3. Gait
Normal Gait
Series of rhythmical , alternating
movements of the trunk & limbs which
result in the forward progression of the
center of gravity…
3
4. Gait Cycle
• Defined as the period of time
from one heel strike to the next
heel strike of the same limb
4
5. Gait Cycle
The gait cycle consists of two
phases…
1) STANCE PHASE
2) SWING PHASE
5
6. • Gait is style , manner or a pattern of walking.
• Walking pattern may differ from individual to
individual
6
9. STANCE PHASE
Begins when the heel of one leg
strikes the ground and ends when the
toe of the same leg lifts off.
Constitutes approximately 60% of
the gait cycle.
9
11. Swing phase represents the period
between a toe off on one foot ad heel
contact on the same foot.
Constitutes approximately 40%
of the gait cycle.
SWING PHASE
11
13. GAIT TERMINOLOGIES
Time and distances are two basic
parameters of motion.
Distance and time mesurement
during gait analysis are reffered to
as Cadence parameters
1. Temporal (Time) variables
2. Distance (Spatial) variables
13
15. Amount of time spent during
the gait cycle when only one
limb is supporting the body wt.
Single Limb Support Time
15
16. Double Support Time
Amount of the time spent with both
feet on the ground during the gait
cycle.
The time of double support may be
increased in elder patients and in
those having balance disorders
The time of double support
decreases when speed of walking
increases
16
17. As the speed at which person walks
increases time spent in double limb
support decreases .During running double
limb support disappears and is replaced by
double limb float , a period during which
neither leg is in contact with the ground
17
22. Degree of toe out
Referred to as foot progression angle.
It is the angle the foot makes with the
path the subject is walking.
Normally it is 10 to 15 degree external
22
24. Neurologicalcontrol
Muscular actions that occour during
gait are programmed as involuntary
reflex arc at the level of brain and
spinal cord.
Extrapyramidal system responsible for
most complex unconcious pathway.
Golgi tendon unit, muscle spindle, and
joint receptors produce neurological
feedback.
Voluntary modulation is done by
motor cortex. 24
25. Neurologicalcontrol
Cerebellum controls balance.
In case of a child earlier with immature
neurological control child walks with
flexion at hip, knee and arms with
wider base of gait. As the neurological
system continues to develop in
cephalocaudal direction efficiency and
smoothness of gait increases
25
26. GAIT ENERGY
• Bipedal gait is inherently unstable and inefficient
to make it efficient joints and muscles of lower
limbs minimize the change in centre of
gravity(CG) which is located just anterior to S2.
• CG moves 1/8th inch during gait with lowest part
at 50 % of gait cycle during double limb support.
• Amount of energy = oxygen consumption =
indirect measurement with heart rate
27. KINEMATICS
• Study of angular rotation of each joint during
movement, in three planes
saggital
coronal
transverse
28. SAGGITAL
• Flexion and extension
• HIP
– Initial contact- flexed
– Stance phase – extends fully and body advances
over plantigrade foot
– At heel rise - flex to take the limb off the ground
and continues to flex during swing phase
29. • KNEE
– Initial contact – flex 15 degree
– Stance phase – extends to neutral position or
minimal flexion
– As heel rise – knee begin to flex again, max flexed
at early swing to allow foot to clear of the ground,
then during rest of swing phase extends passively
using forward momentum
30. • ANKLE
– Initial contact – neutral position
– Foot flat – plantar flexion of 5 to 10°(FIRST ROCKER)
– Midstance – dorsiflex and tibia moves over talus (SECOND
ROCKER)
– Heel rise – ankle plantar flexes and heel rise in preparation for
push off (THIRD ROCKER)
– During swing phase – dorsiflexion of ankle back to neutral
position to allow for clearing of foot (if this dorsiflexion is
hampered during swing phase as in foot drop it is compensated
by hyperflexing the knee and hip in swing phase leading to
steepage gait.
31. CORONAL PLANE
• Adductin and abduction, rise and fall
• Minimal hip movement in coronal plane
– Slight adduction during stance phase
– Slight abduction during swing phase
32. TRANSVERSE PLANE
• Rotation
• Pelvis and hip – rotates minimally
• Tibia – minimal range of motion or mild fixed
external rotation
33.
34.
35. STANCE Subphases
IC: Initial Contact (Heel Strike)
> Both limbs are in contact – Double stance
> The heel strikes the ground
> The stance knee begins to flex slightly.
