GAITGAIT

BYDr. AMRIT KAUR (PT)

Lecturer, N.D.M.V.P college of physiotherapy

nashik

GAITGAIT

Normal GaitNormal Gait

Series of rhythmical , alternating Series of rhythmical , alternating movements of the trunk & limbs which movements of the trunk & limbs which result in the forward progression of the result in the forward progression of the center of gravitycenter of gravity

One gait cycleOne gait cycle

period of time from one heel strike to the period of time from one heel strike to the next heel strike of the same limb next heel strike of the same limb

GAIT CYCLEGAIT CYCLE

► The gait cycle consist of 2 phases for each The gait cycle consist of 2 phases for each

footfoot

Stance (60 percent of the cycle ) Begins when the heel of one leg strikes the ground

and ends when the toe of the same leg lifts off.

Swing (40 percent) Swing phase represents the period between a toe

off on one foot ad heel contact on the same foot.

► Time FrameTime Frame::A. Stance vs. Swing:A. Stance vs. Swing:►Stance phaseStance phase = = 60% of gait cycle60% of gait cycle►Swing phaseSwing phase = = 40%40%B. Single vs. Double support:B. Single vs. Double support:►Single support= Single support= 40% of gait cycle40% of gait cycle►Double support=Double support= 20%20%

Gait Cycle - Subdivisions Gait Cycle - Subdivisions

► A. A. Stance phase:Stance phase:1.1. Heel contact: ‘Initial contact’.Heel contact: ‘Initial contact’.

2.2. Foot-flat: ‘Loading response’, initial contact of Foot-flat: ‘Loading response’, initial contact of forefoot on ground.forefoot on ground.

3.3. Midstance: greater trochanter in alignment w. Midstance: greater trochanter in alignment w. vertical bisector of footvertical bisector of foot

4.4. Heel-off: ‘Terminal stance’Heel-off: ‘Terminal stance’

5.5. Toe-off: ‘Pre-swing’Toe-off: ‘Pre-swing’

Gait Cycle - Subdivisions Gait Cycle - Subdivisions ► B. B. Swing phase:Swing phase:1.1. AccelerationAcceleration: ‘Initial swing’: ‘Initial swing’2.2. MidswingMidswing: swinging limb overtakes the limb in : swinging limb overtakes the limb in

stance stance 3.3. DecelerationDeceleration: ‘Terminal swing’: ‘Terminal swing’

DISTANCE AND TIME VARIABLES

► Temporal variables

1. Stance time2. Single limb

support time 3. Double limb

support time4. Swing time5. Stride and step

time6. Cadence7. speed

► Distance variables

1. Stride length2. Step length3. Width of walking

► Step length

Distance between corresponding successive points of Distance between corresponding successive points of heel contact of the opposite feetheel contact of the opposite feet

► Stride length

Stride length is determined by measuring the linear distance from point of heel strike of one lower extremity to next heel strike of same extremity.

► Width of base of support

Side-to-side distance between the line of the two feetSide-to-side distance between the line of the two feet► Degree of toe outDegree of toe out

It is the angle formed by each foot’s line of progression and a line intersecting the centre of the heel and second toe.

KINEMATICS AND KINETICS OF GAIT

►Path of Center of Path of Center of GravityGravity midway between the midway between the

hipships Few cm in front of S2Few cm in front of S2 Least energy Least energy

consumption if CG consumption if CG travels in straight linetravels in straight line

Path of Center of GravityPath of Center of Gravity

Path of Center of GravityPath of Center of Gravity

HEEL STRIKE TO FOOT FLAT► Heel strike to forefoot loading ► Foot pronates at subtalar

joint► Only time (stance phase)

normal pronation occurs► This absorbs shock & adapts

foot to uneven surfaces► Ground reaction forces peak► Leg is internally rotating► Ends with metatarsal heads

contacting ground

Sagittal plane analysis

Joint Motion GRF Mome-nt

Muscle Contraction

Hip Flexion

30-25

Anterior flexion G.Maximus

Hamstring

Add.magnus,

Isometric to ecentric

knee Flexion

0-15

Anterior To Posterior

Extensi-on to flexion

quadriceps Concentric to ecentric

ankle Plantar-Flexion

0-15

Posterior PF Tibialis anterior

Ex. digitorum longus

Ex.hallucis longus

ecentric

Frontal plane analysis

JOINT MOTION

Pelvis Forwardly rotated position

Hip Medial rotation of femur on pelvis

knee Valgus thrust with increasing valgus

Medial rotation of tibia

Ankle Increase pronation

Thorax posterior position at leading ipsilateral side

Shoulder Shoulder is slightly behind the hip at ipsilateral extremity side

FOOT FLAT TO MIDSTANCE

FOOT FLAT TO MIDSTANCE (SAGITTAL PLANE)

