Pathological Gait: Orthopedic Conditions

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Questions and Answers

What happens to the pelvis when the gluteus medius is weak?

The pelvis drops on the side opposite the weak gluteus medius. (This is known as a Trendelenburg gait.)

A Trendelenburg gait is caused by bilateral gluteus medius weakness.

False

What is the compensation mechanism for a weak gluteus medius?

Leaning the trunk laterally towards the ipsilateral side of weakness during midstance.

What happens to the GRFV when it passes lateral to the hip joint?

It creates an abduction moment, which is compensated by activity in the adductor moment. Signup and view all the answers

A Trendelenburg gait is characterized by a lurch towards the affected side.

True Signup and view all the answers

What is the compensation mechanism for a weak gluteus maximus muscle?

The patient will try to prevent the trunk from falling forward by leaning the trunk backward to shift the GRFV behind the axis of the hip joint. Signup and view all the answers

What are the three main causes of difficulties in stabilizing the pelvis using the abductors?

Congenital dislocation of the hip (CDH), coxa vara, and slipped femoral epiphysis. Signup and view all the answers

A patient with a false hip joint is more likely to experience pain in a Trendelenburg gait.

False Signup and view all the answers

What is meant by a 'functional leg length discrepancy'?

This means that one or both legs are unable to adjust to the appropriate length for a particular phase of the gait cycle, even though the actual lengths of the legs may be the same. Signup and view all the answers

What is the difference between 'anatomical' leg length discrepancy and 'functional' leg length discrepancy?

An anatomical leg length discrepancy refers to the legs having different lengths as measured with a tape measure or x-rays. A functional leg length discrepancy refers to the legs being unable to adjust to the appropriate length for a particular phase of the gait cycle, even if they are the same length. Signup and view all the answers

What is circumduction and when does it occur?

Circumduction is a gait modification where the swinging leg is moved in an arc instead of straight forwards to increase ground clearance. It usually occurs when the swinging leg is too long, such as after a stroke. Signup and view all the answers

What is hip hiking and what is it commonly used for?

Hip hiking is a gait modification where the pelvis is lifted on the side of the swinging leg by contracting the spinal muscles and lateral abdominal wall. It is commonly used in slow walking with weak hamstrings. Signup and view all the answers

What is steppage and what is it used to compensate for?

Steppage is a gait modification where the knee and hip are flexed more than usual to lift the foot higher, increasing ground clearance. It is used to compensate for a plantarflexed ankle, or 'foot drop.' Signup and view all the answers

What is vaulting and how is it different from other gait modifications?

Vaulting is a gait modification where the subject goes up on the toes of the stance leg, resulting in an exaggerated vertical movement of the trunk. It is a stance phase modification, whereas steppage, circumduction, and hip hiking are swing phase modifications. Signup and view all the answers

What are the three main causes of abnormal hip rotation during gait?

<ol> <li>Problems with the muscles producing hip rotation. 2. Faults in the way the foot makes contact with the ground. 3. Compensatory movements to overcome another problem.</li> </ol> Signup and view all the answers

An 'in-toeing' gait pattern is a sign of internal hip rotation, which is often caused by weakness of the biceps femoris.

False Signup and view all the answers

Inversion of the foot, whether due to a fixed inversion or weakness of the peroneal muscle, can cause external hip rotation.

False Signup and view all the answers

What are the common causes of internal hip rotation?

Spasticity of the medial hamstrings or weakness of the biceps femoris. Signup and view all the answers

Study Notes

Pathological Gait: Impaired Gait in Common Orthopedic Conditions

Gluteus Medius Weakness: Weakness can result from a direct injury or secondary to other issues. Gravity's medial pull on the hip joint causes a tendency for the pelvis and trunk to drop to the opposite side during the stance phase. Compensation is needed by abductor muscle activity.
Gluteus Medius Weakness & Trendelenburg Gait: If the gluteus medius is weak, the pelvis on the stance side will drop. This is called Trendelenburg gait, where the opposite hip and pelvis drop during midstance.
Compensation for Gluteus Medius Deficiency: Individuals compensate by leaning their trunk laterally toward the weak side during midstance.
Impact of GRFV Direction on Gait: The direction of the ground reaction force vector (GRFV) impacts the moment arm for the gluteus medius. If the GRFV passes laterally, it creates an abduction moment.
Unilateral vs. Bilateral Weakness: Unilateral weakness results in Trendelenburg gait. Bilateral weakness causes waddling gait. Both conditions can lead to scoliosis, back pain, and/or fatigue from long-term issues.

Gluteus Maximus Weakness

Gluteus Maximus Weakness Effect on Gait: During initial contact and loading response, the ground reaction force (GRFV) passes anterior to the hip. This creates a flexion moment that the gluteus maximus should compensate. If it is weak, it can't, leading to excessive hip flexion (also known as "jack-knifing").
Compensation Strategy for Gluteus Maximus Weakness: To balance the trunk, the patient leans backward to shift the GRFV behind the hip joint axis during midstance. This is called gluteus maximus gait. Unilateral weakness can cause this.
Hip Abnormalities and Gluteus Maximus Weakness: Three conditions can lead to instability in the pelvis and make it challenging for gluteus medius compensation: congenital hip dislocation (CDH), coxa vara, and slipped femoral epiphyses. These conditions effectively lessen the length of the gluteus medius, making its function reduced due to the greater trochanter moving proximally and shortening the muscle. Shortened muscles can't provide sufficient tension.

Unequal Leg Length

Unequal Leg Length & Gait: In walking with an unequal leg length, the pelvis tilts in the direction of the shorter leg as the body weight transfers to it. Compensatory lateral trunk bending often occurs.
Unequal Leg Length Terminology: 'Stepping into a Hole': The condition results in the sensation of 'stepping into a hole' due to the pelvic tilt.
Functional vs. Anatomical Leg Length Discrepancy: Functional discrepancy is when the legs aren't necessarily different lengths to begin, but one can't correctly handle the amount during the stride cycle. Anatomical discrepancy is a measurable, observable difference in length.

Abnormal Hip Rotation

Functional Hip Rotation Issues: Large hip rotations are not easily compensated by knee/ankle function. This can cause a "toe-in" or "toe-out" gait alignment.
Causes of Abnormal Hip Rotation: Abnormal hip rotation is caused by problems in muscles' ability to control rotation, contact with the floor, and even by other gait problems. Examples include issues with hamstring/biceps femoris muscle strengths, weakness of muscles controlling hip rotation, and issues related to the way the foot-ground meets.

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Description

This quiz examines the factors affecting gait patterns in common orthopedic conditions, focusing on gluteus medius weakness and its implications. Participants will explore how different gait abnormalities, such as Trendelenburg gait, are compensated for and influenced by ground reaction forces. Gain a deeper understanding of the mechanics behind impaired gait.