Gait normal & abnormal


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Gait normal & abnormal

  1. 1. Gait(normal & abnormal) Dr. P. Ratan Khuman (PT) M.P.T., (Ortho & Sports)
  2. 2. Definition Locomotion or gait –  It is defined as a translatory progression of the body as a whole produce by coordinated, rotatory movements of body segments. Normal gait –  It is a rhythmic & characterized by alternating propulsive & retropulsive motions of the lower extremities. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 2
  3. 3. Task involves in walking According to “Rancho Los Amigos” (RLA), California  Weight acceptance  Single limb support  Swing limb advance 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 3
  4. 4. Gait initiation A series of events occur from the initiation of body movt to beginning of gait cycle. It is stereotyped activity in both young & old healthy people. Total duration of this phase is about – 0.60sec 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 4
  5. 5. Kinematics of gait22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 5
  6. 6. Phases of gait Stance phase Swing phase 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 6
  7. 7. Stance phase It begins at the instant that one extremity contacts the ground & continuous only as long as some portion of the foot is in contact with the ground. It is approx 60% of normal gait duration. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 7
  8. 8. Swing phase It begins as soon as the toe of one extremity leaves the ground & ceases just before heel strike or contact of the same extremity. It makes up 40% of normal gait cycle. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 8
  9. 9. Double support Lower limb of one side of body is beginning its stance phase & the opposite side is ending its stance phase. During double support both the lower limb are in contact with the ground at the same time. It account approx 22% of gait cycle. This phase is absent in running 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 9
  10. 10. Subdivision of phasesStance phase – Swing phase –1) Heel strike 1) Acceleration2) Foot flat 2) Mid-swing3) Mid-stance 3) Deceleration4) Heel off5) Toe off 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 10
  11. 11. Comparison of gait terminology Traditional –  RLA – 1) Heel strike 1) Initial contact 2) Foot flat 2) Loading response 3) Mid-stance 3) Mid-stance 4) Heel off 4) Terminal stance 5) Toe off 5) Pre-swing 6) Acceleration 6) Initial swing 7) Mid-swing 7) Mid-swing 8) Deceleration 8) Terminal swing 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 11
  12. 12. Traditional phases of gait22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 12
  13. 13. Stance phase Heel strike phase:  Begins with initial contact & ends with foot flat  It is beginning of the stance phase when the heel contacts the ground. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 13
  14. 14. Stance phase Foot flat:  It occurs immediately following heel strike  It is the point at which the foot fully contacts the floor. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 14
  15. 15. Stance phase Mid stance:  It is the point at which the body passes directly over the supporting extremity. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 15
  16. 16. Stance phase Heel off:  the point following midstance at which time the heel of the reference extremity leaves the ground. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 16
  17. 17. Stance phase Toe off:  The point following heel off when only the toe of the reference extremity is in contact with the ground. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 17
  18. 18. Swing phase Acceleration phase:  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. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 18
  19. 19.  Mid-swing:  It occurs approx when the extremity passes directly beneath the body, or from the end of acceleration to the beginning of deceleration. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 19
  20. 20. Swing phase Deceleration:  It occurs after mid-swing when limb is decelerating in preparation for heel strike. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 20
  21. 21. Sub-divisions of stance phase22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 21
  22. 22. Sub-divisions of swing phase22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 22
  23. 23. Sub component of stance phase 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 23
  24. 24. Sub component of swing phase 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 24
  25. 25. RLA phases of gait22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 25
  26. 26. Initial contact It refer to the initial contact of the foot of leading lower limb. Normally the heel pointed first to contact. In abnormal gait it is possible to either whole foot or toes rather than the heel to strike. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 26
  27. 27. Load response Begins at initial contact & ends when the contra lateral extremity lifts off the ground at the end of the double- support phase. It occupies about 11% of gait 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 27