Joint Motion GRF Moment Muscle Contraction

Hip Extension 25-0

Flexion-0

Anterior to posterior

Flexion to extensi-on

G.maximus Concentric to no activity

Knee Extension 15-5

15-5 flexion

Posterior to anterior

Flexion to extensi-on

Quadriceps Concentric to no activity

Ankle 15 of PF to 5-10 of DF

Posterior to anterior

PF to DF

Soleus, gastronem-ius, PF

Eccentric

Frontal plane analysisJoint Motion

Pelvis Ipsilateral side rotating backward to reach neutral at midstance ,lateral tilting towards the swinging extremity.

Hip Medial rotation of femur on the pelvis continue to neutral position at midstance. adduction moment continue throughout single support.

Knee There is reduction in valgus thrust and the tibia begins to rotate laterally.

Ankle The foot begins to move in the direction of supination from its pronated position at the end of loading response. The foot reaches a neutral position at midstance.

Frontal plane analysis

Ankle The foot begins to move in the direction of supination from its pronated position at the end of loading response. The foot reaches a neutral position at midstance.

Thorax Ipsilateral side moving forward to neutral.

shoulder Moving forward

MIDSTANCE TO HEEL OFF

MIDSTANCE TO HEEL OFF(sagittal plane analysis)

Joint Motion GRF Moment

Muscle

Contract-ion

Hip Extension 0 to hyperextension of 10-20

Posterior Extension Hip flexors

Eccentric

Knee Extension 5 degree of flexion to 0 degree

Posterior to anterior

Flexion to extension

No activity

Ankle PF:5 degree of DF to 0 degree.

Anterior DF Soleus

PF

Eccentric to concentric.

Toes Extension: o-30 degree of hyperextens-ion.

Flexor hallicus longus and brevis

Abductor digiti quinti, interossei, lumbricals

MIDSTANCE TO HEEL OFF(frontal plane analysis)

Joint Motion

Pelvis Pelvis moving posteriorly form neutral position

Hip Lateral rotation of femur and adduction

Knee Lateral rotation of tibia

Ankle –foot

Supination of subtalar joint increases

Thorax Ipsilateral side moving forward

Shoulder Ipsilateral shoulder moving forward.

HEEL OFF TO TOE OFF

HEEL OFF TO TOE OFF(sagittal plane analysis)

Joint Motion GRF Moment Muscle Contraction

Hip Flexion :20 degree of hyperextensi-on to 0 degree.

Posterior Extension to neutral

iliopsoas

Adductor magnus

Adductor longues

concentric

Knee Flexion :o-30degree of flexion

Posterior Flexion Quadriceps

Ecentric to no activity

Ankle PF :0-20 degree of PF

Anterior DF Gastronemius.

soleus, peroneus brevis, peronius longus.

Concentric to no activity

Toes (MTP)

Extension: 50- 60 of hyperextension.

Flexor hallucis longus

Adductor hallicus

Abductor digiti minimi

Flexion digitorum brevis and hallicus brevis, inrossei, lumbricals

Close chain resonse to increasing PF at the ankle.

HEEL OFF TO TOE OFF(frontal plane analysis)

Joint Motion

pelvis Contralateral side moving forward unless contralateral heel touches the ground.

Hip Abduction occur, lateral rotation of femur

Knee Inconsistent lateral rotation tibia

Foot / ankle

Weight is shifted to toes and at toe off only the first toe is in contact., supination of subtalar joint.

Thorax Translation on the ipsilaterior side.

Shoulder Moving forward.

