Gait in RA

Gait in RA

RA a systemic inflammatory disease process, characterized by B/L symmetrical pattern of joint involvement and chronic inflammation of the synovium

*According to a study in J Biomechanics in 1988, “Gait in RA” following results were concluded on a study of 17 female RA patients.

• Stride length & duration of g art cycle were decreased .
• Mobility (ROM) of ankle joint was significantly less in both rotation & adduction among RA patients.

AT HIP JOINT

• Rotation of the hip joint increased.
• Adduction at hip joint decreased

AT KNEE JOINT

• No ssd were ascertained in ROM of knee joint.

AT ANKLE JOINT

• Maximum angular execution of ankle at toe off.

• Pattern of ankle flexion- different in RA patients.

• Smaller PF at toe off than normals.

• In advanced stages of disease, tendency to valgus deformity.

• Inflammation of ankle joint prevented the normal mechanism of adduction in subtlar joint at the end of stance, for an energetic push off (by rigid lever)

*According to a study by D Laroche et al in J Biomechanics, 2005 on “Effect of loss of MTP joint mobility on gait in RA”, it was concluded.

• Walking velocity & stride length were decreased +vely related to MTP DF ROM
• Decreased MTP ROM –esp in DF rom
• Pain during walking was exp by 5/9 patients and DF tended to be decreased in these patients
• Negative relationship b/w MTP DF rom & maximal hip and knee flexion during walking.

OA marked by two localized , pathological features

Progressive destruction of articular & formation of bone at the margins of joint.

Confines itself to affected joint.

Mechanical factors play a significant role in the ethology of the disease by giving rise to instating

joint damage.

High loading rates-increases risk if OA.

*According to study by H.S. Gill of Biomechanics, 2003 on”Heel strike & pathomechanics of OA” it was concluded that;

The test population was divided into two gps

Displayed markedly different loading during H S phrase of gait- attributed to differences in the vertical velocity of the ankle at HS.

Differences in loading -more apparent in saggital plane.

Subtle differences in the trajectories appeared to produce large difference on ankle velocity at HS .

The Non -loader gp lifted their ankle higher (ssd) than loader gp during early swing phase.

Antalgic Gait

It reflects the body’s efforts to compensate for pain or instability in the stance- phase limb by minimizing the duration and magnitude of loading. It is a gait pattern characterized by diminished single limb stance time.

• Habitual limp
• Distinguished by awkward displacement of shoulder &
• Characteristic rhythm

*According to a study in JBJS, 1939

Probable cause

1. Shortening – a sufficiently large number of coxalgic patient are cured with affected limb, the same length as the other

• i.e. there is no shortening but patients continue to limp
• patients with shortening following fracture of the thigh do not commence to limp (unless 3-4 cm)

2. Ankylosis – Bony ankylosis of hip, consequent to a true osseous fusion of femur to pelvis causes only a very slight limp

- the less complete the ankylosis the more attentuated limp

3) Deformity – (flexion, abduction, adduction, irotation)

• deformities when very marked – render walking almost impossible

• compensatory attitude – ascent of pelvis, accentuated lorsosis – too render walking possible but with awkward and painful limp

• with correction of deformity antalgic gait reappears

Trendelenburg Limp – mechanical phenomenon

• insufficiency of the gluteus medius
• causes pivoting of the pelvis around femoral head
• descent of iliac spine on the contra-lateral side, as a result
• lack of opposition of this descent
• may be associated with CDH