Gait Evaluation is standard procedure in the biomechanical world. In training Podiatrists of the future, we focus on the gait of walking with its slower motions and more established normals and abnormals. Yet, the same category concerns the running gait pattern, the cycling pattern, the ballet technique dancer's use, etc. Gait evaluation is primarily used in repetitive motion activities where a slight flaw done over and over and over again can lead to stress somewhere. These repetitive overuse patterns tend to be well accepted in the medical community, and give great help to the injured patient when reversed. The first question I ask in any gait evaluation session: Is this patient stable? The second question: If they are not stable, why? And, the third question: If they are not stable, how can I treat them?
One gait finding can make people unstable and I use the word unstable to mean that they are not perfectly aligned. Therefore, excessive pronation is primarily a medial instability issue, and equinus and limb length discrepancy are primarily sagittal plane deformities. Question #1: What are some common transverse plane problems? (Answer at the end) Some gait findings are easier to correct than others that may be impossible to correct. What is the Checklist I use in performing a good Gait Evaluation?
- Head Tilt (Straight, Lean Right, Lean Left)
- Shoulder Drop
- Asymmetrical Arm Swing
- Dominance to One Side
- Trunk Mobility (Limited, Normal, Excessive)
- Hip Hike (Right or Left)
- Belt Line (Higher Right or Left)
- Hip Rotation (limited, normal, excessive)
- Excessive Shock (right or left or both)
- Limited Knee Rotation (Right straight vs external, left straight vs external)
- Excessive Internal Knee Rotation (right or left or both)
- Heel Motion at Contact (Right-eversion, none, inversion) (Left-eversion, none, inversion)
- Symmetry of Arch Collapse (Right more vs Left more)
- Digital Clawing (Right or Left or Both)
- Angle of Gait (Right-internal, straight, external) (Left-internal, straight, external)
- Other Structural Variations: Pes Cavus, Pes Planus, Tibial Varum, Genu Valgum, etc.
- Correlation to Symptoms:
- Other Observations:
An earlier post has talked about the common signs that you are observing a patient with limb length discrepancy. These include:
- Limb Dominance where the patient spends more of their time over one side
- Asymmetrical arm swing (longer leg can have the arm closer to the body)
- Shoulder Drop is usually to the long side (when compensated with the spine)
- Head Tilt is usually to the short side (also when compensated with the spine)
- More pronation or supination on one side
- Belt Height is angled up towards one side
Question #2: What statement is false about limb length discrepancies? (Answer at the end)
- The typical limb dominance is the long side
- A true shoulder drop findings has the fingers lower also on that side?
- The more pronated side is the short side
- A Standing AP Pelvic X-Ray without lifts is the most important x-ray
Question #3: Which is the short side?
Question #4: Which side is short?
Question #1: What are some common transverse plane instabilities we find in our patients? Metatarsus Adductus, High pitched subtalar joint axis, Internal or External Femoral torsions/positions, and External or Internal Malleolar Torsions.
Question #2: What statement is false about limb length discrepancies? The more pronated side is the short side.
Question #3: Which is the short side? Head tilt normally to the short side and shoulder drop normally to the long side. Therefore, this image points to a possible right short leg.
Question #4: Which is the short side? Head tilt normally to the short side and shoulder drop normally to the long side. Therefore, this image points to a possible short left side.
The discussion of Gait Evaluation will be continued next week.