DETERMINANTS OF GAIT DETERMINANTS OF GAIT ►Six optimizations used to minimize Six optimizations used to minimize

excursion of CG in vertical & horizontal excursion of CG in vertical & horizontal planesplanes

►Reduce significantly energy Reduce significantly energy consumption of ambulationconsumption of ambulation

►The six determinants areThe six determinants are Lateral pelvis tiltLateral pelvis tilt Knee flexionKnee flexion Knee, ankle and foot interactions Knee, ankle and foot interactions Forward and backward rotation of pelvisForward and backward rotation of pelvis Physiological valgus of kneePhysiological valgus of knee

DETERMINANTS OF GAITDETERMINANTS OF GAIT

1) 1) Pelvic rotationPelvic rotation:: Forward rotation of the pelvis in the horizontal Forward rotation of the pelvis in the horizontal

plane approx. 8o on the swing-phase sideplane approx. 8o on the swing-phase side Reduces the angle of hip flexion & extensionReduces the angle of hip flexion & extension Enables a slightly longer step-length w/o further Enables a slightly longer step-length w/o further

lowering oflowering of CGCG

(2) (2) Pelvic tiltPelvic tilt:: 5 degree dip of the swinging side (i.e. hip 5 degree dip of the swinging side (i.e. hip

adduction)adduction) In standing, this dip is a positive Trendelenberg signIn standing, this dip is a positive Trendelenberg sign Reduces the height of the apex of the curve of CGReduces the height of the apex of the curve of CG

((3) 3) Knee flexion in stance phaseKnee flexion in stance phase:: Approx. 20o dipApprox. 20o dip Shortens the leg in the middle of stance phaseShortens the leg in the middle of stance phase Reduces the height of the apex of the curve of Reduces the height of the apex of the curve of

CGCG

(4) (4) Ankle mechanismAnkle mechanism:: Lengthens the leg at heel contactLengthens the leg at heel contact Smoothens the curve of CGSmoothens the curve of CG Reduces the lowering of CGReduces the lowering of CG

(5) (5) Foot mechanismFoot mechanism:: Lengthens the leg at toe-off as ankle Lengthens the leg at toe-off as ankle

moves from dorsiflexion to plantarflexionmoves from dorsiflexion to plantarflexion Smoothens the curve of CGSmoothens the curve of CG Reduces the lowering of CGReduces the lowering of CG

►Physiological valgus of knee Reduces the base of support, so only little lateral

motion of pelvis is necessary.

FACTORS AFFECTING GAIT

►Age ►Gender ►Assistive devices►Disease states►Muscle weakness or

paralysis►Asymmetries of the lower

extremities►Injuries and malalignments

GAIT EXAMINATION

►Take a history►Couch examination►Static examination►Allow patient time to relax►Reasonable length walkway - gait

pattern changes before & after turn►Various systematic ways►Look for the obvious!

COUCH EXAMINATION

►Observe deformities & lesions►Check ROM’s►Check muscle tightness/strength►Neurological & vascular assessment

STATIC EXAMINATION ►Feet non-weight bearing (hanging)

with weight bearing►Standing from front

Shoulders, hips, knees, feet From behind Shoulders, hips, calcaneus

GENERAL POINTS

►Is the gait fast or slow?►Is it smooth?►Does the patient appear

relaxed & comfortable or pained?

►Is it noisy?

FEET

►Is the 1st MPJ functioning properly?►Are the toes bearing weight?►When is the heel lifting?►Is toe off through the hallux?►Does the swing phase appear normal?►Are the feet too close or is the base of

gait wide?

FEET

LEGS

►Are the knees pointing forwards?►Is there genu valgum or varum?►Is there tibial varum present?►Do they appear internally or externally

rotated?►Knees from the side – are they fully

extending?

HIPS & BODY

HEAD & SHOULDERS

►Are the shoulders level?►Do the arms swing equally?►Does the head & neck appear normal?

