This document defines and describes various aspects of human gait including: 1. It provides definitions of gait from physiological, mechanical, and neurological perspectives. Gait involves coordinated movement of body segments to produce forward progression. 2. The gait cycle and its phases (stance, swing) are described in detail along with events within each phase like initial contact, loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing and terminal swing. 3. Prerequisites for walking including equilibrium, locomotion, musculoskeletal integrity and neurological control are outlined. Forces involved in gait production are also noted. 4. Purposes of gait like support, maintenance of

1. GAITGAIT
► Translatory progression ofTranslatory progression of
the body as a whole,the body as a whole,
produced by coordinated,produced by coordinated,
rotatory movements ofrotatory movements of
the body segmentsthe body segments
► Lower extremities – carryLower extremities – carry
the weight of the head,the weight of the head,
arms & trunk ( HAT )arms & trunk ( HAT )

2. Gait is the medical term to describe humanGait is the medical term to describe human
locomotion, or the way that we walk.locomotion, or the way that we walk.
Interestingly, every individual has a uniqueInterestingly, every individual has a unique
gait pattern.gait pattern.

3. Definition:Definition:
► Physiological Definition:
► It is a mechanism which depends upon closely
integrated action of the subjects, bones, muscles and
nervous system (including peripheral and central
nervous system)
► The degree of integration determines the different gait
patterns. Any defect of any part of them or all of them
will lead to pathological gait.
► ..

4. ►Mechanical definition;
►It is a form of bipedal locomotion as there is an
alternating action between lower extremities.
One leg is in touch with the ground for
restraining, supporting and propulsion.
►The other leg is in swing phase for creating a
new step forward. So gait is the result of a series
of rhythmic alternating movement of arms, legs,
and trunk which create forward movement of the
body

5. ► Gait initiation is defined as stereotyped activity
that includes the series or sequence of events that
occur from the initiation of movement to the
beginning of gait cycle
► Bilateral concentric cont of tibialis anterior
inclines body ant from ankles
► Abduction of swing hip occurs
► Cop shifts post and lat towards swing foot and
medi towards supporting limb

6. Prerequisites of gaitPrerequisites of gait
There are (4) major criteria essential to walking.There are (4) major criteria essential to walking.
► EquilibriumEquilibrium::
The ability to assume an upright posture and maintain balance.The ability to assume an upright posture and maintain balance.
► LocomotionLocomotion::
The ability to initiate and maintain rhythmic steppingThe ability to initiate and maintain rhythmic stepping
► Musculoskeletal Integrity:Musculoskeletal Integrity:
Normal bone, joint, and muscle functionNormal bone, joint, and muscle function
► Neurological ControlNeurological Control::
Must receive and sendMust receive and send messagesmessages telling the body how and when to move.telling the body how and when to move.
(visual, vestibular, auditory, sensori-motor input)(visual, vestibular, auditory, sensori-motor input)
► Forces for gait:Forces for gait:
Muscular force.Muscular force.
Gravitational force.Gravitational force.
Forces of momentum.Forces of momentum.
Floor reaction force.Floor reaction force.

7. Purposes ofPurposes of gaitgait
► Support of the HAT
► Maintenance of upright posture & balance of the
body
► Achieve safe ground clearance & a gentle heel or
toe landing
► Generation of mechanical energy to maintain the
present forward velocity or to increase the forward
velocity
► Absorption of mechanical energy for shock
absorption & stability or to decrease the forward
velocity of the body

8. Gait Cycle - Definitions:Gait Cycle - Definitions:
►Normal Gait =
 Series of rhythmical , alternating movements of the
trunk & limbs which result in the forward
progression of the center of gravity
 series of ‘controlled falls’
 Gait cycle spans 2 successive events of the same
limb usually initial contact of LL
 One cycle has stance and swing phase

9. Gait Cycle - Definitions:Gait Cycle - Definitions:
► Gait CycleGait Cycle ==
 Single sequence of functions bySingle sequence of functions by one limbone limb
 Begins when reference font contacts the groundBegins when reference font contacts the ground
 Ends with subsequent floor contact of theEnds with subsequent floor contact of the same footsame foot

