Clinical and Biomechanical Assessment of Walking Gait: Introduction (01:53)
Reed Ferber orients viewers to the objectives of the presentation on assessing the walking gait. Topics include foot mechanics and hip mechanics.
Foot Mechanics (02:16)
The foot collapses inwards during pronation; prolonged pronation is a problem. Foot pronation is linked to tibial rotation. Approximately 78% of people have a typical magnitude of pronation.
Lack of Foot Pronation (02:26)
See an example of a foot that does not pronate; the patient has a fused subtalar joint. The patient has osteoarthritis and severe difficulties with his knees because of his feet. Pronation is multi-factorial
Excessive Foot Pronation (01:37)
See an example of a left foot that pronates excessively while the right does not; the patient has different structures in the feet.
Foot Structure Consideration (04:41)
Ferber states that 80% of people have a neutral or valgus rearfoot position; see images of neutral, valgus, and varus feet. A varus rearfoot is oriented outward and incapable of excessive pronation; it can pronate for too long a period of time.
Rearfoot Varus Mechanics (02:08)
See an example of a rearfoot varus individual who experienced a number of lower extremity injuries; doctors tried to change the patient's foot mechanics. Consider callus formation and wear patterns on the shoes.
Shoe Types and Foot Structure (03:36)
Shoes have three categories: neutral, stability, and motion control. See video of a rearfoot varus individual running in a motion control shoe; a high stability shoe does not allow for pronation. Review the main points on foot mechanics discussed thus far.
Ankle Muscle Strength (08:33)
Five main muscles work for stabilization—tibialis posterior, peroneals, tibialis anterior, soleus, and foot intrinsics. Ferber discusses tibialis posterior anatomy, dysfunction, and fatigue; see a chart on mechanics results.
Hip-induced Pronation (02:52)
See an example of an individual who has unilateral hip muscle weakness on the left side; the tibialis posterior is the primary culprit. Evaluate muscle strength to gain a better understanding of mechanics.
Hip-to-Foot Link (05:57)
Atypical foot mechanics require compensation up top, and vice versa. Ferber explains hip mechanics involving hips abductors, manual muscle testing, and the goals of injury prevention and rehabilitation.
Hip-to-Foot Link: Hip Abductor Weakness (06:10)
See an example of bilateral genu valgum; it places a large demand on the tibialis posterior. Consider the EMG contribution for the gluteus medius during functional testing. See examples of functional tests.
Trendelenburg Sign (01:27)
Markers give an indication of global pelvic stability. A knee genu valgum accompanies a large Trendelenburg—weakness of hip stabilizers. See examples of a positive Trendelenburg.
Medial Heel Whip (04:37)
The lateral rotators and gluteus maximus control the natural inward rotation while walking—you need sufficient strength and flexibility. Separate rearfoot frontal plane motion from the transverse plane motion. Calluses are a clinical indicator.
Gait Patterns and Functional Tests (03:37)
See examples of a lateral knee thrust. Functional tests include abduction at zero degrees hip extension and hip hike/pelvic drop.
Gait Assessment Summary (01:22)
A walking gait assessment requires integrated information. Every injury is a puzzle. Ferber thanks research sponsors and introduces the women who will run the labs portion of the presentation.
Lab One: Foot Type (04:25)
Audience members determine a volunteer has a valgus foot. They pair up and use markings on the leg to determine who has a neutral, valgus, or varus foot.
Lab Two: Valgus or Vaurs Rearfoot (02:54)
Audience members determine what type of rearfoot a volunteer has while she is standing. They go through "the checklist" to evaluate an excessive pronated position.
Lab Three: Excessive and Prolonged Pronation (02:19)
Audience members determine a volunteer has equal rearfoot standing posture. They look for a forefoot abduction and midfoot collapse. The left foot has the potential for excessive pronation; both feet have the potential for prolonged pronation.
Lab Four: Shoe Wear and Callusing (04:47)
Audience members receive instruction on how to look for wear patterns on the bottom of their shoes and calluses on the toes or balls of their feet. They gather in groups and examine shoes and feet.
Lab Five: Rearfoot Varus Fast Crash (03:40)
Audience members receive tips for determining biomechanics and whether or not a client will need a stability shoe. Ferber explains why scoliosis would cause a patient to kick out significantly on the left side.
Lab Six: Functional Tests (05:58)
Audience members practice examination techniques. See a man whose glute knee does not function properly and a man with prolonged pronation.
Hiking Uphill (01:01)
Hiking places a large demand on the calf muscles. Seven muscles raise you on your toes; gastrocsoleus does most of the work.
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