  28. 28. Mid-stance phase (RLA) Begins when the contra-lateral extremity lifts off the ground at about 11% of the gait cycle Ends when the body is directly over the supporting limb at about 30% of the gait cycle. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 28
  29. 29. Terminal stance (RLA) Begins when the body is directly over the supporting limb at about 30% of the gait cycle Ends just before initial contact of the contra-lateral extremity at about 50% of the gait cycle. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 29
  30. 30. Pre-Swing (RLA) It is the last 10% of stance phase and begins with initial contact of the contra-lateral foot (at 50% of the gait cycle) and ends with toe-off (at 60%). 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 30
  31. 31. Initial swing (RLA) Begins when the toe leaves the ground & continues until max knee flexion occurs. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 31
  32. 32. Mid-Swing (RLA)  Encompasses the period from maximum knee flexion until the tibia is in a vertical position.22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 32
  33. 33. Terminal swing (RLA) Includes the period from the point at which the tibia is in the vertical position to a point just before initial contact. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 33
  34. 34. Gait cycle22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 34
  35. 35. Variables of gait There are two basic variables which provide a basic description of human gait.  Time/ Temporal variable & Distance variables. Provide essential quantitative information about gait 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 35
  36. 36. factors affecting variables Age,  Joint mobility, Gender,  Muscle strength, Height,  Type of clothing & Size & shape of bony footwear, components,  Habit, Distribution of mass in  Psychological status. body segments, 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 36
  37. 37. variables Temporal variable –  Distance variable –  Stance time  Stride length,  Single-limb & double-  Step length and width support time,  Degree of toe-out  Swing time,  Stride and step time,  Cadence and  Speed 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 37
  38. 38.  Stance time:  It is the amount of time that elapses during the stance phase of one extremity in a gait cycle. Single-support time:  It is the amount of time that elapses during the period when only one extremity is on the supporting surface in a gait cycle. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 38
  39. 39.  Double-support time:  It is the amount of time spent with both feet on the ground during one gait cycle.  The % of time spent increased in elderly persons and in those with balance disorders.  The percentage of time spent decreases as the speed of walking increases. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 39
  40. 40.  Stride length:  It is the linear distance from the heel strike of one lower limb to the next heel strike of the same limb. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 40
  41. 41.  Step length:  It is the linear distance from the heel strike of one lower limb to the next heel strike of opposite limb. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 41
  42. 42.  Stride duration:  It refers to amount of time taken to accomplish one stride.  Stride duration and gait cycle duration are synonymous.  One stride, for a normal adult, lasts approx 1 sec 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 42
  43. 43.  Step duration:  It refers to the amount of time spent during a single step.  Measurement usually is expressed as sec/step.  When weakness or pain in limb, step duration may be decreased on the affected side and increased on the unaffected side. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 43
  44. 44.  Cadence:  It is the no of steps taken by a person per unit of time.  It is measured as the no of steps / sec or per minute. Cadence = Number of steps / Time 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 44
  45. 45.  Walking velocity:  It is the rate of linear forward motion of the body, which can be measured in meters or cm/second, meters/minute, or miles/hour.Walking velocity (meters/sec)=Distance walked (meters)/time (sec) 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 45
  46. 46.  Speed of gait:  It is referred to as slow, free, and fast.  Free speed of gait refers to a person‟s normal walking speed  Slow & fast speeds of gait refer to speeds slower or faster than the person‟s normal comfortable walking speed, designated in a variety of ways. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 46
  47. 47.  Step width or width of the walking base:  It is the measure of linear distance between the midpoint of the heel of one foot and the same point on the other foot 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 47
  48. 48.  Degree of toe-out (DTO):  It represents the angle of foot formed by each foot‟s line of progression and a line intersecting the centre of the heel and the second toe.  The angle for men is about 70 from the line of progression of each foot at free speed walking.  The DTO decreases as the speed of walking increases in normal men. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 48
  49. 49. Degree of toe out22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 49