10. Kinematics of the gaitKinematics of the gait
►Phases of the gait cycle:Phases of the gait cycle:

11. Events in Stance PhaseEvents in Stance Phase
► Traditional:
1. Heel Strike
2. Foot Flat - 7%
3. Midstance- 30%
4. Heel off – 40%
5. Toe off – 60%
► Rancho Los Amigos
1. Initial Contact
2. Loading response
3. Midstance
4. Terminal Stance
5. Preswing

12. Events in Swing PhaseEvents in Swing Phase
► Traditional
1. Acceleration
2. Midswing
3. Deceleration
► Rancho Los Amigos
1. Initial Swing
2. Midswing
3. Terminal swing

13. Double SupportDouble Support
► In normal walking speed –
each period of double
support occupies about 11%
of the gait cycle - 22 % for
full cycle
► The body supported – by
only one limb for nearly 80
% of the gait cycle

14. Each gait cycle can be described in theEach gait cycle can be described in the
phasic termsphasic terms..
► Stance Phase:Stance Phase:
► Is defined as the interval in which the foot is on the groundIs defined as the interval in which the foot is on the ground
(60% of the gait cycle).(60% of the gait cycle).
► Stance Phase is divided into:Stance Phase is divided into:
1)Heel strike to foot flat1)Heel strike to foot flat
2) Foot flat through mid-stance2) Foot flat through mid-stance
3) Mid-stance through Heel off3) Mid-stance through Heel off
4) Heel off to Toe off.4) Heel off to Toe off.

15. Stance phaseStance phase
► Heel strike - instanct at which the heel of the leadingHeel strike - instanct at which the heel of the leading
extremity strikesextremity strikes the groundthe ground
► Foot flat – immediately after heel strike and it is the point atFoot flat – immediately after heel strike and it is the point at
which the foot fully contact the groundwhich the foot fully contact the ground
► Midstance – point at which the body wt is directly over theMidstance – point at which the body wt is directly over the
supporting extermitysupporting extermity
► Heel off- point at which heel of the reference exxtermityHeel off- point at which heel of the reference exxtermity
leaves the groundleaves the ground
► Toe off- point at which only the toe of the ipsilateral extremityToe off- point at which only the toe of the ipsilateral extremity
is in contact withis in contact with

17. Phases of GaitPhases of Gait

18. ►The stance period consists of the first five
phases: initial contact, loading response, mid-
stance and terminal stance.

19. 1) Initial Contact1) Initial Contact
Initial contact is an instantaneous point in time only and occurs the instant the foot ofInitial contact is an instantaneous point in time only and occurs the instant the foot of
the leading lower limb touches the ground.the leading lower limb touches the ground.
Most of the motor function that occurs during initial contact is in preparation for theMost of the motor function that occurs during initial contact is in preparation for the
loading response phase that will follow.loading response phase that will follow.
Initial contact represents the beginning of the stance phase.Initial contact represents the beginning of the stance phase.
Heel strike and heel contact serve as poor descriptors of this period since there areHeel strike and heel contact serve as poor descriptors of this period since there are
many circumstances when initial contact is not made with the heel alone. The termmany circumstances when initial contact is not made with the heel alone. The term
"foot strike" sometimes is used as an alternative descriptor"foot strike" sometimes is used as an alternative descriptor..

20. 2) Loading Response2) Loading Response
► The loading response phase occupies about 10 percent of the
gait cycle and constitutes the period of initial double-limb
support.
► During loading response, the foot comes in full contact with
the floor, and body weight is fully transferred onto the stance
limb.
► The initial double-support stance period occasionally is
referred to as initial stance.
► The term foot flat (FF) is the point in time when the foot
becomes plantar grade. The loading response period probably
is best described by the typical quantified values of the
vertical force curve. The ascending initial peak of the vertical
force graph reveals the period of loading response.

