Foot Slap/Spasticity

[Tyler DeChiara]

This is a question medbridge NCS prep exam. Not really a discussion board on there wanted to see if it could be answered here.

Question

Range of motion in your patient’s right foot is WNL for all movements, but spasticity in the plantiflexors is evident in the last 50% of ROM during passive dorsiflexion. From this, you would expect what gait deviation?

A.
Right foot drag

B.
Right foot slap

Explanation

Because ROM is full, there will not be a foot drag, but the spasticity will result in a slapping of the foot following the dorsiflexion during stance phase.

C.
Right shuffle

D.
Right steppage

B is the Right answer in these choices, but foot slap to me occurred During loading/response to initial contact due to more eccentric strength deficits of DF. Not as much as a result of stance phase due to PF spasticity. I think I ended up with C as my rationale was it was due to a stance phase issue occurring in mid/late terminal stance. Shuffle to me was the closest answer to decreased stance time as a compensatory movement to avoid PF spasticity.

[Chrissy Durrough Lugge]

Hi Tyler!

I think I’m with you and don’t like the foot slap answer. Interested to hear what others think.

If someone has PF spasticity at mid-end range DF, that would present in mid-terminal stance and mid-terminal swing through initial contact. I don’t think we are less likely to see right foot drag or steppage gait (due to PF at mid-swing when the foot should be dorsiflexed) or even a shuffle on the right foot.

I guess we have more dorsiflexion at terminal swing going into initial contact – if they are trying to test when there is the most DF to induce the spasticity, but the other deviations could occur during the last 50% of ankle ROM.

[Tyler DeChiara]

That makes sense. Just more of a question of what gait deviation matches up with when spasticity occurs in last 50% of available ROM. Think my brain went straight to mid stance/terminal stance and picked the closest gait deviation to it.

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