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Question:

A patient presents with an extremely painful corn on the sole of their foot. The corn is located directly under the first metatarsal-phalangealjoint. What gait pattern would be expected.? What would the effects of their condition be on various parts of the gait cycle?
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Answer:

Gait pattern:

Considering the given case study identifying the patient with very painful corn on the sole of the foot under the first metatarsal-phalangeal joint, it is expected that the patient will develop an antalgic gait pattern. In this pattern, the patient intends to avoid pain while walking by avoiding certain specific movements (Lowth, 2015). In the given case scenario the patient with the pain in the foot experience limitation in joint range of motion due to the inability to bear the complete body weight on the extremity, which is affected with the corn on the sole. It thus results in slow, limp and short steps in the patient movement with a loss in the heel-to-toe motion.

As stated by Lakany (2008), since the patient faces gait in the forefoot, therefore an intension to avoid plantarflexion and toe-off is expected. As depicted in the antalgic gait pattern, the patient is expected to reduce the forefoot loading by increasing the load bearing on the heel and hind foot. This gait pattern mainly results from pain. This gait pattern is mostly evident in aged people and athletes. Its incidence is higher in men than in women. Alcock et al. (2013) however argued that the antalgic gait is age independent and it may be severe, moderate or mild with temporary or permanent occurrence.

 

Effects on parts of gait cycle:

The antalgic gait pattern is seen to affect the normal gait cycle of the patient in terms of style and posture. According to Buonocore (2013), the origin of antalgic gait pattern can be due to sudden incidence of a disease or due to gradual damage through a disease to the musculoskeletal system or nervous system. Two major phases comprising the gait cycle are swing phase and stance phase (Umberger, 2010). The stance phase constitutes of five sub phases as heel strike, early flatfoot, late flatfoot, heel rise and toe off. The antalgic gait pattern expected in the given patient affects the stance phase of the gait cycle, which is shortened considerably with heel weight bearing as the patient suffers from pain in the forefoot.

Although, the 2 phases of gait cycle are equally divided in normal case, but the patient with extreme pain in the foot due to the corn on the sole under the metatarsal-phalangeal joint is expected to spend lesser stance time almost 20-30% of the gait cycle in place of 50% (Nakayama et al. 2010). The stride length of the patient is also expected to shorten due to this condition. It results in elongation of one stride than the other. Due to the extreme pain, the locomotion of the patient is disrupted with the resulting fast, soft and short footsteps taken by the patient in order to avoid pain and load in the affected foot. Automatically it increases the length of the swing phase. Antalgic gait may also result in a full-blown flexor withdrawal by the patient (Buonocore, 2013). A lack of forceful activation is also evident in certain cases. 

 

References

Alcock, L., Vanicek, N. and O’Brien, T. (2013). Alterations in gait speed and age do not fully explain the changes in gait mechanics associated with healthy older women. Gait & Posture, 37(4), pp.586-592.

Buonocore, M. (2013). Neurophysiological Responses for Better Understanding the Antalgic Mechanisms of Spinal Cord Stimulation. J Pain Relief, 02(02).

Lakany, H. (2008). Extracting a diagnostic gait signature. Pattern Recognition, 41(5), pp.1627-1637.

Lowth, D. (2015). Abnormal Gait. Gait abnormality. Abnormal Gait info. Patient | Patient.co.uk. [online] Patient.co.uk. Available at: https://www.patient.co.uk/doctor/abnormal-gait [Accessed 21 May 2015].

Nakayama, Y., Kudo, K. and Ohtsuki, T. (2010). Variability and fluctuation in running gait cycle of trained runners and non-runners. Gait & Posture, 31(3), pp.331-335.

Umberger, B. (2010). Stance and swing phase costs in human walking. Journal of The Royal Society Interface, 7(50), pp.1329-1340.

 

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