21. 3) Mid-stance3) Mid-stance
► Mid-stance represents the first half of single support, which occurs fromMid-stance represents the first half of single support, which occurs from
the 10- to 30-percent periods of the gait cycle.the 10- to 30-percent periods of the gait cycle.
► It begins when the contra-lateral foot leaves the ground and continues asIt begins when the contra-lateral foot leaves the ground and continues as
the body weight travels along the length of the foot until it is aligned overthe body weight travels along the length of the foot until it is aligned over
the forefoot.the forefoot.
► The descending initial peak of the vertical force graph reveals the period ofThe descending initial peak of the vertical force graph reveals the period of
mid-stancemid-stance

22. 4)Terminal Stance4)Terminal Stance
► Terminal stance constitutes the second half of single-limb
support.
► It begins with heel rise and ends when the contra-lateral foot
contacts the ground.
► Terminal stance occurs from the 30- to 50- percent periods of
the gait cycle..
► The term heel off (HO) is a descriptor useful in observational
analysis and is the point during the stance phase when the heel
leaves the ground.
► The ascending second peak of the vertical force graph
demonstrates the period of terminal stance .

23. ►Roll off describes the period of late stance (from
the 40- to 50- percent periods of the gait cycle)
when there is an ankle plantar-flexor moment
and simultaneous power generation of the
triceps surae to initiate advancement of the tibia
over the fulcrum of the metatarsal heads in
preparation for the next phase

24. Pre-swingPre-swing
► Pre-swing is the terminal double-limb support
period and occupies the last 12 percent of stance
phase, from 50 percent to 62 percent.
► It begins when the contra-lateral foot contacts the
ground and ends with ipsilateral toe off.
► During this period, the stance limb is unloaded and
body weight is transferred onto the contra-lateral
limb. The descending portion of the second peak of
the vertical force graph demonstrates the period of
pre-swing.

25. ► Terminal contact (TC), a term rarely used, describes the
instantaneous point in the gait cycle when the foot leaves the
ground. It thus represents either the end of the stance phase or
the beginning of swing phase. In pathologies where the foot
never leaves the ground, the term foot drag is used. In foot
drag, the termination of stance and the onset of swing may be
somewhat arbitrary.
► The termination of stance and the onset of swing is defined as
the point where all portions of the foot have achieved motion
relative to the floor. Likewise, the termination of swing and the
onset of stance may be defined as the point when the foot ends
motion relative to the floor. Toe off occurs when terminal
contact is made with the toe

26. 2) Swing Phase:2) Swing Phase:
► is defined as the interval in which the foot is not in contactis defined as the interval in which the foot is not in contact
with the ground (40% of the gait cycle).denotes the time whenwith the ground (40% of the gait cycle).denotes the time when
the foot is in the air, constituting the remaining 38 percent ofthe foot is in the air, constituting the remaining 38 percent of
the gait cycle.the gait cycle.
► The swing phase could be defined as the phase when allThe swing phase could be defined as the phase when all
portions of the foot are in forward motion.portions of the foot are in forward motion.

27. ►Acceleration – begins once the toe of theAcceleration – begins once the toe of the
reference extremity leaves the ground andreference extremity leaves the ground and
continues until midswingcontinues until midswing
►Midswing – when the ipsilateral extremityMidswing – when the ipsilateral extremity
passes directly beneath the bodypasses directly beneath the body
►deceleration – after midswing when the tibiadeceleration – after midswing when the tibia
passes beyond the perpendicular and knee ispasses beyond the perpendicular and knee is
extending in preparation for the heel strikeextending in preparation for the heel strike

28. Swing is divided into two phases:Swing is divided into two phases:
1)1) Acceleration to mid-swingAcceleration to mid-swing
2)2) Mid-swing to decelerationMid-swing to deceleration
► The swing period primarily is divided intoThe swing period primarily is divided into three phases: initialthree phases: initial
swing, mid-swing and terminal swing. Pre-swing, however,swing, mid-swing and terminal swing. Pre-swing, however,
prepares the limb for swing advancement and in that sense couldprepares the limb for swing advancement and in that sense could
be considered a component of swing phase.be considered a component of swing phase.

29. b) Initial Swingb) Initial Swing
► The initial one-third of the swing period, from the 62- to 75-The initial one-third of the swing period, from the 62- to 75-
percent periods of the gait cycle (6), is spent in initial swing. Itpercent periods of the gait cycle (6), is spent in initial swing. It
begins the moment the foot leaves the ground and continuesbegins the moment the foot leaves the ground and continues
until maximum knee flexion occurs, when the swinginguntil maximum knee flexion occurs, when the swinging
extremity is directly under the body and directly opposite theextremity is directly under the body and directly opposite the
stance limb.stance limb.

