Eok

Eok, a 14-year-old boy with left hemiplegia, who was an independent ambulator in the community, was referred for gait evaluation because of inturning of his left foot. Physical examination on the right was normal, and on the left the popliteal angle was 47 degrees, extended knee dorsiflexion minus 7 degrees and flexed knee dorsiflexion was 2 degrees. The left internal rotation of the hip was 65 degrees and external rotation was 21 degrees. Subtalar motion showed forefoot abduction to neutral and hindfoot eversion to 10 degrees. Transmalleolar axis to thigh was 12 degrees internal. The kinematics demonstrated left ankle plantar flexion at foot contact of minus 5 degrees and maximum dorsiflexion very early and only to 10 degrees. No first rocker is noted on the left side but was present on the right side. There was a 42 degrees internal foot progression angle on the left and 7 degrees internal on the right. Image 13-14.2 EMG of the tibialis anterior was appropriately phasic while the tibialis posterior and peroneus brevis had activity throughout stance phase of the gait cycle except the early stance phase. The hamstrings and rectus were co-contracting in early stance as secondary stabilizers of the knee. Image 13-14.4 Pediobarograph showed decreased heel impulse, minimal heel contact, and relatively symmetric pressure in the lateral midfoot and forefoot with normal varus –valgus measure. Image 13-14.3 The rotational profile of the kinematics demonstrated that the right side of the pelvis was forward throughout most of the cycle, and the hip on the left was internally rotated approximately 20 degrees. There was approximately 20 degrees of internal tibial torsion on the left. The foot progression angle (FPA) was internal 40 degrees on the left side. Image 13-14.6 Kinematics showed increased knee flexion at foot contact, coming to full extension in stance, but with late and decreased knee flexion in swing. Ankle dorsiflexion showed no first rocker on the left, and early dorsiflexion in stance. Knee moment showed significant knee flexion moment throughout stance and the ankle moment on the left had a consistent high plantarflexion moment on the left, while this was much more variable on the right. The left ankle power curve shows high absorption and midstance vault generation pattern. Image 13-14.6