  50. 50. Variables of gait22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 50
  51. 51. Path of COG Center of Gravity (CG):  Midway between the hips  Few cm in front of S2 Least energy consumption if CG travels in straight line 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 51
  52. 52. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 52
  53. 53.  Vertical displacement:  Rhythmic up & down movement  Highest point: midstance  Lowest point: double support  Average displacement: 5cm  Path: extremely smooth sinusoidal curve 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 53
  54. 54.  Lateral displacement:  Rhythmic side-to-side movement  Lateral limit: mid-stance  Average displacement: 5cm  Path: extremely smooth sinusoidal curve 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 54
  55. 55.  Overall displacement: Horizontal plane  Sum of vertical & horizontal displacement  Figure „8‟ movement Vertical plane of CG as seen from AP view 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 55
  56. 56. SaunderS’ Determinants of gait Gait “determinants” was first described by “Saunders & Coworkers” in 1953. Six optimizations used to minimize excursion of CG in vertical & horizontal planes. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 56
  57. 57.  The “determinants” represent adjustments made by the pelvis, hips, knees, and ankles that help to keep movt of the body‟s COG to a minimum. By decreasing the vertical & lateral excursions of the body‟s COM it was thought that energy expenditure would be less & gait more efficient. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 57
  58. 58. Pelvic rotation: Forward rotation of the pelvis in the horizontal plane is approx. 8o on the swing-phase side. It reduces the angle of hip flexion & extension It enables a slightly longer step-length 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 58
  59. 59. Pelvic tilt: 5o dip of the swinging side (i.e. hip abd) In standing, this dip is –  A +ve Trendelenberg sign It reduces the height of the apex of the curve of CG 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 59
  60. 60. Knee flexion in stance phase Approx. 20o dip It shortens the leg in the middle of stance phase It reduces the height of the apex of CG curve 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 60
  61. 61. Ankle mechanism It lengthens the leg at heel contact It helps in smoothens the curve of CG It reduces the lowering of CG 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 61
  62. 62. Foot mechanism: Lengthens the leg at toe-off as ankle moves from dorsiflexion to plantarflexion Smoothens the curve of CG Reduces the lowering of CG 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 62
  63. 63. Lateral displacement of body Physiologic valgus of the knee reduce side-to- side movement of the COM in frontal plane. The normally narrow width of the walking base minimizes the lateral displacement of CG Reduced muscular energy consumption due to reduced lateral acceleration & deceleration 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 63
  64. 64. Physiological knee valgus22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 64
  65. 65. Abnormal(Atypical) Gait22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 65
  66. 66.  There are numerous causes of abnormal gait. There can be great variation depending upon the severity of the problem.  If a muscle is weak, how weak is it?  If joint motion is limited, how limited is it? 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 66
  67. 67. Pathological gaits Abnormality in gait may be caused by –  Pain  Joint muscle range-of-motion (ROM) limitation  Muscular weakness/paralysis  Neurological involvement (UMNL/ LMNL)  Leg length discrepancy 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 67
  68. 68. Types of pathological gait Due to pain –  Antalgic or limping gait – (Psoatic Gait) Due to neurological disturbance –  Muscular paralysis – both  Spastic (Circumductory Gait, Scissoring Gait, Dragging or Paralytic Gait, Robotic Gait[Quadriplegic]) and  Flaccid (Lurching Gait, Waddaling Gait, Gluteus Maximus Gait, Quadriceps Gait, Foot Drop or Stapping Gait,)  Cerebellar dysfunction (Ataxic Gait)  Loss of kinesthetic sensation (Stamping Gait)  Basal ganglia dysfunction (FestinautGait) 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 68
  69. 69. Types of pathological gait Due to abnormal deformities –  Equinus gait  Equinovarous gait  Calcaneal gait  Knock & bow knee gait  Genurecurvatum gait Due to Leg Length Discrepancy (LLD) –  Equinus gait 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 69
  70. 70. Antalgic gait This is a compensatory gait pattern adopted in order to remove or diminish the discomfort caused by pain in the LL or pelvis. Characteristic features:  Decreased in duration of stance phase of the affected limb (unable of weight bear due to pain)  There is a lack of weight shift laterally over the stance limb and also to keep weight off the involved limb  Decrease in stance phase in affected side will result in a decrease in swing phase of sound limb. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 70
  71. 71. Psoatic gait  Psoas bursa may be inflamed & edematous, which cause limitation of movement due to pain & produce a atypical gait.  Hip externally rotated  Hip adducted  Knee in slight flexion  This process seems to relieve tension of the muscle & hence relieve the inflamed structures.22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 71