30. c) Mid-swingc) Mid-swing
Mid-swing occurs in the second third of the swing period, fromMid-swing occurs in the second third of the swing period, from
the 75- to 85-percent periods of the gait cycle. Critical eventsthe 75- to 85-percent periods of the gait cycle. Critical events
include continued limb advancement and foot clearance. Thisinclude continued limb advancement and foot clearance. This
phase begins following maximum knee flexion and ends whenphase begins following maximum knee flexion and ends when
the tibia is in a vertical position.the tibia is in a vertical position.

31. d) Terminal Swingd) Terminal Swing
► In the final phase of terminal swing from the 85- to 100-In the final phase of terminal swing from the 85- to 100-
percent periods of the gait cycle, the tibia passes beyondpercent periods of the gait cycle, the tibia passes beyond
perpendicular, and the knee fully extends in preparation forperpendicular, and the knee fully extends in preparation for
heel contact.heel contact.

32. GAIT TERMINOLGYGAIT TERMINOLGY
► TemporalTemporal
VariableVariable
1.1. Stance timeStance time
2.2. Single limb &Single limb &
double timedouble time
3.3. Swing timeSwing time
4.4. Stride & Step timeStride & Step time
5.5. CadenceCadence
6.6. SpeedSpeed
► Distance VariableDistance Variable
1.1. Stride lengthStride length
2.2. Step lengthStep length
3.3. WidthWidth
4.4. Degree of toe-outDegree of toe-out

33. Distance VariablesDistance Variables
►Stride lengthStride length: is the linear distance between: is the linear distance between
two successive events that are accomplishedtwo successive events that are accomplished
by the same lower extremityby the same lower extremity
►It is measured from the point of one heelIt is measured from the point of one heel
strike of one lower extremity to the point ofstrike of one lower extremity to the point of
the next heel strike of the same extremitythe next heel strike of the same extremity
►↓↓ - elderly pts &- elderly pts & ↑↑ - speed of gait increases- speed of gait increases

34. Distance VariablesDistance Variables
►CadenceCadence –– no of steps /no of steps /
unit of time, it is usuallyunit of time, it is usually
measured steps / minmeasured steps / min
►Adult men – 110 steps /Adult men – 110 steps /
minmin
►Adult women – 116 steps /Adult women – 116 steps /
minmin

35. Gait terminologyGait terminology
►Step width – measuring the
linear distance between the mid
point of the heel of one foot &
the same point on the other foot
► Step width in elderly persons↑
& children as they demand more
stability
► In young children, COG is
higher than in adults, as wide
base of support is necessary for
stability
► Normal width – 3.5 inches &
varies between 1 – 5 inches

36. Double Support timeDouble Support time
►Increased in elderlyIncreased in elderly
persons & in thosepersons & in those
with balancewith balance
disordersdisorders
►Decreases as theDecreases as the
speed of walkingspeed of walking
increasesincreases

37. Gait Cycle - Definitions:Gait Cycle - Definitions:
► Stride LengthStride Length ==
 Distance between successive points of heel contact of theDistance between successive points of heel contact of the
same footsame foot
 Double the step length (in normal gait)Double the step length (in normal gait)

38. Gait Cycle - Definitions:Gait Cycle - Definitions:
► Step LengthStep Length ==
 Distance between corresponding successiveDistance between corresponding successive points of heelpoints of heel
contact of the opposite feetcontact of the opposite feet
 Rt step length = Lt step lengthRt step length = Lt step length (in normal gait)(in normal gait)

39. Gait Cycle - Definitions:Gait Cycle - Definitions:
► Walking BaseWalking Base ==
 Side-to-side distance between the line of the two feetSide-to-side distance between the line of the two feet
 Also known as ‘stride width’Also known as ‘stride width’

40. Gait Cycle - Definitions:Gait Cycle - Definitions:
►CadenceCadence ==
 Number of steps per unit timeNumber of steps per unit time
 Normal: 100 – 115Normal: 100 – 115 steps/minsteps/min
 Cultural/social variationsCultural/social variations

