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Gait Analysis - Components and Abnormalities.pptx

The document provides an overview of normal gait and gait analysis. It defines key terminology like the gait cycle, stride, step, and phases of gait. The major determinants of normal gait are described, including pelvic rotation and tilt, knee flexion, and foot and muscle mechanics. Pathologies are discussed for each phase of gait, such as foot slap, genu recurvatum, and Trendelenburg gait. Causes and clinical presentations of various gait deviations are outlined. In summary, the document serves as a comprehensive reference for understanding normal and abnormal human locomotion.

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GAIT ANALYSIS Dr. Md. Mamunul Abedin MBBS, BCS (Health) FCPS trainee Assistant Registrar Dept of Physical Medicine & Rehabilitation Shaheed Suhrawardy Medical College Hospital, Dhaka
“Many people will walk in and out of your life, but only true friends will leave footprints in your heart”
Dr M M Abedin Normal Gait :: Definitions Series of rhythmical, alternating movements of the trunk & limbs which result in the forward progression of the center of gravity (CoG). 3
Dr M M Abedin Normal Gait :: Terminology The Gait Cycle: A single sequence of functions of one limb. Heel strike to subsequent heel strike of the same foot. 1 Gait Cycle = 1 Stride = 2 Steps 4
Dr M M Abedin Normal Gait :: Terminology Stride Length: Distance between successive points of Heel contact of same foot. -> Heel strike to heel strike of the same foot Step Length: Distance between successive contact points of opposite feet. -> Heel strike of one foot to heel strike of other foot. -> approx. 15 to 20 inches. 5
Dr M M Abedin Normal Gait :: Terminology Cadence: Number of steps per unit of time. Center of gravity (COG): Typically located 5 cm anterior to the S2 vertebra. • displaced 5 cm (<2 inches) horizontally • 5 cm vertically 6
Dr M M Abedin Normal Gait :: Terminology Two Phases: 1. Stance Phase: limb is in contact with the ground. - 5 subdivisions - 60% 2. Swing Phase: foot is in the air for limb advancement. - 3 subdivisions -40% 7
Dr M M Abedin Normal Gait :: Terminology Two Supports: 1. Double-limb Support: Both limbs are in contact with the ground. - 20% of gait cycle 2. Single-limb Support: foot is in the air for limb advancement. -80% of gait cycle 8
Dr M M Abedin Normal Gait :: Terminology Base of support: The space outlined by the feet and any assistive device in contact with the ground. -Falling is avoided if the COG remains positioned over the base of support. -Normal base of support (distance between heels) = 6 to 10 cm 9
Dr M M Abedin STANCE PHASE: Five Subdivisions 1. Initial contact (IC): Instant the foot contacts the ground. 2. Loading response: Initial contact to contralateral toe off. 3. Midstance: Contralateral toe off to ipsilateral heel off. It has the highest COG. 10
Dr M M Abedin STANCE PHASE: Five Subdivisions 4. Terminal stance: Ipsilateral heel off to initial contact of the contralateral extremity. 5. Preswing: Initial contact of the contralateral extremity to just prior to toe off of ipsilateral limb (unloading weight). 11
Dr M M Abedin SWING PHASE: Three Subdivisions 1. Initial swing: Lift of the extremity from the ground to position of maximum knee flexion. 2. Midswing: Immediately following knee flexion to vertical tibia position. 3. Terminal swing: Following vertical tibia position to just prior to initial contact. 12
Dr M M Abedin Right Initial Contact 13 Both Feet on the Ground 2% Instant the foot contacts the ground.
Dr M M Abedin 14 Left Toe Off Right LOADING RESPONSE Both Feet on the Ground 10% Initial contact to contralateral toe off.
Dr M M Abedin 15 Left foot is still on air Right MIDSTANCE Right Heel Off 30% Midstance: Contralateral toe off to ipsilateral heel off. It has the highest COG
Dr M M Abedin 16 Right TERMINAL STANCE Both Feet on the Ground Left Initial Contact 50% Terminal stance: Ipsilateral heel off to initial contact of the contralateral extremity.
Dr M M Abedin 17 Right PRESWING Both Feet on the Ground Right Toe Off 60% Preswing: Initial contact of the contralateral extremity to just prior to toe off of ipsilateral limb (unloading weight). Left LOADING RESPONSE
Dr M M Abedin 18 Right INITIAL SWING Both FOOT ALIGNED 73% Initial swing: Lift of the extremity from the ground to position of maximum knee flexion.
