Gait Mechanics

Last week I was evaluating a patient with a left 5th metatarsal fracture. He was 12 weeks post injury, but still having considerable pain with weight bearing and walking. What do you see?

As you can see during the clip, this patient does not have a toe-off phase of his gait cycle. Additionally he does not use his plantarflexors for propulsion during the gait cycle. In terminal stance he raises his left foot and extends his toes for foot clearance. An interesting finding during his examination was a weak tibialis anterior. From the video, one might think the tib anterior is over-facilitated. However, this patient had a very week anterior tibialis and over dominant toe extensors. Treatment has focused on isolated strengthening of the tibialis anterior, stretching the toe extensors, manual therapy to the hindfoot, and strengthening the toe flexors, intrinics, and plantarflexors.

-Jim