Gate analysis

1. GAIT PATTERNS IN HIP
DISORDERS
Dr. K.K. CHANDRABABU,
Professor of Orthopaedics,
Medical College,Thiruvananthapuram.

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. 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. 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. 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. GAIT ANALYSIS
 Study of human locomotion
 Walking consists of a series of gait
cycles
 A single gait cycle is known as a STRIDE

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. 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. 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. 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. 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. 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. 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. 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. Swing Phase
When foot is NOT contacting the
ground
Limb advancement phase
3 parts of swing phase:
-Initial swing
-Midswing
-Terminal swing

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. 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. 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. 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. 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. Tasks and divisions of gait cycle

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. gait parameters
Stride length
L step lengthR step length
L
L
R
Walking
base
8cm
70-82 cm
35-40cm

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. 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. 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. 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. the locomotor system has
several methods to try to
reduce its amplitude
heel strike mid stance toe off

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. 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. 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. 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. CLINICAL GAIT ANALYSIS
OBSERVATIONAL GAIT ANALYSIS
3D GAIT ANALYSIS

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. 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. 3D gait analysis
THIS IS DONE IN A GAIT LABORATARY

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. Gait Patterns in Cerebral Palsy

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. 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. Crouch gait Jump gait

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. 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. 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. ANTALGIC GAIT
 Infective
 Inflammatory
 Early perthes
 Acute silp
 Trauma

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. 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. 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. TRENELENBURG GAIT
UNCOMPENSATED
COMPENSATED

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. 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. 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. 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. Gait in bilateral hip diseases
 Waddling gait
Bilateral trendelenberg
CDH
COXA VARA

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.  Ankylosis in adduction
Knee close
cannot lift leg
walking not possible
Gait in bilateral ankylosis

57. Thank You