Types of pathological marches
Ataxic / Tabetic Walking:
Impaired coordination of voluntary movements and balance.
Affected Anatomy: There are three types of ataxia:
- Cerebellar: coordinates the movement.
- Proprioceptive: neurological origin, the information of the sole of the foot is affected.
- Vestibular: origin in the inner ear, involved in balance.
How to walk: Unstable gait without coordination in the movements of the lower extremities.
Being unstable, it needs a wide support base, which is why the gait is characterized by a backward-facing upper hem and with the arms apart.
Weakness of the quadriceps:
Absence of knee flexion during the initial support phase and excessive extension during the rest of the phases.
Affected anatomy: weakness of the quadriceps.
How to walk: placing the foot supported, in external rotation; tilt the torso forward, allowing the weight to stabilize the knee by pushing the hip of the affected limb back; hip lift.
The extensors of the hip and the plantar flexors of the foot act as compensators. These compensatory actions begin in the final phase of the oscillation and continue throughout the support. In the final phase of the swing you can passively extend the knee.
Spastic / scissor walking:
Affected anatomy: lesion of the pyramidal bundle.
How to walk: The legs move forward in rigid jolts, often accompanied by compensatory movements of the trunk and upper limbs.
Excessive adduction with alternating movements of the hip during rocking, crossing the limb in this phase with the other limb in the support phase.
That way, you'll be able to take short steps.
Horse riding var:
Excessive plantar flexion.
Affected anatomy:
- Atrophy of the peroneal musculature.
- Contracture of the Achilles tendon, the posterior tibia, and the tendons of the long flexors of the fingers.
How to walk: on tiptoe supporting the outside of the foot. The femorotibial angle is equal to or greater than 25º.
Horseback riding:
Excessive plantar flexion.
Affected anatomy: paralysis or weakness of the anterior tibia.
How to walk: on tiptoe supporting the inner side of the foot.
March in trendelenburg:
Affected anatomy: paralysis of the middle gluteus.
How to walk: During the unilateral support phase of the affected side, there is a descent of the pelvis to the side against the side associated with an inclination of the trunk to the compromised hip, as a compensation mechanism. That is, the individual is forced to stagger to the affected side to place the center of gravity on the hip. This movement is called abduction or tilting of the middle gluteus.
Parkinson's gait:
Affected Anatomy: The patient has little movement of the lower limb due to a generalized extension of the ankle, knee, hip and torso.
How to walk: There is a decrease in the length of the step and a loss of swinging of the arms. Patients have trouble starting the movement, which is why it is considered a slow gait in which they drag their feet.
They usually have a bent position with the center of gravity shifted forward, which is a risk factor for losing stability. They take short steps to restore balance, which increases the patient's speed when walking. Sometimes patients will end up running and will only be able to stop when they come across an object in front of them.
Fallen walking / stepping:
Affected anatomy: paralysis or weakness of the fibula.
How to walk: Impossible to perform a dorsiflexion. You should raise your leg higher so that you do not drag your foot, first resting your toe.
Greater gluteal weakness:
Affected anatomy: paralysis or weakness of the gluteus maximus.
How to walk: A wobbly gait characterized by a posterior displacement of the chest at the heel support to maintain the extension of the hip of the leg that adopts the posture.
The knee is stretched in tension in the middle posture, which slightly raises the hip on this side.
Dystrophic gait (penguin):
For Duchenne dystrophy.
Affected anatomy: usually due to muscular dystrophy (myopathies).
How to walk: Duck walking, on horseback.
Rotation of hips on both sides in the postural phase of each step forward to shift body weight.
There is an exaggeration of lumbar lordosis when walking or standing.
It usually causes difficulty lifting (Gowler's sign), and can lead to developing contractures in limb flexion and scoliosis.
Flip hemiplegic / hemiparetic gait:
A motor disorder in which half of the body is paralyzed, caused by a decrease or lack of oxygen in some area of the brain, which has become necrotic and the brain tissue in the affected area has died.
Affected anatomy: lack of abductor muscles.
How to walk: The lower limb makes a semicircle by dragging the outer side and toe, so there is usually no heel support, the patient only supports with the front of the foot.
His arm is in contact with his side. The forearm and hand, in front of the torso, are in semi-flexion and pronation.
