The document discusses normal and pathological gait patterns. It describes the normal horizontal dip of the pelvis, pelvic and trunk rotation in the transverse plane, and arm swing during gait. It then examines several pathological gaits including high steppage gait, hip hike gait, Trendelenburg gait, calcaneal gait, Parkinson's gait, and hemiplegic gait. It also discusses antalgic gait and how spinal, hip, knee, and ankle pain can affect gait. Rehabilitation strategies aim to address muscle weaknesses, reduce flexor synergies, and relieve pain.

1. PTY 4304 PATHOKINESIOLOGY
LESSON 4 ; NORMAL AND
PATHOLOGICAL GAIT B
Prof. Ganiyu Oluwaleke, SOKUNBI
FNPPCN (Orthopaedics)

2. Horizontal Dip of the pelvis
• when in stance on one leg there is a very slight drop in the
hip on the other leg, usually ~5° (4-6°) away from the leg in
stance and toward the leg in swing
• 5° dip of the pelvis is determined by drawing lines between
both posterior superior iliac spines (ASIS’s)
• Pelvic tilt is essentially controlled by contraction of the hip
adductors of the stance side while the contraction of the
abductors of the swing leg prevent gravity from dipping the
pelvis deeper than normal. Thus, weakness of the adductors
of the stance leg and abductors of the swing leg could cause
a positive tredelenburg
Pelvic Rotation, Trunk & Arm Rotation in transverse plane
• As rt. heel strike the rt hip comes forward & the L trunk goes back
– they are reciprocal. These alternating rotations occur essentially
at the hip joints due to the relative rigidity of the pelvis usually
pelvic/trunk rotate by ~4° (3-5 degrees) forward in heel strike & 4°
back in terminal stance
• the angle of pelvic rotation increases when walking faster because
stride gets longer, using a larger amount of trunk rotation thus
leading to greater energy expenditure.
• people have a tendency to lose both of these as they age

3. Arm Swing
• Opposite arm move with the opposite leg. Although swinging the
arms has no effect upon shifting the center of mass during body
oscillation, it provides a means of neutralizing total angular
Momentum.
• That is as the leg advance and pelvic rotate that produce an
angular momentum to the lower body and this is normally
balanced by a reverse angular momentum of the upper body
aided by arm swing resulting from shoulder rotation.
• Arm swing help to control weight over the stance hip, maintain
forward momentum, and smooth forward progression of the body
as a whole.
• The inertia of the arms is overcome essentially by the
alternating lumbar rotation and by a reverse rotation of the
thoracic spine.

4. Observational Gait analysis
• During examination, have the subject sit in a chair, arise,
and then walk across the room if you. The chair should be
one that gives firm sitting support and provides for 90°
flexion of the knees and hips with feet flat on the floor.
• While the patient is sitting, note from the front the
patient's sitting balance, levelness of ears, shoulders, and
pelvis. From the side, note head, shoulder, and pelvic
carriage.
• Observe how the patient rises from the chair to the
standing position. Note the needed base of support: how
far the knees are apart and how far the forward foot is
from the back foot.
• If the chair has arms, note the degree the hands are
used from sitting to standing to assist weak knees,
weak hip extensors, or to maintain stability,
balance, and coordination
Observational gait analysis
While in standing take note of the following
• Walking speed – normal reduced or unusually higher
than normal
• Base Width. Check the walking base width for
broadness, stability, and consistency. From heel to
heel, base width is normally not more than from 2 to
4 inches.
• If wider, dizziness, unsteadiness, fear of movements,
a cerebellar problem, or numbness of a foot's plantar
surface may be a cause for the wider base.
• An abnormally decreased base usually produces a
crossover "scissor" action after midswing.
• Limp. Any particular malfunction from the spine to
the foot may result in a limp.
• Establish the cause for a limp.

