GAIT PATTERNS IN HIP
DISORDERS
Dr. K.K. CHANDRABABU,
Professor of Orthopaedics,
Medical College,Thiruvananthapuram.
Normal gait Definition
Gait analysis
Pathological gait Spastic gait
Antalgic gait
Trendelenberg gait
Short limb gait
Glute...
Normal Gait
 Definition
Human gait is bipedal,
biphasic,forward propulsion
of centre of gravity,
in which there is altern...
Normal Gait
 Definition
Human gait is bipedal,
biphasic, forward propulsion of
centre of gravity, in which there is
alter...
Normal walking requirements
Equilibrium-ability to assume upright
posture and maintain balance.
Locomotion-ability to init...
GAIT ANALYSIS
 Study of human locomotion
 Walking consists of a series of gait
cycles
 A single gait cycle is known as ...
GAIT CYCLE
A single gait cycle or stride is defined:
 Period when ONE foot contacts the ground to
when that same foot con...
Stance Phase of Gait
When the foot is in
contact with the
ground
Stance phase has 5
parts:
1.Initial Contact (Heel
Strike)...
Initial Contact
 Phase 1
 The moment when
the red heel just
touches the floor,
The first double
stance period begins
 B...
Loading Response
 Phase 2
 Rest of the red foot
comes down to
contact the ground
 The double stance
period continues
 ...
Midstance
 Phase 3
 single limb support
interval.
 Begins with the
lifting of the blue
foot and continues
until the cen...
Terminal Stance
 Phase 4
 Begins when the red
heel rises and
continues until the
heel of the blue foot
hits the ground.
...
Pre swing
Phase 5
 Begins with the initial
contact of the blue foot
and ends with red toe-off.
 The second double stance...
Stance Phase Characteristics
During a single stride, there are 2 periods
of double limb support
 Initial double limb stan...
Swing Phase
When foot is NOT contacting the
ground
Limb advancement phase
3 parts of swing phase:
-Initial swing
-Midswing...
Initial Swing
Phase 6
 Begins when the red
foot is lifted from the
floor and ends when
the red swinging foot
is opposite ...
Midswing
Phase 7
 Starts at the end of the
initial swing and
continues until the red
swinging limb is in front
of the bod...
Terminal Swing
Phase 8
 Begins at the end of
midswing and ends
when the foot
touches the floor.
 Limb advancement is
com...
parts of a gait cycle
0-10% 10-30% 30-50% 50-60% 60-73% 73-87% 87-100%
Initial double
limb stance
single limb
stance
Termi...
Gait Progression
R leg
L leg
R STANCE
L SINGLE
1st
DOUBLE
SUPPORT
2nd
DOUBLE
SUPPORT
DOUBLE
SUPPORTR SINGLE
L SWING L STAN...
Tasks and divisions of gait cycle
Gait parameters(cadence
parameters)
Step length –distance between two feet
during double limb support.it is
measured from ...
gait parameters
Stride length
L step lengthR step length
L
L
R
Walking
base
8cm
70-82 cm
35-40cm
Cadence parameters contd..
Step time –amount of time used to
complete one step length
Cadence –number of steps taken per
m...
CENTRE OF MASS
 Center of mass (COM) is located just
anterior to the second sacral vertebra
 COM deviates from the strai...
Displacement in the plane of
progression
Pelvis and trunk
shift 1-2 inch
laterally during
gait cycle
width of a N base
mea...
Energy expense
 Efficient gait reduces
the amount of energy
required to ambulate
heel strike mid stance toe off
goals-to ...
the locomotor system has
several methods to try to
reduce its amplitude
heel strike mid stance toe off
Determinants of gait
Pelvic rotation
Pelvic tilt
Stance phase knee flexion
Transverse rotation of leg segment
Normal valgu...
Muscle activity during gait
Concentric contraction-generates power
and accelerates body forward
-gastrocsoleus contracts t...
Muscle activity during gait
Eccentric contraction-slows down and stabilises
joint motion
-tibialis anterior-contracts at i...
KINEMATICS
Denotes the motion observed and
measured at pelvis,hip,knee,ankle and
foot
Done in three planes
-sagittal plane...
CLINICAL GAIT ANALYSIS
OBSERVATIONAL GAIT ANALYSIS
3D GAIT ANALYSIS
Obsevational gait analysis
Pt should be viewed from the front, side,
and behind
hyperlordosis . ankle plantarflexion
dorsi...
Observational gait analysis-what
to look for
The head position.
Shoulders - depressed, elevated, protracted, or retracted....
3D gait analysis
THIS IS DONE IN A GAIT LABORATARY
3D gait analysis
Kinematics -movement
Kinetics -forces related to movements
 Ground reaction forces (GRF)
 Moment or tor...
