PRESENTOR: Dr.THOUSEEF A MAJEED
Rhythmic, cyclic movement of the limbs in
relation to the trunk resulting in forward
propulsion of the body.
NORMAL GAIT REQUIRES
Normal functioning of musculoskeletal system of
lower limbs & spine.
Good sensory feedback from propioceptive sensation
from feet and the joints.
Visual ,labrinthine sensory inputs & co ordination
add smoothness, rhythm & elegance to the human
Base of support
Double limb support
Single limb support
Ground reaction force vector
BASIC GAIT TERMS
Base of suppport:
Distance between a person’s
feet while standing or during
Provides balance & stability to
maintain erect posture.
Normally 2-4 inches from
heel to heel.
Linear distance along the line
of progression of one foot
travelled during one gait
Approximately 15 inches.
Linear distance in the plane of
successive point of foot to
floor contact of the same foot.
Normally 27 – 32 inches.
Period of time from one heel strike to next heel strike of
the same limb
It is measured as the number of steps / sec or per
Approximately 70 steps per minute
Double limb support
During normal gait, for a moment , two lower extremities are
in simultaneous contact with the ground.
During this period, both legs support the body weight.
Happens between push off & toe off on same side and heel
strike & foot flat on the contra lateral side.
GAIT CYCLE COMPONENTS
1. Stance phase :60% of the gait cycle.
2. Swing phase :40% of the gait cycle.
Heel strike phase:
Beginning of stance phase when
the heel contacts the ground.
Begins with initial contact & ends
with foot flat
It occurs immediately following heel
It is the point at which the foot fully
contacts the floor.
It is the point at which the body passes
directly over the supporting extremity.
The point following midstance the heel of the
reference extremity leaves the ground.
The point following heel off when only the
toe of the reference extremity is in contact
with the ground.
HIP : STANCE PHASE
PHASE NORMAL MOVEMEMT NORMAL MUSCLE ACTION
Heel strike to foot
30* flexion Erector spinae,gluteus
Foot flat to
30*flexion-(neutral) Gluteus maximus at beginning to
oppose flexion movement, then
activity ceases as moment changes
from flexion to extension
Midstance to heel
extension No activity
Heel off to toe off 10* hyperextension to neutral Iliopsoas,adductor
KNEE : STANCE PHASE
NORMAL MUSCLE ACTION
Heel strike to foot flat 0*-15* flexion Quadriceps contracts initially to hold
knee in extension & then eccentrically
oppose the flexion movement to
controll amount of flexion.
Foot flat to midstance 15*flexion-
Quadriceps contract in early part,&
then no activity is required
Midstance to heel off 5* of flexion-neutral No activity required
Heel off to toe off 0*-40* flexion Quadriceps required to control amount
of knee flexion
ANKLE & FOOT : STANCE PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTIVITY
Heel srike to foot flat 0*-15* plantar flexion Eccentric action of tibialis
anterior oppose plantar flexion
Foot flat to midstance 15*plantar flexio-10*dorsi
Gastronemius & soleus act
eccentrically to oppose
dorsiflexion movement &
control tibial advance
Midstance to heel off 10*-15* dorsiflexion same as above
Heel off to toe off 15*dorsiflexion to 20*
brevis & longus,flexor hallusis
longus contract to plantar flex
• It begins once the toe leaves the ground &
continues until mid-swing, or the point at
which the swinging extremity is directly
under the body.
It occurs approximately when the reference
extremity passes directly under the body.
It extends from end of acceleration to the
beginning of deceleration
It occurs after mid-swing
when the referance extremity is
decelerating in preparation for heel
HIP : SWING PHASE
NORMAL MUSCLE ACTION
Acceleration to mid
20*-30* flexion Hip flexor activity to initiate swing
30*flexion –neutral hamstrings
KNEE :SWING PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTION
40*-60* flexion Little activity in quadriceps,biceps
sartorius contract concentrically
Midswing 60*flexion-30* extension
Deceleration 30*-0* extension Quadriceps contract concentrically
to stabilize knee in extension in
preparation for heel strike
Ankle & foot : swing phase
PHASE NORMAL MOTION NORMAL MUSCLE ACTION
Dorsiflexion to neutral Dorsiflexors contract to bring the
ankle in neutral & prevent toes
from dragging on the floor
Mid swing to
WALKING AND RUNNING
Walking : Always a double support phase
no flight phase
No double support phase, always flight phase
PASSENGER UNIT LOCOMOTOR
HAS NO ROLE .
