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
- 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)
- 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