41. Gait Cycle - Definitions:Gait Cycle - Definitions:
► VelocityVelocity ==
 Distance covered by the body in unit timeDistance covered by the body in unit time
 Usually measured inUsually measured in m/sm/s
 Instantaneous velocity varies during the gait cycleInstantaneous velocity varies during the gait cycle
 Average velocity (m/min) = step length (m) x cadenceAverage velocity (m/min) = step length (m) x cadence
(steps/min)(steps/min)
► Comfortable Walking Speed (CWS)Comfortable Walking Speed (CWS) ==
 Least energy consumption per unit distanceLeast energy consumption per unit distance
 Average=Average= 80 m/min80 m/min (~ 5 km/h , ~ 3 mph)(~ 5 km/h , ~ 3 mph)

42. ►Degree of toe out : angle of foot placement andDegree of toe out : angle of foot placement and
may be found by measuring the angle formed bymay be found by measuring the angle formed by
each foots liome of progression and a lineeach foots liome of progression and a line
intersecting the center of heel and second toeintersecting the center of heel and second toe
►7deg is normal7deg is normal
►Dec with increased speedDec with increased speed

43. Gait Cycle - Components:Gait Cycle - Components:
► PhasesPhases::
(1)(1) Stance PhaseStance Phase:: (2)(2) Swing PhaseSwing Phase::
reference limbreference limb reference limbreference limb
in contactin contact notnot in contactin contact
with the floorwith the floor with the floorwith the floor

44. Gait Cycle - Components:Gait Cycle - Components:
► SupportSupport::
(1)(1) Single SupportSingle Support: only one foot in contact with the floor: only one foot in contact with the floor
(2)(2) Double SupportDouble Support: both feet in contact with floor: both feet in contact with floor

45. Gait Cycle - Subdivisions:Gait Cycle - Subdivisions:
A.A. Stance phase:Stance phase:
1.1. Heel contactHeel contact:: ‘Initial contact’‘Initial contact’
2.2. Foot-flatFoot-flat:: ‘Loading response’, initial contact of forefoot w. ground‘Loading response’, initial contact of forefoot w. ground
3.3. MidstanceMidstance:: greater trochanter in alignment w. vertical bisector of footgreater trochanter in alignment w. vertical bisector of foot
4.4. Heel-offHeel-off:: ‘Terminal stance’‘Terminal stance’
5.5. Toe-offToe-off:: ‘Pre-swing’‘Pre-swing’

46. Gait Cycle - Subdivisions:Gait Cycle - Subdivisions:
B.B. Swing phaseSwing phase::
1.1. AccelerationAcceleration:: ‘Initial swing’‘Initial swing’
2.2. MidswingMidswing:: swinging limb overtakes the limb in stanceswinging limb overtakes the limb in stance
3.3. DecelerationDeceleration:: ‘Terminal swing’‘Terminal swing’

47. Gait Cycle

48. ► Time FrameTime Frame::
A. Stance vs. Swing:A. Stance vs. Swing:
►Stance phaseStance phase == 60% of gait cycle60% of gait cycle
►Swing phaseSwing phase == 40%40%
B. Single vs. Double support:B. Single vs. Double support:
►Single support=Single support= 40% of gait cycle40% of gait cycle
►Double support=Double support= 20%20%

49. ► With increasing walking speeds:With increasing walking speeds:
►Stance phase:Stance phase: decreasesdecreases
►Swing phase:Swing phase: increasesincreases
►Double support:Double support: decreasesdecreases
► RunningRunning::
►By definition: walking without double supportBy definition: walking without double support
►Ratio stance/swing reversesRatio stance/swing reverses
►Double support disappears. ‘Double swing’ developsDouble support disappears. ‘Double swing’ develops

50. Path of Center of GravityPath of Center of Gravity
►Center of Gravity (CG):Center of Gravity (CG):
 midway between the hipsmidway between the hips
 Few cm in front of S2Few cm in front of S2
►Least energy consumption if CG travels inLeast energy consumption if CG travels in
straight linestraight line

51. CG

52. Path of Center of GravityPath of Center of Gravity
A.A. Vertical displacementVertical displacement::
► Rhythmic up & down movementRhythmic up & down movement
► Highest point: midstanceHighest point: midstance
► Lowest point: double supportLowest point: double support
► Average displacement: 5cmAverage displacement: 5cm
► Path: extremely smooth sinusoidalPath: extremely smooth sinusoidal
curvecurve