GOES ALONG THE RIDE
DETERMINANTS OF GAIT
I. Displacement of center of gravity (COG).
II. Factors responsible for minimizing
displacement of center of gravity.
CENTER OF GRAVITY
It is an imaginary point at which all the weight of the
body is concentrated at a given instant.
Center of gravity lies 2 inches in front of the second
Centre of gravity follows vertical displacement and
Rhythmic up & down
Highest point= midstance
Average displacement-5 cm
Vertical displacement Horizontal displacement
Rhythmic side to side
Average displacement-5 cm
Sum of vertical & horizontal
Figure ‘8’ movement of Center of
Gravity as seen from Antero
These displacement require energy
“Greater the displacement more
energy is needed”.
Factors responsible for minimizing
the displacement of centre of gravity
Pelvic Rotation (transverse plane)
Pelvic Lateral Tilt (Obliquity)
Knee Flexion During Stance
Ankle Mechanism (Dorsiflexion)
Ankle Mechanism (Plantarflexion)
1. Neck movement.
2. Swinging of arms.
1. Pelvic rotation
Rotation of pelvis in Horizontal plane in swing phase, total of
Decrease angle of hip flexion & extension
Enables a longer step length without further
lowering of Center of gravity
2. Pelvic tilt
•The pelvis slopes downwards laterally towards the leg which
is in swing phase
•Reduces the vertical movements of the upper body, and
thereby increases energy efficiency.
•Decrease the displacement of Center of gravity
3. Knee flexion in stance
•As the hip joint passes over the foot during the support phase, there
is some flexion of the knee. This reduces vertical movements at the
•Decrease the displacement of Centre of Gravity
4. Ankle mechanism
•Lengthen the leg at heel strike
•Reduce the lowering of Centre of gravity, hence smoothen the
curve of Center of gravity.
5. Foot mechanism
•Lengthen the leg at toe off as ankle moves from dorsiflesion
to planter flexion
•Reduce the lowering of Centre of Gravity, hence smoothen
the curve of Centre of Gravity
Trunk and Arms
• The trunk, arms and shoulders also rotate to ensure
• Upper limb swings opposite to stance leg to produce a
smooth balanced gait.
6. Lateral displacement of body
•In normal gait, width of walking base is narrow,
decrease the lateral displacement of Centre of Gravity
•Decrease muscular energy consumption due to decrease
lateral acceleration & deceleration
Due to complex interaction of muscular activity & joints
motion in lower limb Centre of Gravity follows a smooth
It reduce the significant energy consumption of
GAIT IN CHILDREN (<2years)
Gait of small children differs from that of adult
The walking base is wider.
The stride length & speed are lower & the cycle time
Small children have no heel strike, initial contact being made
by flat foot.
There is very little stance phase and knee flexion.
The whole leg is externally rotated during the swing phase.
There is an absence of reciprocal arm swinging.
GAIT IN ELDERLY
The age related changes in gait takes place in decade
after m 70yrs.
There is a decreased stride length, increased cycle
Relative increase in duration of stance phase of gait
The speed almost always reduced in elderly people.
Reduction in total range of hip flexion & extension,
Reduction in swing phase and knee flexion
Function of the 6 determinants of gait:
1) Increase the efficiency and smoothness of gait.
2) Decrease the vertical and lateral displacement of
center of gravity.
3) Decrease the energy expenditure.
4) Make gait more graceful.
KINETIC GAIT ANALYSIS
Describe the movement
pattern without regard for the
force involved in producing
Determine the force that
are involved in the gait.
Observational method- naked eye examination
Photographic method- television , video, movie analysis
Force plate study method-ground reaction force method
Electromyographic study (EMG)
Energy expenditure/requirement method
Multichannel funtional electrical stimulation
Clinical gait analysis
1. Observational gait data:(Qualitative)
Clinician watches patients walk
1. Require little or no instrumentation
3. Yield general description of gait variables
Clinical gait analysis
2. Gait parameters (Quantitative)
• The gait parameter measurement are made by
timing progress over a 16m walkway & identifying
events by means of foot switch system.