Dr M M Abedin 19 Right MIDSWING Right Tibia VERTICAL 87% Midswing: Immediately following knee flexion to vertical tibia position
Dr M M Abedin 20 Right TERMINAL SWING 100% Right Initial CONTACT Terminal swing: Following vertical tibia position to just prior to initial contact.
Dr M M Abedin Gait Cycle 21
Dr M M Abedin Determinants of Gait • Pelvic Rotation • Pelvic Tilt • Knee Flexion in Stance Phase • Foot Mechanisms • Knee Mechanisms • Lateral Displacement of the Pelvis 22
Dr M M Abedin Determinants of Gait Pelvic Rotation: - The pelvis rotates medially (anteriorly) on the swinging leg side - Lengthening the limb as it prepares to accept weight. - 4-degree pelvic rotation occur in either direction during double support 23
Dr M M Abedin Determinants of Gait Pelvic Tilt: - The pelvis on the side of the swinging leg (opposite to the weight-bearing leg) is lowered 4–5 degrees. -This lowers the COG at midstance. 24
Dr M M Abedin Determinants of Gait Knee Flexion in Stance: - Early knee flexion → knee flexion at foot strike (15˚ ). - Reduces the vertical elevation of the body at midstance by shortening the hip-to-ankle distance. - This lowers the COG , decreasing the energy expenditure. - Also absorb the shock of impact at heel strike. 25
Dr M M Abedin Determinants of Gait Foot Mechanisms: - At heel strike, ankle plantar flexion smoothens the curve of the falling pelvis. - Associated with controlled plantar flexion during the first part of the stance. - Three pivot points (rockers) at the heel, ankle, and forefoot help to functionally lengthen the stance limb at initial contact and preswing, and shorten the limb at midstance.. 26
Dr M M Abedin Determinants of Gait Knee Mechanisms: - After midstance, - the knee extends - the ankle plantar flexes and - the foot supinates - to restore the length to the leg and diminish the fall of the pelvis at the opposite heel strike. 27
Dr M M Abedin Determinants of Gait Lateral displacement of the pelvis: - There is displacement toward the stance limb. - The net COG of the body must lie above the base of support (the stance foot). 28
Dr M M Abedin Major Muscle Activity during Gait Iliopsoas : Terminal stance – Midswing; Concentric Glut Max : Initial Contact (IC); Eccentric Glut Med : IC to Terminal stance; Eccentric Hamstrings : IC – Loading; IS – Terminal swing; Ecc Quads : IC – Loading; Preswing – IS; Ecc Pretibials : IC – Loading; Ecc Swing phase; Concentric Calf : Midstance; Ecc Terminal stance – Preswing; Conc. 29
Dr M M Abedin Determinant s of Gait 30
Dr M M Abedin Gait Pathology 1. Initial Contact 2. Initial Contact through Midstance 3. Initial Contact through Preswing 4. Loading Response through Preswing 5. Midstance through Preswing 6. Swing Phase 31 Stance Phase
Dr M M Abedin Initial Contact 32 Pathology: Foot Slap Probable Causes: Weak Dorsiflexors (3/5)
Dr M M Abedin Pathology • Genu Recurvatum • Excessive Foot Supination • Excessive Trunk Extension • Excessive Trunk Flexion 33 Initial Contact through Midstance
Dr M M Abedin 34 Initial Contact through Midstance (contd.) Pathology: Genu Recurvatum Probable Causes: • Weak, short, or spastic quadriceps • Compensated hamstring weakness • Achilles tendon contracture • Plantar flexor spasticity
Dr M M Abedin 35 Initial Contact through Midstance (contd.) Pathology: Excessive Foot Supination Probable Causes: • Compensated forefoot valgus deformity • Pes cavus • Short limb
Dr M M Abedin 36 Reason for deviation: - Leaning backwards during stance phase shifts body’s COG posterior to hip  reducing need for active hip extension torque. Initial Contact through Midstance (contd.) Pathology: Excessive Trunk Extension Probable Causes: • Weak hip extensor or flexor • Hip pain • Decreased knee ROM
Dr M M Abedin 37 Initial Contact through Midstance (contd.) Pathology: Excessive Trunk Flexion Probable Causes: • Weak gluteus maximus and quadriceps • Hip flexion contracture