Gait Patterns in Cerebral Palsy
 Geographic classification
Hemiplegia (one side; UL>LL)
Diplegia (both sides; LL>UL)
Triplegia (both LL+1UL)
Quadripl...
Spastic Diplegia /quadriplegia
(Sutherlands and Davids)
 True Equinus -distal spasticity
Gastrosoleus spasticity Equinus
...
Crouch gait Jump gait
 Scissoring gait
 Adductor musculature spasm
 Flexion +int. rotn deformity
 TFL is the main deforming force
 Can brin...
ANTALGIC GAIT
 Pain in
lower limb
back
--hip pain Lurch to affected side
Reduce abductor force on hip
No pelvic drop
No g...
ANTALGIC GAIT
 Short stepping
 Asymmetrical step length
 Step length on affected side less
 Unaffected limb is brought...
ANTALGIC GAIT
 Infective
 Inflammatory
 Early perthes
 Acute silp
 Trauma
Abductor muscle function
 Two limb stance
 One limb stance
Cog to wt bearing head =
c o h to abductor x 2
compressive fo...
In 1895 Fredrich
Trendelenburg described a
clinical sign useful for
detecting the function of hip
abductor muscle with spe...
TRENDELENBERG GAIT
 Functional weakening of abductor mechanism.
 Abductor muscles at mechanical disadvantage
 Standing ...
TRENELENBURG GAIT
UNCOMPENSATED
COMPENSATED
TRENDELENBERG GAIT
 Fulcrum – hip joint – DDH
arthritis
 Lever arm - head,neck,and shaft
Congenital coxa vara,
#neck, ma...
SHORT LEG GAIT
 Shift to same side
 Pelvis tilt downward with dip
 Equal period on each side
 Supinate foot or toe wal...
GL. MAXIMUS WEAKNESS GAIT
 GL. MAXIMUS
Terminal swing- opposite side – gluteus maximus locks
hip in extension on wt bear...
Gait after arthrodesis
Pt will not tilt to side
Body moves forwards & backwards
Excessive anterior pelvic tilt & lumbar...
Gait in bilateral hip diseases
 Waddling gait
Bilateral trendelenberg
CDH
COXA VARA
Gait in bilateral ankylosis
 Ankylosis in abduction
 Weight on one side
 Lift other side
 Foot as fulcrum
 Rotate the...
 Ankylosis in adduction
Knee close
cannot lift leg
walking not possible
Gait in bilateral ankylosis
Thank You
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Gate analysis

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Gate analysis

  1. 1. GAIT PATTERNS IN HIP DISORDERS Dr. K.K. CHANDRABABU, Professor of Orthopaedics, Medical College,Thiruvananthapuram.
  2. 2. Normal gait Definition Gait analysis Pathological gait Spastic gait Antalgic gait Trendelenberg gait Short limb gait Gluteus maximus gait gait in bilateral hip problems
  3. 3. Normal Gait  Definition Human gait is bipedal, biphasic,forward propulsion of centre of gravity, in which there is alternate sinuous movement of head and body, with least expenditure of energy
  4. 4. Normal Gait  Definition Human gait is bipedal, biphasic, forward propulsion of centre of gravity, in which there is alternate sinuous movement of head and body, with least expenditure of energy.
  5. 5. Normal walking requirements Equilibrium-ability to assume upright posture and maintain balance. Locomotion-ability to initiate and maintain rhythmic stepping. Muskuloskeletal integrity-normal bone joint and muscle function. Neurological control-visual ,auditory vestibular and sensory motor input
  6. 6. GAIT ANALYSIS  Study of human locomotion  Walking consists of a series of gait cycles  A single gait cycle is known as a STRIDE
  7. 7. GAIT CYCLE A single gait cycle or stride is defined:  Period when ONE foot contacts the ground to when that same foot contacts the ground again  Each stride has 2 phases: Stance Phase -60% of the gait cycle  Foot in contact with the ground Swing Phase -40% of the gait cycle  Foot NOT in contact with the ground
  8. 8. Stance Phase of Gait When the foot is in contact with the ground Stance phase has 5 parts: 1.Initial Contact (Heel Strike) 2.Loading Response (Foot Flat) 3.Midstance 4.Terminalstance(heel raise) 5.Pre-Swing(toe off) 1 2 3 4 5
  9. 9. Initial Contact  Phase 1  The moment when the red heel just touches the floor, The first double stance period begins  Blue leg is at the end of terminal stance
  10. 10. Loading Response  Phase 2  Rest of the red foot comes down to contact the ground  The double stance period continues  Full body weight is transferred onto the red leg.  Blue leg is in pre swing (toe off)
  11. 11. Midstance  Phase 3  single limb support interval.  Begins with the lifting of the blue foot and continues until the centre of mass(body wt) is directly over the red ankle
  12. 12. Terminal Stance  Phase 4  Begins when the red heel rises and continues until the heel of the blue foot hits the ground.  Centre of mass(body wt) progresses beyond the red foot
  13. 13. Pre swing Phase 5  Begins with the initial contact of the blue foot and ends with red toe-off.  The second double stance interval in the gait cycle  Transfer of body weight from ipsilateral to opposite limb takes place.