  72. 72. Gluteus maximus gait The gluteus maximus act as a restraint for forward progression. The trunk quickly shifts posteriorly at heel strike (initial contact). This will shift the body‟s COG posteriorly over the gluteus maximus, moving the line of force posterior to the hip joints. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 72
  73. 73.  With foot in contact with floor, this requires less muscle strength to maintain the hip in extension during stance phase. This shifting is referred to as a “Rocking Horse Gait” because of the extreme backward-forward movement of the trunk. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 73
  74. 74. gluteus medius gait It is also known as “Trendelenberg gait” or “Lurching Gait” when one side affected. The individual shifts the trunk over the affected side during stance phase. When right gluteus medius or hip abductor is weak it cause two thing: 1. The body leans over the left leg during stance phase of the left leg, and 2. Right side of the pelvis will drop when the right leg leaves the ground & begins swing phase. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 74
  75. 75.  Shifting the trunk over the affected side is an attempt to reduce the amount of strength required of the gluteus medius to stabilize the pelvis. Bilateral paralysis, waddling or duck gait. The patient lurch to both sides while walking. The body sways from side to side on a wide base with excessive shoulder swing.  E.g. Muscular dystrophy 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 75
  76. 76. Quadriceps gait Quadriceps action is needed during heel strike & foot flat when there is a flexion movement acting at the knee. Quadriceps weakness/ paralysis will lead to buckling of the knee during gait & thus loss of balance. Patient can compensate this if he has normal hip extensor & plantar flexors. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 76
  77. 77.  Compensation:  With quadriceps weakness, the individual may lean forward over the quadriceps at the early part of stance phase, as weight is being shifted on to the stance leg.  Normally, the line of force falls behind the knee, requiring quadriceps action to keep the knee from buckling.  By leaning forward at the hip, the COG is shifted forward & the line of force now falls in front of the knee.  This will force the knee backward into extension. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 77
  78. 78.  Another compensatory manoeuvre to use is the hip extensors & ankle plantar flexors in a closed chain action to pull the knee into extension at heel strike (initial contact). In addition, the person may physically push on the anterior thigh during stance phase, holding the knee in extension. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 78
  79. 79. genu recurvatum gait Hamstrings are weak, 2 things may happen  During stance phase, the knee will go into excessive hyperextension, referred to as “genu recurvatum” gait.  During the deceleration (terminal swing) part of swing phase, without the hamstrings to slow down the swing forward of the lower leg, the knee will snap into extension. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 79
  80. 80. hemiplegic gait With spastic pattern of hemiplegic leg  Hip into extension, adduction & medial rotation  Knee in extension, though often unstable  Ankle in drop foot with ankle plantar flexion and inversion (equinovarus), which is present during both stance and swing phases. In order to clear the foot from the ground the hip & knee should flex. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 80
  81. 81.  But the spastic muscles won‟t allow the hip & knee to flex for the floor clearance. So the patient hikes hip & bring the affected leg by making a half circle i.e. circumducting the leg. Hence the gait is known as “Circumductory Gait”. Usually, there will be no reciprocal arm swing. Step length tends to be lengthened on the involved side & shortened on the uninvolved side. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 81
  82. 82. Scissoring gait It results from spasticity of bilateral adductor muscle of hip. One leg crosses directly over the other with each step like crossing the blades of a scissor.  E.g. Cerebral Palsy 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 82
  83. 83. Dragging or paraplegic gait There is spasticity of both hip & knee extensors & ankle plantar flexors. In order to clear the ground the patient has to drag his both lower limb swings them & place it forward. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 83
  84. 84. Cerebral Ataxic or drunkard’S gait Abnormal function of cerebellum result in a disturbance of normal mechanism controlling balance & therefore patient walks with wider BOS. The wider BOS creates a larger side to side deviation of COG. This result in irregularly swinging sideways to a tendency to fall with each steps. Hence it is known as “Reeling Gait”. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 84