53. Path of Center of GravityPath of Center of Gravity
B.B. Lateral displacementLateral displacement::
► Rhythmic side-to-side movementRhythmic side-to-side movement
► Lateral limit: midstanceLateral limit: midstance
► Average displacement: 5cmAverage displacement: 5cm
► Path: extremely smooth sinusoidalPath: extremely smooth sinusoidal
curvecurve

54. Path of Center of GravityPath of Center of Gravity
C.C. Overall displacementOverall displacement::
► Sum of vertical & horizontalSum of vertical & horizontal
displacementdisplacement
► Figure ‘8’ movement of CG asFigure ‘8’ movement of CG as
seen from AP viewseen from AP view
Horizontal
plane
Vertical
plane

55. Determinants of Gait :Determinants of Gait :
►Six optimizations used to minimize excursion ofSix optimizations used to minimize excursion of
CG in vertical & horizontal planesCG in vertical & horizontal planes
►Reduce significantly energy consumption ofReduce significantly energy consumption of
ambulationambulation
►Classic papers: Sanders, Inman (1953)Classic papers: Sanders, Inman (1953)

56. Determinants of Gait :Determinants of Gait :
 (1)(1) Pelvic rotationPelvic rotation::
 Forward rotation of the pelvis in the horizontal plane approx. 8Forward rotation of the pelvis in the horizontal plane approx. 8oo
on theon the
swing-phase sideswing-phase side
 Reduces the angle of hip flexion & extensionReduces the angle of hip flexion & extension
 Enables a slightly longer step-length w/o further lowering of CGEnables a slightly longer step-length w/o further lowering of CG

57. Determinants of Gait :Determinants of Gait :
 (2)(2) Pelvic tiltPelvic tilt::
 55oo
dip of the swinging side (i.e. hip adduction)dip of the swinging side (i.e. hip adduction)
 In standing, this dip is a positive Trendelenberg signIn standing, this dip is a positive Trendelenberg sign
 Reduces the height of the apex of the curve of CGReduces the height of the apex of the curve of CG

58. Determinants of Gait :Determinants of Gait :
 (3)(3) Knee flexion in stance phaseKnee flexion in stance phase::
 Approx. 20Approx. 20oo
dipdip
 Shortens the leg in the middle of stance phaseShortens the leg in the middle of stance phase
 Reduces the height of the apex of the curve of CGReduces the height of the apex of the curve of CG

59. Determinants of Gait :Determinants of Gait :
 (4)(4) Ankle mechanismAnkle mechanism::
 Lengthens the leg at heel contactLengthens the leg at heel contact
 Smoothens the curve of CGSmoothens the curve of CG
 Reduces the lowering of CGReduces the lowering of CG

60. Determinants of Gait :Determinants of Gait :
 (5)(5) Foot mechanismFoot mechanism::
 Lengthens the leg at toe-off as ankle moves from dorsiflexion toLengthens the leg at toe-off as ankle moves from dorsiflexion to
plantarflexionplantarflexion
 Smoothens the curve of CGSmoothens the curve of CG
 Reduces the lowering of CGReduces the lowering of CG

61. Determinants of Gait :Determinants of Gait :
 (6)(6) Lateral displacement of bodyLateral displacement of body::
 The normally narrow width of the walking base minimizes theThe normally narrow width of the walking base minimizes the
lateral displacement of CGlateral displacement of CG
 Reduced muscular energy consumption due to reduced lateralReduced muscular energy consumption due to reduced lateral
acceleration & decelerationacceleration & deceleration

62. ►Physiologic valgus at knee – little lateral motionPhysiologic valgus at knee – little lateral motion
of the body is necessary to shift the COG fromof the body is necessary to shift the COG from
one lower extremity to another over the base ofone lower extremity to another over the base of
supportsupport

63. Gait Analysis – Forces:Gait Analysis – Forces:
►Forces which have the most significant InfluenceForces which have the most significant Influence
are due to:are due to:
(1) gravity(1) gravity
(2) muscular contraction(2) muscular contraction
(3) inertia(3) inertia
(4) floor reaction(4) floor reaction