  14. 14. Stance Phase Characteristics During a single stride, there are 2 periods of double limb support  Initial double limb stance- initial contact &Loading response ®  Terminal double limb stance-pre swing ® IC LR MSt TSt PSw ISw MSw TSw
  15. 15. Swing Phase When foot is NOT contacting the ground Limb advancement phase 3 parts of swing phase: -Initial swing -Midswing -Terminal swing
  16. 16. Initial Swing Phase 6  Begins when the red foot is lifted from the floor and ends when the red swinging foot is opposite the blue stance foot.  The blue leg is in mid- stance.
  17. 17. Midswing Phase 7  Starts at the end of the initial swing and continues until the red swinging limb is in front of the body  Advancement of the red leg  The blue leg is in late mid-stance.
  18. 18. Terminal Swing Phase 8  Begins at the end of midswing and ends when the foot touches the floor.  Limb advancement is completed at the end of this phase.
  19. 19. parts of a gait cycle 0-10% 10-30% 30-50% 50-60% 60-73% 73-87% 87-100% Initial double limb stance single limb stance Terminal double limb stance
  20. 20. Gait Progression R leg L leg R STANCE L SINGLE 1st DOUBLE SUPPORT 2nd DOUBLE SUPPORT DOUBLE SUPPORTR SINGLE L SWING L STANCE R SWINGR STANCE
  21. 21. Tasks and divisions of gait cycle
  22. 22. Gait parameters(cadence parameters) Step length –distance between two feet during double limb support.it is measured from the heel of one foot to heel of contralateral foot Stride length -distance one limb travels during the stance and swing phase.it is measured from the point of foot contact at the beginning of stance phase to the point of contact by the same foot at the end of swing phase
  23. 23. gait parameters Stride length L step lengthR step length L L R Walking base 8cm 70-82 cm 35-40cm
  24. 24. Cadence parameters contd.. Step time –amount of time used to complete one step length Cadence –number of steps taken per minute Walking velocity -distance traveled per minute 90-120 steps
  25. 25. CENTRE OF MASS  Center of mass (COM) is located just anterior to the second sacral vertebra  COM deviates from the straight line in vertical and lateral sinusoidal displacements
  26. 26. Displacement in the plane of progression Pelvis and trunk shift 1-2 inch laterally during gait cycle width of a N base measures2-4 inches and step length 15 inches CoG deviates 2 inches vertically during gait cycle in swing phase CoG oscillates 40 degree forward
  27. 27. Energy expense  Efficient gait reduces the amount of energy required to ambulate heel strike mid stance toe off goals-to reduce the maximum ht of body CoM at mid stance,to increase the minimum ht of body CoM at heel strike and toe off
  28. 28. the locomotor system has several methods to try to reduce its amplitude heel strike mid stance toe off
  29. 29. Determinants of gait Pelvic rotation Pelvic tilt Stance phase knee flexion Transverse rotation of leg segment Normal valgus alignment of knee Ankle rockers
  30. 30. Muscle activity during gait Concentric contraction-generates power and accelerates body forward -gastrocsoleus contracts to lift the heel off the ground -iliopsoas contracts flexing the hip and pulling the stance phase limb off the ground
  31. 31. Muscle activity during gait Eccentric contraction-slows down and stabilises joint motion -tibialis anterior-contracts at initial contact ,firing during plantar flexion as the foot is lowered to ground. so the foot is gently lowered to ground -gastrocsoleus-contracts eccentrically through the stance phase controlling the rate of dorsiflexion of ankle
  32. 32. KINEMATICS Denotes the motion observed and measured at pelvis,hip,knee,ankle and foot Done in three planes -sagittal plane-hip flexion ,extension -coronal plane-hip abduction,adduction -transverse plane-rotation hip,tibia,feet
  33. 33. CLINICAL GAIT ANALYSIS OBSERVATIONAL GAIT ANALYSIS 3D GAIT ANALYSIS
  34. 34. Obsevational gait analysis Pt should be viewed from the front, side, and behind hyperlordosis . ankle plantarflexion dorsi flexion, knee flexion extension, and hip flexion extension. pelvic abduction or adduction.