Dr M M Abedin Pathology • Excessive knee flexion • Excessive medial femur rotation • Excessive lateral femur rotation • Wide base of support • Narrow base of support 38 Initial Contact through Preswing
Dr M M Abedin 39 Initial Contact through Preswing (contd.) Pathology: Excessive Knee Flexion (Crouch gait) Probable Causes: • Hamstring contracture • Increased ankle dorsiflexion • Weak plantar flexor • Long limb • Hip flexion contracture
Dr M M Abedin 40 Initial Contact through Preswing (contd.) Pathology: Excessive Medial Femur Rotation (In Toe) Probable Causes: • Tight medial hamstrings • Anteverted femoral shaft • Weakness of opposite muscle group
Dr M M Abedin 41 Initial Contact through Preswing (contd.) Pathology: Excessive Lateral Femur Rotation (Out Toe) Probable Causes: • Tight lateral hamstrings • Retroverted femoral shaft • Weakness of opposite muscle group
Dr M M Abedin 42 Initial Contact through Preswing (contd.) Pathology: Wide Base of Support Probable Causes: • Hip abductor muscle contracture • Instability • Genu valgum • Leg length discrepancy Instability Genu valgum
Dr M M Abedin 43 Initial Contact through Preswing (contd.) Pathology: Narrow Base of Support Probable Causes: • Hip adductor muscle contracture • Genu varum Genu varum Hip adductor muscle contracture
Dr M M Abedin Pathology • Excessive trunk lateral flexion (compensated Trendelenburg gait) • Pelvic drop (uncompensated Trendelenburg gait) • Waddling gait 44 Loading Response through Preswing
Dr M M Abedin 45 Loading Response through Preswing (contd.) Pathology: Excessive Trunk Lateral Flexion (compensated Trendelenburg gait) Probable Causes: • Ipsilateral gluteus medius weakness • Hip pain • Hip dislocation, Coxa vara • Relatively Shorter Limb
Dr M M Abedin 46 Loading Response through Preswing (contd.) Pathology: Pelvic Drop (uncompensated Trendelenburg gait) Probable Causes: • Ipsilateral gluteus medius weakness • Hip pain • Hip dislocation, Coxa vara • Relatively Shorter Limb
Dr M M Abedin 47 Loading Response through Preswing (contd.) Pathology: Waddling gait Probable Causes: • Bilateral gluteus medius weakness
Dr M M Abedin Pathology • Excessive foot pronation • Bouncing or exaggerated • Insufficient push-off • Inadequate hip extension 48 Midstance through Preswing
Dr M M Abedin 49 Midstance through Preswing (contd.) Pathology: Excessive Foot Pronation Probable Causes: • Compensated forefoot or hindfoot varus deformity • Uncompensated forefoot valgus deformity • Pes planus • Decreased ankle dorsiflexion • Increased tibial varum • Long limb • Uncompensated internal rotation of tibia or femur • Weak tibialis posterior
Dr M M Abedin 50 Midstance through Preswing (contd.)
Dr M M Abedin 51 Midstance through Preswing (contd.) Pathology: Bouncing or exaggerated Probable Causes: • Achilles tendon contracture • Gastroc-soleus spasticity plantar flexion
Dr M M Abedin 52 Midstance through Preswing (contd.) Pathology: Insufficient Push-off Probable Causes: • Gastroc-soleus weakness • Achilles tendon rupture • Metatarsalgia • Hallux rigidus
Dr M M Abedin 53 Midstance through Preswing (contd.) Pathology: Inadequate Hip Extension Probable Causes: • Hip flexor contracture • Weak hip extensor
Dr M M Abedin Pathology • Steppage gait/ Foot drop • Circumduction • Hip hiking 54 Swing Phase
Dr M M Abedin 55 Swing Phase (contd.) Pathology: Steppage Gait/ Foot Drop Probable Causes: • Severely weak dorsiflexors • Equinus deformity • Plantar flexor • Spasticity
Dr M M Abedin 56 Swing Phase (contd.) Pathology: Circumduction Probable Causes: • Long limb • Abductor muscle shortening or overuse • Stiff knee
Dr M M Abedin 57 Swing Phase (contd.) Pathology: Hip Hiking Probable Causes: • Long limb • Quadratus lumborum shortening • Weak hamstring • Stiff knee
Thank You 58