Info

CONTACT PHASE MIDSTANCE PHASE PROPULSIVE PHASE Heel strike ->■ Forefoot ->■ Full -Heel lift -Toe off

Subtalar joint motion: Supination

Neutral

-v- Forefoot loading

Full foot

Subtalar joint motion: Supination

Rigid foot for propulsion

Abnormal

Pronation

Pronation

Normal

Rigid foot for propulsion

Abnormal

Flexible foot for propulsion pathology

Figure 20-23 A and B, Positions of the foot in the normal gait cycle.

manner in which the patient squats and then stands provides an excellent impression of the muscle strength and joint action of the lower extremities.

In addition, assessment of specific muscle groups can be performed and integrated into the arthrometric examination. Muscle strength can be graded according to the scale described in Chapter 21, The Nervous System.

Measure the dorsiflexors and plantar flexors. With the patient seated, have the patient dorsiflex and plantarflex the foot against resistance. This can also be accomplished by asking the patient to walk toward and away from you on the heels and then on the toes. Injury to the common peroneal nerve causes weakness of the anterior muscle group, with a diminished

Figure 20-24 Technique for evaluating ''straightness'' of the spine. Lateral deviation of the spine may be related to a herniated disc or to spasm of the paravertebral muscles. This functional deviation is often termed a list. True scoliosis may result from an actual deformity of the spine. In many cases, the spine twists in the opposite direction, so that a plumb line may actually be in the center.

Figure 20-24 Technique for evaluating ''straightness'' of the spine. Lateral deviation of the spine may be related to a herniated disc or to spasm of the paravertebral muscles. This functional deviation is often termed a list. True scoliosis may result from an actual deformity of the spine. In many cases, the spine twists in the opposite direction, so that a plumb line may actually be in the center.

Figure 20-25 A, Severe kyphoscoliosis. B, Patient asked to bend forward.

Figure 20-26 Technique for evaluating motion of the lumbar spine. A, Test for extension of the spine. B, Test for rotation of the spine.
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