  35. 35. Observational gait analysis-what to look for The head position. Shoulders - depressed, elevated, protracted, or retracted. Amount of arm swing - normal, increased, or decreased The trunk - forward or backward lurch or a list to the R or L The pelvis -hiked, level, dropped, or fixed. The hip - extension, flexion, rotation, circumduction, or an adducted or abducted posture. The knee - flexion, extension, and general stability The ankle- plantarflexion and dorsiflexion, eversion and inversion. The foot - proper push off and pronation and supination Pain-where and when Cadence,base width,stride length
  36. 36. 3D gait analysis THIS IS DONE IN A GAIT LABORATARY
  37. 37. 3D gait analysis Kinematics -movement Kinetics -forces related to movements  Ground reaction forces (GRF)  Moment or torque - a turning force that results in angular change of position of a segment/joint  Power - a function of joint angular velocity and joint moment; rate of doing work Electromyography (EMG) -recording of myoelectrical activity
  38. 38. Gait Patterns in Cerebral Palsy
  39. 39.  Geographic classification Hemiplegia (one side; UL>LL) Diplegia (both sides; LL>UL) Triplegia (both LL+1UL) Quadriplegia (both UL+both LL+trunk)  Common: Spastic hemiplegia or diplegia(91%) Cerebral Palsy
  40. 40. Spastic Diplegia /quadriplegia (Sutherlands and Davids)  True Equinus -distal spasticity Gastrosoleus spasticity Equinus Genu recurvatum  Jump Gait Spasticity of hamstrings and hip flexors and calf Equinus +hip and knee in flexion ,ant. pelvic tilt + exaggerated lumbar lordosis+ knee stiff (rectus femoris)  Crouch gait Excessive dorsiflexion or calcaneus at ankle +excessive flexion at knee and hip +ant. pelvic tilt may be Iatrogenic due to isolated lengthening of TA (w/o correcting hamstring & iliopsoas spasm)
  41. 41. Crouch gait Jump gait
  42. 42.  Scissoring gait  Adductor musculature spasm  Flexion +int. rotn deformity  TFL is the main deforming force  Can bring the swing limb up to the stance limb  Cadence parameters are grossly decreased
  43. 43. ANTALGIC GAIT  Pain in lower limb back --hip pain Lurch to affected side Reduce abductor force on hip No pelvic drop No gluteal weakness
  44. 44. ANTALGIC GAIT  Short stepping  Asymmetrical step length  Step length on affected side less  Unaffected limb is brought forward more quickly than normal in swing phase  Duration of stance phase increased on normal side
  45. 45. ANTALGIC GAIT  Infective  Inflammatory  Early perthes  Acute silp  Trauma
  46. 46. Abductor muscle function  Two limb stance  One limb stance Cog to wt bearing head = c o h to abductor x 2 compressive force on wt bearing head = 3x wt of upper body
  47. 47. In 1895 Fredrich Trendelenburg described a clinical sign useful for detecting the function of hip abductor muscle with special referance to CDH and progressive muscular dystrophy
  48. 48. TRENDELENBERG GAIT  Functional weakening of abductor mechanism.  Abductor muscles at mechanical disadvantage  Standing on affected side pelvis drop to normal side  To compensate pt lurch to affected side steppage gait No need to compensate – tilt to opposite side
  49. 49. TRENELENBURG GAIT UNCOMPENSATED COMPENSATED
  50. 50. TRENDELENBERG GAIT  Fulcrum – hip joint – DDH arthritis  Lever arm - head,neck,and shaft Congenital coxa vara, #neck, malunited # trochanter  Power - abductors polio, myopathy etc.
  51. 51. SHORT LEG GAIT  Shift to same side  Pelvis tilt downward with dip  Equal period on each side  Supinate foot or toe walk  Flex knee and hip on normal side  Raise pelvis on normal side in swing phase – hip hiking – to clear ground
  52. 52. GL. MAXIMUS WEAKNESS GAIT  GL. MAXIMUS Terminal swing- opposite side – gluteus maximus locks hip in extension on wt bearing side  Weakness- pelvis thrust forward and trunk backward shift COG backwards– no force GM need to lock  increased lordosis lurch back &forth over the hips Gowers’ sign
  53. 53. Gait after arthrodesis Pt will not tilt to side Body moves forwards & backwards Excessive anterior pelvic tilt & lumbar lordosis were necessary to extend the femur on the involved side while the normal limb was being advanced Transverse pelvic rotation about the contralateral hip increased walking speed 84 per cent of normal
  54. 54. Gait in bilateral hip diseases  Waddling gait Bilateral trendelenberg CDH COXA VARA
  55. 55. Gait in bilateral ankylosis  Ankylosis in abduction  Weight on one side  Lift other side  Foot as fulcrum  Rotate the whole body  Advance opp leg  Repeat on other side ‘a curious clockwork gait’– Herbert Sedden
  56. 56.  Ankylosis in adduction Knee close cannot lift leg walking not possible Gait in bilateral ankylosis
  57. 57. Thank You
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