> The ankle is at the neutral position
> The knee is close to full extension
Knee – 0o Flexion, Tibia externally rotated
> Hip 30° of flexion Femur externally rotated
36. STANCE Subphases
LR: Loading Response (Foot Flat)
>Flattening of the foot – reacting to impact of body weight
>Double stance ends
>Knee – 15o flexion, tibia internally rotates and then begins to
externally rotate
>Hip – 30o flexion, femur internally rotating moving to neutral
>Maximum Impact Loading occurs
>Foot rapidly moves into pronation
>Weight has still not been been shifted to the support leg
37. STANCE Subphases
MS: MidStance
Early Midstance- Late Mid Stance
> Single stance
> Knee – 15o flexion, tibia externally rotating
> Hip – 25o flexion, femur internally rotated
38. STANCE Subphases
TS:Terminal Stance(Heel-off)
>Single stance – “Falling forward”
forward fall of the body moves the vector further anterior to the ankle,
creating a large dorsiflexion moment
>Begins as COG passes over foot and
ends when opposite foot touches ground
>Knee – 5o flexion to 0o, tibia externally
rotates
>Hip – 0 to 10o extension, femur
externally rotates and begins abduction
39. STANCE Subphases
PS:Pre-Swing(Toe-Off/ Knee Break)
>Double stance – “Transition”
>Limb is rapidly unloaded – “Toe-off”
>Knee – 0-30o flexion, tibia externally rotates
>Hip – 20o extension, femur externally rotates with abduction
>The ankle moves rapidly from its dorsiflexion position at
terminal stance to 20 degrees of plantarflexion
40. SWING Subphases
IS:Initial Swing( acceleration )
>From “toe-off” until maximum knee flexion
>Knee – 30–60o flexion, tibia internally rotates
>Hip – 0–20o flexion, femur moves from
internal rotation to neutral (externally rotating)
41. SWING Subphases
MS:Mid Swing
>Goal is fortibia toreach vertical position perpendicular to
surface
>Knee – moves to0o, tibia externally rotates
>Hip –20-30o flexion, femur externally rotates
>Kneeextension and hip flexion continueby inertia
43. MUSCLE ACTIVITY
• Gait is maintained by combination of muscle
activity , momentum , and gravity.
• Muscle contraction-
– Concentric – muscle shorten ,generate power and
accelerate body forward.
– Eccentric – muscle lenghten despite electrical
stimulation which slows down and stabilizes motion
during gait.
• At any time eccentric contraction outnumber
concentric contraction
44. • CONCENTRIC contraction
• At terminal stance phase
– Gastrosoleus - to lift heel off the ground
– Iliopsos – flexes the hip to pull the stance phase
limb off the ground
• During swing phase
– Tibialis anterior which dorsiflexes the foot and
help in easy clearance
45. • ECCENTRIC contraction
• Slows down and smoothens the motion
– At initial contact to plantar flexion –Tibialis
anterior contract so that foot is gently lowered to
ground (if it does not fire foot slaps to the ground
at initial contact)
– During 2nd rocker – gastrosoleus contract and limit
the rate of dorsiflexion( if it does not contract
ankle dorsiflexes excessively leading to poor push
off and calcaneal gait)
46. – During weight acceptance of stance phase –
adductors of stance limb fire to limit contralateral
pelvis drop(if do not contract opposite pelvis
drops ,trendelenburg gait)
– Meanwhile the stance limb adducts slightly
47. GAIT KINETICS
• Study of force generated by joints during gait
• Reported as moments(force acting around a
centre of rotation) and powers.
• Eg – TA eccentrically contract at initial contact to
lower foot which can be measured as power
absorption.
• Gastosoleus concentrically contract at push off
leading to power generation
• Kinetics depend on walking velocity and an adult
pattern of kinetics is reached at 5 years of age
48. (1) ANTALGIC GAIT :-
- Any gait which relieves pain is known as antalgic gait.Patient does not
bear weight on the affected side.Therefore, body lurches to the same side.
- decrease stance phase
- decrease step length
- decrease stride length
49. (2) TRENDELENBURG GAIT :-
-Abductor lever mechanism :-
-Ask patient to stand on one leg opposite side pelvis tends to dip down .
-This is prevented by contraction of the abductors (gluteus medius & minimus) on
the same side.
-So pelvis drop is prevented
Here body weight acts as load, hip joint as the fulcrum & abductors as the power.
Defect in fulcrum
i.e. fracture neck femur
dislocation of hip
Defect in power Opposite pelvis dips down
i.e. Poliomyelitis i.e TRENDELENBURG SIGN POSITIVE
Gluteii paralysis
50. (3) WADDLING GAIT :-
When Trendelenburg sign is present bilaterally, it will result in swaying of the
patient side to side on a wide base.This is called waddling gait (duck gait).
51. (4) HIGH STEPPAGE/FOOT DROP/EQUINUS GAIT :-
During heel strike attempt,toes drop to the ground first due to the foot drop. Hence,
to clear the ground,patient will flex hip and knee excessively, raises the foot and slaps it
on the floor forcibly.
Common in foot drop due to muscle paralysis (common peroneal nerve palsy).
52. (5) STAMPING GAIT :-
In posterior column affection of the spinal cord,there is loss of joint, position
& vibration sense.One is not able to percieve the distance of floor from the
feet resulting in a hard thump.
e.g tabes dorsalis,syringomyelia,diabetes mellitus,leprosy,etc.
53. (6) CEREBRAL PALSY
Scissoring gait
Here one lower limb passes in front of the other lower limb due to marked
adductor spasm as seen in cases of cerebral palsy.
54. – Spastic gait as a result of hypertonicity and
imbalanced activity between muscle groups.
