gait description

1. GAIT

2. GAIT
▪ Normal Gait
Series of rhythmical , alternating movements of
the trunk & limbs which result in the forward
progression of the center of gravity
▪ One gait cycle
period of time from one heel strike to the next
heel strike of the same limb

3. GAIT CYCLE
►The gait cycle consist of 2 phases for each foot
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.

5. ► Time Frame:
A. Stance vs. Swing:
►Stance phase = 60% of gait cycle
►Swing phase = 40%
B. Single vs. Double support:
►Single support= 40% of gait cycle
►Double support= 20%

7. Gait Cycle - Subdivisions
► A. Stance phase:
1. Heel contact: ‘Initial contact’.
2. Foot-flat: ‘Loading response’, initial contact of
forefoot on ground.
3. Midstance: greater trochanter in alignment w.
vertical bisector of foot
4. Heel-off: ‘Terminal stance’
5. Toe-off: ‘Pre-swing’

10. Gait Cycle - Subdivisions
► B. Swing phase:
1. Acceleration: ‘Initial swing’
2. Midswing: swinging limb overtakes the limb in
stance
3. Deceleration: ‘Terminal swing’

11. DISTANCE AND TIME
VARIABLES
► Temporal
variables
1. Stance time
2. Single limb support
time
3. Double limb support
time
4. Swing time
5. Stride and step time
6. Cadence
7. speed
► Distance
variables
1. Stride length
2. Step length
3. Width of walking

12. ► Step length
Distance between corresponding successive points of
heel 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 feet
► Degree 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.

14. KINEMATICS AND KINETICS OF
GAIT
►Path of Center of
Gravity
▪ midway between the
hips
▪ Few cm in front of S2
▪ Least energy
consumption if CG
travels in straight line

15. Path of Center of Gravity

16. Path of Center of Gravity

17. SAGITTAL PLANE ANALYSIS
 INITIAL CONTACT
Hip 20 degree of flexion
Knee is extended
Ankle is neutral
GRF
 - Anterior to Hip, drives the hip
into flexion
 - Anterior to Knee, drives the
knee into extension
 - posterior to Ankle into planter
flexion

18. HIP:- hamstrings, gluteus maximus, and adductor
magnus (i to e)
 KNEE:- quadriceps (c to e)
TIBIOTALAR joint: tibialis anterior (e)
SUBTALAR joint:- anterior and lateral
compartment muscles (e)

19. SAGITTAL PLANE ANALYSIS
LOADING RESPONSE
 Hip flexion 15°
 Knee flexion 15°
 Ankle planter flexion 5° to 10°
 Contra-lateral pelvis rotates anterior
 GRF
 > Anterior to hip
 > Posterior to knee
 > Posterior to ankle

20.  HIP:- Extensors (e), Abductors (e)
limit contra-lateral drop 5 degree
 KNEE:- Quadriceps fire (c)
 ANKLE:- Tibialis anterior (e)

21. SAGITTAL PLANE ANALYSIS
MID STANCE
GRF through hip, Knee, and
ankle
Muscular activity terminaters
Hip and knee stability
provided by ligamentous
restraints

22. GRF
 Posterior to hip
 Anterior to knee and ankle
 Gastroc-soleus complex fires to
initiate knee flexion
 Pelvis continues to rotate,
abductors continue to resist
pelvic drop

23. SAGITTAL PLANE ANALYSIS
TERMINAL STANCE
 Single stance : falling
forward
 Forward fall of the body
moves the vector further
anterior to the ankle, creating
a large dorsi-flexion moment
 Strong activation of gastroc-
soleus complex
 Begins as COG passes over
foot & ends when opposite
foot touches ground

24.  The body moves past the foot
 Hip is in 20 degrees extension
(apparent motion; some of these
comes from pelvic rotation)
 Knee is in 5 degrees of flexion
 Ankle is in 10 degreed of
dorsiflexion

25. SAGITTAL PLANE ANALYSIS
PRE-SWING
 Hip 20° of hyper-extension
 Knee 30° of flexion
 Ankle 20° of plantar-flexion
 Toes 50° of hyper extension

26. GRF
 Posterior to hip, knee anterior to
ankle
 Rapid flexion of knee from rapid
heel rise and unweighting of limb
 Rectus femoris initiates hip flexion
 Adductor longus
 Hip: iliopsoas, adductor magnus,
adductor longus
 Knee: Quadriceps
 Ankle: Gastrocsoleus complex
 Toes: Ab.hal. FDB, FHB, Introssei,
lumb.

