Pathological Gait: Orthopedic Conditions

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.

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.