– Spasticity of hamstrings restrict extension of knee
and child crouch at knee and walk with shortened
stride length
– Spastic quadriceps may result in stiff extended
knee gait
– Sustained activity of gastrosoleus cause toe
walking and ankle equinus
55. (7) IN TOEING AND OUT TOEING :-
When there is increased anteversion of femoral neck,there is internal rotation of the
hip joint to contain femoral head in the acetabular cavity results in internal rotation
of the entire lower limb noted by inward pointing of the toes.
This may persist or compensatory external torsion of tibia may occur.Hence, the toes
point forward.In such a case, look at the patella.Due to femoral torsion, both patella
point inwards rather than forwards KISSING PATELLA.
Normal range of out toeing is from 8 – 15 degrees….Usually associated with lateral tibial
torsion…..results in CHARLIE CHAPLIN GAIT.
56. (8) SHORT LIMB GAIT :-
In an effort to keep the pelvis level throughout the gait cycle
the person will walk on the toes of the shorter limb.
the longer limb hip and knee may be forced to be kept in
flexion during stance phase.
57. (9) GLUTEUS MAXIMUS GAIT :-
Due to gluteus maximus paralysis,it is not possible to extend the
supported hip in the swing phase.This is overcome by backwaed lurch of
the trunk.Therefore, while walking, forward & backward movements of
the trunk occur.Hence, also called as ROCKING HORSE GAIT.
58. (10) HAND TO KNEE/QUADRICEPS GAIT :-
Normally ,to transmit weight of lower limb during midstance, the knee is
locked by quadriceps contraction.If it is weak,locking is hampered & buckling at
knees will occur.Therefore, to stabilise the knee for weight bearing,patient places
his hand in front of the knee and lower thigh region.
e.g poliomyelitis
59. (11) CALCANEUS GAIT :-
Just before the swing phase,there is push off at the ankle joint by plantar
flexion.This is absent in paralysis or rupture of tendo-achilles.Weight is largely
borne by the heel & there is widening & thickening of heel. Foot remains flat on
the ground.
60. (12) SHUFFLING/FESTINANT GAIT :-
Here, the patient takes short steps, has a stooping posture (flexed
neck, trunk, hip, knee) and is propelled forward quickly as if trying to catch
up with the centre of gravity which is placed anteriorly. Seen in
parkinsonism.
(13) ATAXIC/CEREBELLAR GAIT :-
Here, there is loss of sense of balance . patient sways in different
directions or generally towards the stance phase limb during ambulation.
61. (14) HEMIPLEGIC GAIT :-
There is rigidity in lower limb muscles due to UMN lesion. Therefore,
extension at knee & plantar flexion at ankle prevail. Hence, there is
circumduction of limb at hip while swinging the limb to achieve forward
propulsion.
62. (15) STIFF HIP GAIT :-
In normal gait, 20 degree flexion occurs at the hip.In stiff hip, patient does not
flex hip.To compensate, patient raises the pelvis & semi-circumducts the limb to
propel it forward.
(16) STIFF KNEE GAIT :-
Due to loss of flexion at knee,patient raises pelvis to clear off the ground and
swing sideways with circumduction to propel it forward.Looks like that of a
German Soldier marching.
(17) FLAT FOOT :-
There is affection of arches of the foot.Foot is flat on the ground.There is loss of
spring in the gait.
63. OTHERS :-
(1) BROAD BASED GAIT :-
- Rare
- Earlier seen in seamen due to habit of standing in boat with a broad
base to balance self (centre of gravity falls between two feet).
(2) HELICOPOD GAIT :-
- Legs & feet thrown in half circles as in hemiplegia.
(3) LATHYRIATIC GAIT :-
-Combination of spasticity, hyperabduction & dragging of lower limb elements.
(4) DRUNKERS/REELING GAIT :-
- Irregular walk on a wide base,sideways swing without stability,tendency to fall with every step.
- seen in drunken state or cerebellar inco-ordination.
(5) KNOCK KNEE GAIT :-
- Knees point & oppose each other while ankle & feet are kept apart.
(6) GENU RECURVATUM GAIT :-
- Hyperextension at knee.Seen in paralysis of hamstring (e.g polio).
(7) CHARCOT GAIT :-
- In hereditary ataxia.
64. VARIATIONS OF NORMAL GAIT :-
(1) ATHLETE’S GAIT :-
At end of game,the players have a crouching attitude.This keeps the
centre of gravity as low as possible Prevents fatigue.
(2) MOURNER’S GAIT :-
In a mourning ceremony,people of various height are present.
But crowd moves together at the same pace.This can be done by altering
the cadence.However,this alteration cannot be sustained for a long
time.Hence a tall person will alter his step length.he takes a step forward
& then brings it back a bit.In such a case,there is more expenditure of
energy.
65. GAIT ANALYSIS
LABORATORIES
• Dates back to 1957 for polio, cp,
myelomeningocele
• Nowdays computer software used to allow 3D
analysis which can assess motion at large as
well as small joints(foot)
• Gait analysis are used for preoperative
planning and outcome evaluation of
neurological as well as postsurgical non
neurological orthopaedic conditions.