• These instrument identify the part contacting the
ground with data transmitted by telemetry.
•Photographic methods are most
•After film development, each frame
is analysed using vanguard motion
analyser and sonic digitizer.
4. Force plate data
It represent the ground reaction force of walking
generated by force plate
It is used to study
the joints during
Deals with measurement of oxygen consumption
during a specific task
Oxygen uptake is inversely related to the efficiency of
Gait pattern in which stance phase on affected side is
shortened due to pain in the weight bearing limb.
There is corresponding increase in stance phase on
Common causes: Osteoarthritis, Fractures, tendinitis
Any condition which distrupts the osseo-muscular
mechanism between pelvis and femur
Weak abductors (power),acetabulo femoral articulation
defect(fulcrum),defective lever system causes trendelenberg
Here the abductor action in pulling the pelvis downwards in
stance phase becomes ineffective and the pelvis drops on the
opposite side causing instability.
To prevent this body lurches on the same side.
If bilateral = waddling gait
1. Weak abductors :poliomyelitis . muscular dystrophies,
motor neuron disease
2. Defective fulcrum: Congenital dislocaion of hip(CDH),
pathological dislocation of hip
3. Defective lever : Fracture neck of femur, Perthes disease,
In hemiplegic patients
To avoid the foot from
scrapping the ground, the hip
and the lower limb rotates
High stepping gait
Due to foot drop
On attempt of heel strike, the toe drops to the ground
To avoid this the patient
flexes the hip and knee
extensively to raise the
foot and slaps it on the
Here one leg crosses directly over the other with each
step due to adductor tightness.
Seen in Cerebral palsy
Drunkers or reeling gait
Patient tends to walk irregularly on wide base, swinging
sideways without stability and balance.
Caused due to cerebellar lesion.
With unilateral lesion of cerebellum, balance is lost towards the
side of the lesion.
Genu recurvatum gait
In Paralysis of hamstring muscles the knee goes in for
hyper extension while transmitting the weight in mid
Seen in poliomyelitis
Short limb gait
Shortening less than 1.5 cm compensated by pelvic tilt, and
shortening upto 5 cm compensated by equinus.
Shortening more than 5 cm the patient dips his body on that
Seen in Parkinson's disease
Steps are short that the feet barely clears the ground.
Normally the knee is locked by the quadriceps contraction
while transmitting weight to the lower limb during
Hence patient with weak quadriceps stabilizes his knee by
leaning forward on the affected side & pressing over lower
thigh by his Ispilateral hand or fingers.
Gluteus maximus gait(BACKWARD
Due to weakness in gluteus maximus
muscle, while the body propels
forward during midstance
phase,trunk is lurched posterior
to effect posterior pelvic and
shifting the centre of gravity
towards stance hip.
Seen in poliomyelities & above knee amputation with
Stiff hip gait
When the hip is ankylosed, it is not possible
to flex at the hip joint during walking to
clear the ground in the swing phase.
Hence the person with stiff hip, lifts
the pelvis on that side and swings the leg with
the pelvis in circumduction and moves it
It occurs in sensory ataxia in which there is loss of sensation
in lower extremity due to disease processes in peripheral
nerves, dorsal roots, dorsal column of spinal cord.
Due to absence of deep position sense,the patient constantly
observes placing of his feet.
Hip is hyperflexed & externally rotated & forefoot is
dorsiflexed to strike ground with a Stamp.
Seen in peripheral neuritis &
brain stem lesion in
children, tabes dorsalis in
• Seen in Tuberculosis of spine in lower dorsal and upper
• Patient walk with head and chest thrown backward and
protuberant abdomen and legs thrown wide apart.
To achieve safe, easy, effortless normal gait pattern.
Non ambulatory phase
1. Asses and improve the range of movement
2. Treat contractures
3. Improve the cardio respiratory status
4. Shadow walking
5. Assisted device
1. Support by orthotic & prosthesis
2. Parallel bar walking
3. Encourage reciprocal arm swinging
4. Follow other forms of walking
Walking on uneven rough surface