Transcript Propulsive gait

OSTEOLOGY
Session Two:
 Leg
(Tibia, Fibula)
 Foot
 Arches of the foot
 Gait
Tibia
Proximal End
2 Condoyle: Lat. & Med.
Tibial Tuberosity
Shaft or Body
3 Borders: Anterior (Shin),
Lat. (Interosseus), Med.
3 Surfaces: Med., Lat.
& Post.
Distal End
5 Surfaces: Ant. ,Post. ,Med.
,Lat. & Inf.
1 Malleolus (Medial)
Landmarks of Tibia
Tibial
tuberosity
Lateral condyle
Medial condyle
Anterior border (shin)
Medial malleolus
Fibula
Proximal End
Shaft or Body
Head: Apex
Neck
3 Borders: Ant., Post. &
Med. (Interosseus)
3 Surfaces: Ant. or Med. (Narrow)
, Lat. & Post. (Largest)
Distal End
(Lat Malleolus)
4 Surfaces:
Ant. (Rounded)
Post. (Groove)
Med. (Articular Facet)
Lat. (Subcutaneous)
Back
Landmarks of Fibula
Head
of fibula
Neck of fibula
¼ of distal end of body
Lateral malleolus
Tarsal Bone
Proximal Row
Talus
Calcaneus
Middle Row
Navicular
Distal Row
Medial to Lateral:
Medial , Intermediate
Lateral Cuneiform
Cuboid
Superior view
Lateral view
HOW TO LEARN OF TARSAL BONES

3
2
4
5
1.
2.
3.
4.
5.
1
C
: show the names of 5
bones of the foot :
Calcaneus
Cuboid
Cuniform (Lat.)
Cuniform (Intermediat)
Cuniform (Med.)
T : show
the names of 1
bone of the foot :
Talus
 N: show the names of 1
bone of the foot :
Navicular
 Easy guess to the tarsal
joints

Talus bone (superior & inferior view)
Talus bone (lateral & medial view)
Navicular bone
Tarsal Bone
Proximal Row
Talus
Calcaneus
Middle Row
Navicular
Distal Row
Medial to Lateral:
Medial , Intermediate
Lateral Cuneiform
Cuboid
ARCHEs OF THE
FOOT
 Longitudinal
 Medial
 Lateral
 Transverse
 Anterior
 Posterior
arch
Arch
Medial Longitudinal arch
Transverse Arch
Flexible Flatfoot
Flexible flatfoot is one of the most common types of
flatfoot. It typically begins in childhood or adolescence.
It usually occurs in both feet and generally progresses
in severity throughout the adult years. As the deformity
worsens, the soft tissues (tendons and ligaments) of
the arch may stretch or tear and can become inflamed.
GAIT
Walking abnormalities
• Walking abnormalities are unusual and
uncontrollable walking patterns that are
usually due to diseases or injuries to the
legs, feet, brain, spinal cord, or inner ear.
• Considerations
• The pattern of how a person walks is
called the gait. Many different types of
walking problems occur without a person's
control. Most, but not all, are due to some
physical condition.
Scissors gait

legs flexed slightly
at the hips and
knees like
crouching, with
the knees and
thighs hitting or
crossing in a
scissors-like
movement
Spastic gait

A stiff, footdragging walk
caused by a
long muscle
contraction on
one side
Propulsive gait

A stooped, stiff
posture with
the head and
neck bent
forward
Steppage gait

foot drop where the
foot hangs with the
toes pointing down,
causing the toes to
scrape the ground
while walking,
requiring someone to
lift the leg higher than
normal when walking
Waddling gait
A
duck-like
walk that may
appear in
childhood or
later in life
Some walking abnormalities have been given names:
• Propulsive gait - a stooped, stiff posture with the head
and neck bent forward
• Scissors gait - legs flexed slightly at the hips and knees
like crouching, with the knees and thighs hitting or
crossing in a scissors-like movement
• Spastic gait - a stiff, foot-dragging walk caused by a
long muscle contraction on one side
• Steppage gait - foot drop where the foot hangs with the
toes pointing down, causing the toes to scrape the
ground while walking, requiring someone to lift the leg
higher than normal when walking
• Waddling gait - a duck-like walk that may appear in
childhood or later in life
Cause:
• Abnormal gait may be caused by diseases in many different areas of
the body.General causes of abnormal gait may include:
• Arthritis of the leg or foot joints
• Conversion disorder (a psychological disorder)
• Foot problems (such as a callus, corn, ingrown toenail, wart, pain,
skin sore, swelling, or spasms)
• Fracture
• Injections into muscles that causes soreness in the leg or buttocks
• Infection
• Injury
• Legs that are different lengths
• Myositis
• Shin splints
• Shoe problems
• Tendonitis
• Torsion of the testis
Propulsive gait:
– Carbon monoxide poisoning
– Manganese poisoning
– Parkinson's disease
– Use of certain drugs including phenothiazines,
haloperidol, thiothixene, loxapine, and
metoclopramide (usually drug effects are
temporary)
Spastic (scissors) gait:
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Brain abscess
Brain or head trauma
Brain tumor
Cerebrovascular accident (stroke)
Cerebral palsy
Cervical spondylosis with myelopathy (a problem with the
vertebrae in the neck)
Liver failure
Multiple sclerosis
Pernicious anemia
Spinal cord trauma
Spinal cord tumor
Syphilitic meningomyelitis
Syringomyelia
Steppage gait:
– Guillain-Barre syndrome
– Herniated lumbar disk
– Multiple sclerosis
– Muscle weakness of the tibia
– Peroneal neuropathy
– Poliomyelitis
– Spinal cord injury
Ataxic or broad-based gait
– Acute cerebellar ataxia
– Alcohol intoxication
– Brain injury
– Damage to nerve cells in the cerebellum of
the brain (cerebellar degeneration)
– Medications (phenytoin and other seizure
medications)
– Polyneuropathy (damage to many nerves, as
occurs with diabetes)
– Stroke
Waddling gait:
– Congenital hip dysplasia
– Muscular dystrophy
– Muscle disease (myopathy)
– Spinal muscle atrophy
Home Care
• Treating the cause often improves the gait. For example, gait
abnormalities from trauma to part of the leg will improve as the leg
heals.
• Physical therapy almost always helps with short-term or long-term
gait disorders. Therapy will reduce the risk of falls and other injuries.
• For an abnormal gait that occurs with conversion disorder,
counseling and support from family members are strongly
recommended.
• For a propulsive gait:
• Encourage the person to be as independent as possible.
• Allow plenty of time for daily activities, especially walking. People
with this problem are likely to fall because they have poor balance
and are always trying to catch up.
• Provide walking assistance for safety reasons, especially on uneven
ground.
• See a physical therapist for exercise therapy and walking retraining.
• For a scissors gait:
Home Care(con…)
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People with a scissors gait often lose skin sensation. Skin care should be used to
avoid skin sores.
Leg braces and in-shoe splints can help keep the foot in the right position for standing
and walking. A physical therapist can supply these and provide exercise therapy, if
needed.
Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle
overactivity.
For a spastic gait:
Exercises are encouraged.
Leg braces and in-shoe splints can help keep the foot in the right position for standing
and walking. A physical therapist can supply these and provide exercise therapy, if
needed.
A cane or a walker is recommended for those with poor balance.
Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle
overactivity.
For a steppage gait:
Get enough rest. Fatigue can often cause a person to stub a toe and fall.
Leg braces and in-shoe splints can help keep the foot in the right position for standing
and walking. A physical therapist can supply these and provide exercise therapy, if
needed.