64. Gait Analysis – Forces:Gait Analysis – Forces:
► The force that the foot exertsThe force that the foot exerts
on the floor due to gravity &on the floor due to gravity &
inertia is opposed by theinertia is opposed by the
ground reaction forceground reaction force
► Ground reaction force (RF)Ground reaction force (RF)
may be resolved intomay be resolved into
horizontal (HF) & verticalhorizontal (HF) & vertical
(VF) components.(VF) components.
► Understanding joint position &Understanding joint position &
RF leads to understanding ofRF leads to understanding of
muscle activity during gaitmuscle activity during gait

65. Gait Analysis:Gait Analysis:
► At initial heel-contact: ‘heel transient’At initial heel-contact: ‘heel transient’
► At heel-contact:At heel-contact:
 Ankle:Ankle: DFDF
 Knee:Knee: QuadQuad
 Hip:Hip: Glut. Max&HamstringsGlut. Max&Hamstrings

66. GaitGait
Initial HC
‘Heel transient’
HC
Foot-Flat Mid-
stance

67. GaitGait
Initial HC
‘Heel transient’
HC
Heel-off
Toe-off

68. GAITGAIT
► Low muscular demand:Low muscular demand:
 ~ 20-25% max. muscle strength~ 20-25% max. muscle strength
 MMT of ~ 3MMT of ~ 3++

69. COMMON GAIT ABNORMALITIESCOMMON GAIT ABNORMALITIES
A.A. Antalgic GaitAntalgic Gait
B.B. Lateral Trunk bendingLateral Trunk bending
C.C. Functional Leg-Length DiscrepancyFunctional Leg-Length Discrepancy
D.D. Increased Walking BaseIncreased Walking Base
E.E. Inadequate Dorsiflexion ControlInadequate Dorsiflexion Control
F.F. Excessive Knee ExtensionExcessive Knee Extension

70. ““ Don’t walk behind me, I may not lead.Don’t walk behind me, I may not lead.
Don’t walk ahead of me, I may not follow.Don’t walk ahead of me, I may not follow.
Walk next to me and be my friend.”Walk next to me and be my friend.”
Albert CamusAlbert Camus

71. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
A. Antalgic GaitA. Antalgic Gait
►Gait pattern in which stance phase on affectedGait pattern in which stance phase on affected
side is shortenedside is shortened
►Corresponding increase in stance on unaffectedCorresponding increase in stance on unaffected
sideside
►Common causes: OA, Fx, tendinitisCommon causes: OA, Fx, tendinitis

72. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
B.B. Lateral Trunk bendingLateral Trunk bending
►TrendelenbergTrendelenberg gaitgait
►Usually unilateralUsually unilateral
►Bilateral = waddling gaitBilateral = waddling gait
►Common causes:Common causes:
A. Painful hipA. Painful hip
B. Hip abductor weaknessB. Hip abductor weakness
C. Leg-length discrepancyC. Leg-length discrepancy
D. Abnormal hip jointD. Abnormal hip joint

73. Ex. 2: Hip abductor load & hip joint reaction forceEx. 2: Hip abductor load & hip joint reaction force

74. Ex. 2: Hip abductor load & hip joint reaction forceEx. 2: Hip abductor load & hip joint reaction force

75. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
C.C. Functional Leg-Length DiscrepancyFunctional Leg-Length Discrepancy
►Swing leg: longer than stance legSwing leg: longer than stance leg
►4 common compensations:4 common compensations:
A. CircumductionA. Circumduction
B. Hip hikingB. Hip hiking
C. SteppageC. Steppage
D. VaultingD. Vaulting

76. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
D.D. Increased Walking BaseIncreased Walking Base
►Normal walking base: 5-10 cm
►Common causes:
 Deformities
►Abducted hip
►Valgus knee
 Instability
►Cerebellar ataxia
►Proprioception deficits

77. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
E.E. Inadequate Dorsiflexion ControlInadequate Dorsiflexion Control
►In stance phase (Heel contact – Foot flat):
Foot slap
►In swing phase (mid-swing):
Toe drag
►Causes:
 Weak Tibialis Ant.
 Spastic plantarflexors

78. COMMON GAIT ABNORMALITIES:COMMON GAIT ABNORMALITIES:
F.F. Excessive knee extensionExcessive 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)
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