PATHOLOGICAL GAIT IN RESIDUAL POLIOMYELITIS

¹ Orthopaedic Department, State University of Iowa, Iowa City, Iowa

1. Photographic studies were made of the pathways of motion in the lower extremities of selected cases of residual infantile paralysis.

2. The importance of the technique of this particular investigation was the fact that the patient was not weighted down with cumbersome apparatus, and was not required to walk on a treadmill. Either of the above adds further embarrassment to the gait of a paralyzed individual already operating under reduced efficiency, and the recordings thus obtained do not portray the true state of locomotion.

3. The kinesiological soundness of operative procedures may be scrutinized by this method by means of preoperative and postoperative studies.

4. Shortening of two inches did not fundamentally affect the pathwyys. It produced some increased rotation in the frontal plane and was reflected in the profile view by an exaggerated undulatory hip pathway, and, to a lesser degree, by a corresponding change in the knee pathway.

5. In equinus deformities, owing to the relative increase in the length of the extremity, a great deal of increased flexion occurred in the knee and hip in order to enable the foot to clear the ground; in stance the forefoot either struck the ground before the heel or simultaneously, depending on the degree of equinus; after the impact of the forefoot some of the patients showed a marked rebound resulting from the stretch reflex.

6. In calcaneus deformities, the heel struck the ground first in stance and remained in contact for a longer time than normal; the ankle and toe pathways were depressed, indicative of the fact that the foot was able to clear the ground with greater ease than the normal; the subjects tended to pivot on the heel with the knee fully extended.

7. An analysis of one case of calcaneovalgus following an astragalectomy and transplantation of the peroneus longus to the tendo achillis revealed striking graphic improvement in the gait consisting of: disappearance of heel pivoting; slight flexion of the knee in stance; decrease in the duration of the heel contact with the ground; normal pattern of the ankle curve; and striking of the forefoot on the ground a moment before the heel in stance (slight overcorrection).

8. This is a preliminary report, but the results indicate very defininitely that additional work in this field would be of great value in clarifying many of the problems of this complex subject.

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