation and coordination. In each gait cycle of limb action there is a stance or  period of weight-bearing and an swing or interval of self-advancement. Normal gait comprises 60% of stance and 40% in swing.

(iii) Their Pathological Presentation - leads to lack of heel strike and also decreased floor clearance resulting in  increased step height and prolonged swing phase.

(iv) Recommendation to improve or correct the gait abnormalities: Seated Marching, Ankle Dorsiflexion, Assisted Toe Raises, Heel raising.

2- Knee Flexion Contracture

(iii) Their Pathological Presentation: Resulting in limping type gait pattern withr estricted knee extension and reduced step length. Knee flexion contractures of more than 30 degrees is very visible in normal paced gait and lesser is evident with higher speed. The action resemble the toe walk during stance phase.

(iv) Recommendation to improve or correct the gait abnormalities: Manual and prolonged stretching with tilt table and sandbag over the distal femur. The mechanical traction with joint mobilization and passive range of motion exercises also could help with correcting the abnormality.