REIDER PART 208

268 Chapter 7_Lower Leg, Foot, and Ankle

B C

Figurę 7-32. A, Normal heel alignment. B, Yalgus heel alignment (right foot). C, Yarus heel alignment (left foot).

question the patient to determine the exact source of the pain. In an antalgic gait, the stance phase on the affected limb is shorter than on the normal limb because the patient attempts to remove weight from the affected limb as quickly as possible. To effect this change, the normal limb is brought forward morę quickly, and the time it spends in swing phase is thus decreased. The result is a shorter stride length on the uninvolved side, decreased walking velocity, and a decreased cadence, that is, fewer steps per minutę. An antalgic gait can be seen in arthritic conditions involving the ankle, the subtalar joint, or the midfoot; plantar fasciitis; infections; or any other painful condition.

Short Leg Gait. A short leg gait may develop in response to a leg length discrepancy. Again, this pattern is not spc-cific for leg length discrepancies arising from the lower leg, the ankle, or the foot. A patient with one leg shorter than the other may develop a lateral shift to the affected side, with the pelvis tilting downward toward the same side. The patient may supinate the foot on the affected side or even toe walk in an attempt to lengthen the shorter limb. The unaffected limb may demonstrate exag-gerated hip or knee flexion to help compensate for the limb length discrepancy. Finally, the patient may demonstrate hip hiking on the unaffected side, raising the pelvis on the unaffected side during swing phase to allow the foot of the longer limb to elear the ground.

Drop Foot Gait. A patient with weak or paralyzed ankle dorsiflexors walks with what is called a drop foot or steppage gait. Possible causes include a lumbar radicu-lopathy, a peroneal nerve palsy, or a tibialis anterior rup-ture. In order to avoid dragging the toes of the involved