Gait: Major points of observation. 1.Cadence 

a. Symmetrical b. Rhythmic

2.Pain

 a. Where b. When

3.Stride 

a. Even/uneven

4.Shoulders 

Dipping. Elevated,   depressed,   protracted,   retracted

5.Trunk 

a. Fixed deviation b. Lurch

6.Pelvic  a. Anterior or posterior

tilt b. Hike c. Level

7.Knee  a. Flexion, extension

b. Stability8.Ankle  a. Dorsiflexion

b. Eversion, inversion 9.Foot  a. Heelstrike10.Base  a. Stable/variable

b. Wide/narrow

COMMON GAIT COMMON GAIT ABNORMALITIESABNORMALITIES

► Antalgic GaitAntalgic Gait • Gait pattern in which stance phase Gait pattern in which stance phase

on affected side is shortenedon affected side is shortened• Corresponding increase in stance on Corresponding increase in stance on

unaffected sideunaffected side• Common causes: OA, Fx, tendinitisCommon causes: OA, Fx, tendinitis

Lateral Trunk bending/Lateral Trunk bending/ TrendelenbergTrendelenberg gait gait

►Usually unilateralUsually unilateral►Bilateral = waddling gaitBilateral = waddling gait►Common causes:Common causes:

A. Painful hipA. Painful hip

B. Hip abductor weaknessB. Hip abductor weakness

C. Leg-length discrepancyC. Leg-length discrepancy

D. Abnormal hip jointD. Abnormal hip joint

Functional Leg-Length Functional Leg-Length DiscrepancyDiscrepancy

►Swing leg: longer than stance legSwing leg: longer than stance leg►4 common compensations:4 common compensations:

A. CircumductionA. Circumduction

B. Hip hikingB. Hip hiking

C. SteppageC. Steppage

D. VaultingD. Vaulting

Increased Walking BaseIncreased Walking Base

►Normal walking base: 5-10 cmNormal walking base: 5-10 cm

Common causes:Common causes:►DeformitiesDeformities►Abducted hipAbducted hip►Valgus kneeValgus knee

InstabilityInstability►Cerebellar ataxiaCerebellar ataxia►Proprioception deficitsProprioception deficits

Inadequate Dorsiflexion Inadequate Dorsiflexion Control/foot drop gaitControl/foot drop gait

► In stance phase (Heel contact – Foot In stance phase (Heel contact – Foot flat):flat):

Foot slapFoot slap► In swing phase (mid-swing):In swing phase (mid-swing):

Toe dragToe drag Causes:Causes: Weak Tibialis Ant.Weak Tibialis Ant. Spastic plantarflexorsSpastic plantarflexors

Excessive knee extensionExcessive knee extension ►Loss of normal knee flexion during Loss of normal knee flexion during

stance phasestance phase►Knee may go into hyperextensionKnee may go into hyperextension►Genu recurvatumGenu recurvatum: hyperextension : hyperextension

deformity of kneedeformity of kneeCommon causes:Common causes: Quadriceps weakness (mid-stance)Quadriceps weakness (mid-stance) Quadriceps spasticity (mid-stance)Quadriceps spasticity (mid-stance) Knee flexor weakness (end-stance)Knee flexor weakness (end-stance)

Others pathological gaits

►Arthrogenic gait ( stiff hip or knee)►Contracture gait►Gluteus maximus gait►Planter flexor gait►Scissors gait

Neurological gait

►Ataxic gait►Parkinsons gait►Hemiplegic gait►Spectic diplegic►Myopatic gait►Hyperkinetic gait

RUNNING GAIT► Require greater balance, muscle

strength, ROM than normal walking.► Difference b/w running and walking► Reduced BOS► Absence of double support► More coordination and strength

needed► Muscle must generate higher

energy bout to raise HAT higher than in normal walking.

► Divided into flight and support phase.

STAIR GAIT

► Ascending and descending stairs is a basic body movement required for ADL

► Stair gait involved stance and swing phase

kinematics

► SWING PHASE(36%)

• Foot clearance • Foot placement

► STANCE PHASE(64%)

• Weight acceptance • Pull up• Forward

continuance

SIMILARITIES & DIFFERNCES BETWEEN LEVEL GROUND GAIT AND STAIR GATE

►Similarities to WalkingDouble support periods

Ground reaction forces have double peak

Cadence similar

Support moment is similar (always positive with two peaks)

Differences with Walking

► More hip and knee flexion ► Greater Rom needed► Peak forces slightly higher► Centre of pressure is concentrated under

metatarsals, rarely near heel► Step height and tread vary from stairway to

stairway► Railings may be present

……….. THANK YOU ….