27. SAGITTAL PLANE ANALYSIS
INITIAL SWING
 Hip 0- 30° of flexion
 Knee from 30- 60° of flexion and
extension from 60-30°
 Ankle 20° of plantar-flexion to neutral
 Foot clearance is passive due to rapid hip
flexion, unless gait is very slow
 In slow gait, tibialis anterior and
hamstring fire to help
 Gait cadence (speed) governed by
accelerations of hip flexion during this
phase

28.  Hip flexion
 - Rectus femoris
 - Hiacus
 - Adductor longus
 - Gracilis
 - Sartorius
 Rest of limb is passive
pendulum

29. SAGITTAL PLANE ANALYSIS
MID SWING
 Tibialis anterior fires to
maintain foot position
 Knee extension and hip
flexion continue by
inertia

30.  Leg has advanced past the
stance limb
 Hip is in 25 degrees of flexion
 Knee is in 25 degrees of flexion
(perpendicular to the ground)
 Ankle is in 0 degree dorsiflexion

31. SAGITTAL PLANE ANALYSIS
TERMINAL SWING
 Decelerate Knee extension and
hip flexion
 - Hamstrings
 - Gluteus maximus
 Quads Co-contract
 Tibialis anterior maintains
ankle position

32.  The leg extends to provide
length to the step
 The hip is in 20 degrees of
flexion
 The knee is in 5 degrees of
flexion
 The ankle is in 0 degrees of
flexion

35. Sagittal plane analysis
Joint Motion GRF Mome- Muscle
nt
Contraction
Hip Flexion
30-25
Anterior flexion G.Maximus
Hamstring
Add.magnus,
Isometric
to ecentric
knee Flexion
0-15
Anterior
To on to
Posterior flexion
Extensi- quadriceps Concentric
to ecentric
ankle Plantar- Posterior PF
Flexion
0-15
Tibialis anterior
Ex. digitorum
longus
Ex.hallucis
longus
ecentric

36. Frontal plane analysis
JOINT
Pelvis
Hip
MOTION
Forwardly rotated position
Medial rotation of femur on pelvis
knee
Ankle
Valgus thrust with increasing valgus
Medial rotation of tibia
Increase pronation
Thorax posterior position at leading ipsilateral side
Shoulder Shoulder is slightly behind the hip at ipsilateral
extremity side

37. FOOT FLAT TO MIDSTANCE

38. FOOT FLAT TO MIDSTANCE
(SAGITTAL PLANE)
Joint Motion GRF Moment Muscle
Hip Extension
25-0
Flexion-0
Anterior to
posterior
Flexion
to
extensi-
on
G.maximus
Contractio
n
Concentric
to no
activity
Knee Extension
15-5
15-5
flexion
anterior
Posterior to Flexion
to
extensi-
on
Quadriceps Concentric
to no
activity
Ankle 15 of PF to Posterior to PF to
5-10 of DF anterior DF
Soleus,
gastronem-
ius, PF
Eccentric

39. Frontal plane analysis
Joint
Pelvis
Hip
Knee
Ankle
Motion
Ipsilateral side rotating backward to reach
neutral at midstance ,lateral tilting towards the
swinging extremity.
Medial rotation of femur on the pelvis continue
to neutral position at midstance. adduction
moment continue throughout single support.
There is reduction in valgus thrust and the tibia
begins to rotate laterally.
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.

40. 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

41. MIDSTANCE TO HEEL OFF

42. MIDSTANCE TO HEEL OFF
(sagittal plane analysis)
Contract-
ion
Eccentric
Joint Motion GRF Moment Muscl
e
Hip Extension 0
to
hyperexten
sion of 10-
20
Posterior Extension Hip
flexors
Knee Extension 5
degree of
flexion to 0
degree
Posterior
to
anterior
Flexion to
extension
No
activity

43. 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

44. MIDSTANCE TO HEEL OFF
(frontal plane analysis)
Joint
Pelvis
Hip
Knee
Motion
Pelvis moving posteriorly form neutral position
Lateral rotation of femur and adduction
Lateral rotation of tibia
Supination of subtalar joint increases
Ankle –
foot
Thorax Ipsilateral side moving forward
Shoulder Ipsilateral shoulder moving forward.

45. HEEL OFF TO TOE OFF

46. HEEL OFF TO TOE OFF
(sagittal plane analysis)
Joint Motion GRF Moment Muscle Contraction
Hip Flexion :20
degree of
hyperextensi-
on to 0
degree.
to neutral
Posterior Extension iliopsoas concentric
Knee Flexion :o-
30degree of
flexion
Posterior Flexion
Adductor
magnus
Adductor
longues
Quadrice
ps
Ecentric to
no activity

47. Ankle PF :0-20
degree of PF
Anterior DF Gastronemius.
soleus, peroneus
brevis, peronius
longus.
Concentri
c 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.

48. HEEL OFF TO TOE OFF
(frontal plane analysis)
Joint Motion
pelvis
Hip
Contralateral side moving forward unless
contralateral heel touches the ground.
Abduction occur, lateral rotation of femur
Knee Inconsistent lateral rotation tibia
Foot /
ankle
Thorax
Weight is shifted to toes and at toe off only the first
toe is in contact., supination of subtalar joint.
Translation on the ipsilaterior side.
Shoulder Moving forward.