  85. 85. Sensory ataxic gait This is a typical gait pattern seen in patients affected by tabes dorsalis. It is a degenerative disease affecting the posterior horn cells & posterior column of the spinal cord. Because of lesion, the proprioceptive impulse won‟t reach the cerebellum. The patient will loss his joint sense & position for his limb on space. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 85
  86. 86.  Because of loss of joint sense, the patient abnormally raises his leg (high step) jerks it forward to strike the ground with a stamp. So it is also called as “Stamping Gait”. The patient compensated this loss of joint position sense by vision. So his head will be down while he is walking. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 86
  87. 87. Short shuffling or festinate gait Normal function at basal ganglia are:  Control of muscle tone  Planning & programming of normal movements.  Control of associated movements like reciprocal arm swing.  Typical example for basal ganglia leision is parkinsonism. Because of rigidity, all the joint will go for a flexion position with spine stooping forward. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 87
  88. 88.  This posture displaces the COG anteriorly. So in order to keep the COG within the BOS, the patient will no of small shuffling steps. Due to loss of voluntary control over the movement, they loses balance & walks faster as if he is chasing the COG. So it is called as “Festinate Gait”. Since his shuffling steps, it is otherwise called as “Shuffling Gait”. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 88
  89. 89. Foot drop or slapping gait This is due to dorsiflexor weakness caused by paralysis of common peroneal nerve. There won‟t be normal heel strike, instead the foot comes in contact with ground as a whole with a slapping sound. So it is also known as “Slapping gait”. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 89
  90. 90.  Due to plantarflexion of the ankle, there will be relatively lengthening at the leading extremity. So to clear the ground the patient lift the limb too high. Hence the gait get s its another name i.e. “High Stepping Gait” 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 90
  91. 91. Equinus gait Equinus = Horse Because of paralysis of dorsiflexor which result in plantar flexor contracture. The patients will walk on his toes (toe walking). Other cause may be compensation by plantar flexor for a short leg. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 91
  92. 92. Unequal Leg Length We all have unequal leg length, usually a discrepancy of approx 1/4 inch between the right and left legs. Clinically, these smaller discrepancies are often corrected by inserting heel lifts of various thicknesses into the shoe. Leg length discrepancy (LLD) are divided in –  Minimal leg length discrepancy  Moderate leg length discrepancy  Severe leg length discrepancy22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 92
  93. 93. Minimal LLD Compensation occurs by dropping the pelvis on the affected side. The person may compensate by leaning over shorter leg (up to 3 inches can be accommodated with these tech). 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 93
  94. 94. Moderate LLD Approx between 3 & 5 cm, dropping the pelvis on the affected side will no longer be effective. A longer leg is needed, so the person usually walks on the ball of the foot on the involved (shorter) side. This is called an “Equinnus Gait”. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 94
  95. 95. Severe LLD It is usually discrepancy of more than 5 inches. The person may compensate in a variety of ways. Dropping the pelvis and walking in an equinnus gait plus flexing the knee on the uninvolved side is often used. To gain an appreciation for how this may feel or look, walk down the street with one leg in the street and the other on the sidewalk. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 95
  96. 96. Equinovarous gait There will be ankle plantar flexion & subtalar inversion. So the patient will be walking on the outer border of the foot.  E.g. CETV 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 96
  97. 97. Calcaneal gait Result from paralysis plantar flexors causing dorsiflexor contracture. The patient will be walking on his heel (heel walking) It is characterized by greater amounts of ankle dorsiflexion & knee flexion during stance & a shorter step length on the affected side. Single-limb support duration is shortened because of the difficulty of stabilizing the tibia & the knee. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 97
  98. 98. Knock knee gait It is also known as genu valgum gait. Due to decreased physiological valgus of knee. Both the knee face each other widening the BOS. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 98
  99. 99. Bow leg gait It is also known as genu varum gait. Knee face outwards. Due to increase increased physiological valgus of knee. The legs will be in a bowed position. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 99
  100. 100. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 100
  101. 101. 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 101
  102. 102. Reference Lann S. Lippert, CLINICAL KINESIOLOGY and ANATOMY, 4th edition, 2006 Cynthia C. Norkin, joint structure and function: A comprehensive analysis 4th edition, 2005 Jacquelin perry, GAIT ANALYSIS normal and pathological function, 1992 22-Jun-12 P.R.Khuman(MPT,Ortho & Sports) 102