49. DETERMINANTS OF GAIT
 Six optimizations used to
minimize excursion of CG in
vertical & horizontal planes
 Reduce significantly energy
consumption of ambulation
 The six determinants are
▪
▪
▪
▪
▪
Lateral pelvis tilt
Knee flexion
Knee, ankle and foot interactions
Forward and backward rotation of pelvis
Physiological valgus of knee

50. DETERMINANTS OF GAIT
1) Pelvic rotation:
▪ Forward rotation of the pelvis in the horizontal
plane approx. 8o on the swing-phase side
▪ Reduces the angle of hip flexion & extension
▪ Enables a slightly longer step-length w/o further
lowering of CG

51. (2) Pelvic tilt:
▪ 5 degree dip of the swinging side (i.e. hip
adduction)
▪ In standing, this dip is a positive Trendelenberg sign
▪ Reduces the height of the apex of the curve of CG

52. (3) Knee flexion in stance phase:
▪ Approx. 20o dip
▪ Shortens the leg in the middle of stance phase
▪ Reduces the height of the apex of the curve of
CG

53. (4) Ankle mechanism:
▪ Lengthens the leg at heel contact
▪ Smoothens the curve of CG
▪ Reduces the lowering of CG

54. (5) 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

55. ►Physiological valgus of knee
Reduces the base of support, so only little lateral
motion of pelvis is necessary.

56. FACTORS AFFECTING GAIT
►Age
►Gender
►Assistive devices
►Disease states
►Muscle weakness or paralysis
►Asymmetries of the lower
extremities
►Injuries and malalignments

57. 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!

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

59. STATIC EXAMINATION
►Feet non-weight bearing (hanging) with
weight bearing
►Standing from front
▪ Shoulders, hips, knees, feet
▪ From behind
▪ Shoulders, hips, calcaneus

60. GENERAL POINTS
►Is the gait fast or slow?
►Is it smooth?
►Does the patient appear
relaxed & comfortable or
pained?
►Is it noisy?

61. FEET

62. ►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

63. 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?

64. HIPS & BODY

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

66. 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,
protracted,
depressed,
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. Stability
8.Ankle
a. Dorsiflexion
b. Eversion, inversion
9.Foot
a. Heelstrike
10.Base
a. Stable/variable
b. Wide/narrow

67. COMMON GAIT
ABNORMALITIES
►
•
•
•
Antalgic Gait
Gait pattern in which stance phase on
affected side is shortened
Corresponding increase in stance on
unaffected side
Common causes: OA, Fx, tendinitis

68. Lateral Trunk bending/
Trendelenberg gait
►Usually unilateral
►Bilateral = waddling gait
►Common causes:
A. Painful hip
B. Hip abductor weakness
C. Leg-length discrepancy
D. Abnormal hip joint

71. Functional Leg-Length
Discrepancy
►Swing leg: longer than stance leg
►4 common compensations:
A. Circumduction
B. Hip hiking
C. Steppage
D. Vaulting

72. Increased Walking Base
►Normal walking base: 5-10 cm
Common causes:
►Deformities
►Abducted hip
►Valgus knee
Instability
►Cerebellar ataxia
►Proprioception deficits

73. Inadequate Dorsiflexion
Control/foot drop gait
►In stance phase (Heel contact – Foot flat):
Foot slap
►In swing phase (mid-swing):
Toe drag
▪ Causes:
▪ Weak Tibialis Ant.
▪ Spastic plantarflexors

74. Excessive knee extension
►Loss of normal knee flexion during stance
phase
►Knee may go into hyperextension
►Genu recurvatum: hyperextension deformity
of knee
Common causes:
▪ Quadriceps weakness (mid-stance)
▪ Quadriceps spasticity (mid-stance)
▪ Knee flexor weakness (end-stance)

75. Others pathological
gaits
►Arthrogenic gait ( stiff hip or knee)
►Contracture gait
►Gluteus maximus gait
►Planter flexor gait
►Scissors gait

76. Neurological
gait
►Ataxic gait
►Parkinsons gait
►Hemiplegic gait
►Spectic diplegic
►Myopatic gait
►Hyperkinetic gait

77. 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.

78. STAIR GAIT
► Ascending and
descending stairs
is a basic body
movement
required for ADL
► Stair gait involved
stance and swing
phase

79. kinematics
•
•
► SWING PHASE(36%)
Foot clearance
Foot placement
► STANCE
PHASE(64%)
•
•
•
Weight acceptance
Pull up
Forward continuance

83. SIMILARITIES & DIFFERNCES
BETWEEN LEVEL GROUND
GAIT AND STAIR GATE
►Similarities to Walking
Double support periods
Ground reaction forces have double peak
Cadence similar
Support moment is similar (always positive with
two peaks)

84. 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

85. THANK YOU