5. Observational Gait analysis (standing)
• Generally, limp can be traced to a knee, ankle, or foot dysfunction or
deformity, a hip disorder, or a sacroiliac or lumbar lesion.
Heel-strike.
• Inability of a foot to heel strike is an indication of a heel spur and
associated bursitis or a blister.
• Failure of the knee to fully extend during heel strike is a sign of weak
quadriceps or a flexion fixed deformity (FFD) of the knee.
• A harsh heel strike, usually associated with knee hyperextension, is a
frequent sign of weak hamstrings.
Foot flat. When the foot slaps down sharply after heels trike, weak
dorsiflexors should be suspected.
Mid stance.
• Fused ankles and or pathology of the subtalar joint will prevent a
midstance flat foot.
• Weak quadriceps display themselves in excessive flexion and poor knee
stability during midstance.
• A mid stance forward lurch of the hip is a typical indication of a weak
hip flexors
• A mid stance backward lurch is a sign of a weak gluteus maximus.

6. Observational Gait analysis (standing)
Push-off and Swing.
• If the patient must rotate the pelvis severely anterior to provide
a thrust for the leg, the cause is most likely hip flexors.
• If the hip is flexed excessively to bend the knee and thus
prevent the toe from scraping the floor as in a high steppage
gait, weak ankle dorsiflexors are the usual cause.
• Failure to hyperextend the foot and the digits of the toes during
push off is a sign of arthritis.
• Pushing off with the lateral side of the front of the foot is
usually seen in disorders involving the great toe.
• A flatfooted calcaneal gait during push off is symptomatic of
weak gastrocnemius, soleus, and flexor hallucis longis muscles.
The foot
• Watch out for any abnormality associated with pelvic tilt, pelvic
rotation and arm swing –might be due to numbr of conditions as
hemiplegia. Parkinson and most of others gait abnormalities

7. PATHOLOGICAL GAIT
• Pathological gait implies walking abnormalities
and uncontrolled walking patterns. It may be
caused by:
• CNS disorders e.g. stroke, poliomyelitis,
Parkinson disease etc.
• Peripheral nervous disorders; common
peroneal nerve injury
• purely musculoskeletal problems e.g. ankle
ligament sprain
• dx of the inner ear
• Combination of a to d

8. High Steppage gait
• High Steppage gait-caused by
Anterior Tibialis weakness and/or
paralysis. Other Causes include
poliomyelities, Guillianbarre
syndrome etc.
• It is characterised with:
• Foot drop where the foot hang with
the toes pointing downward
• foot slap in Early Stance
• Toe drag during swing with the toes
scratching the ground while walking
• It requires excessive hip flexion (High
steppage) to clear the toe from
dragging
• Rehabilitation should aim at
encouraging rest to prevent muscle
fatigue and the use of toe raise devices
Hip Hike gait (Forward
lurching gait)-
caused by hip flexors
weakness/paralysis
characterised with
• hip hike – use trunk & pelvic
muscles to get the hip forward
• may also see some pelvic
circumduction – a circular
movement to swing hip
forward typically seen in
hemiplegic patient
Hip Hike gait (Backward lurching
gait)-
• caused by hamstrings & Glut
Max weakness/paralysis
• the hip may posteriorly lurch
during early part of stance –
hang on their Y ligaments
• patient will keep upper trunk
behind to stay behind hip to
prevent a flexion moment at the
hip since the patient can’t
eccentrically control that hip
flexion & would fall forward

9. PATHOLOGICAL GAIT
Trendelenburg gait-caused by Gluteus Medius
weakness of the swing leg and or hip
adductors of the stance leg and characterised
with
• dropping of contralateral pelvis in mid
stance
• Patient lean to weak side when in mid
stance to lessen torque
Calcaneal GAIT [Lack of heel to
toe]-caused by Gastrocnemius
and/or soleus muscles
weakness/paralysis. It is
characterised with
• lack of heel to toe gait with
lack of push off in late stance
• patient bear a lot of weight in
hind foot without nice
progression to forefoot
• Patient rely more on hip
flexors to propel leg forward
for swing phase
Short Leg Syndrome (SLS) / Limb length
discrepancy (LLD) gait
* A difference in leg lengths increases the
vertical oscillatory amplitude of the body's
center of gravity. In compensation on the
involved side,
i. i. the pelvis drops on heels trike and
remains tipped throughout stance
ii. Ii. Heel strike reduces in proportion to the
leg deficiency, stride length is shortened,
and
iii. Iii. toe walking is seen throughout the
stance phase.
On the side of the long limb,increased hip and
knee flexion occurs during both the swing and
stance phases.

10. PATHOLOGICAL GAIT
Parkinson gait
• Parkinson GAIT
• It is characterized with Parkinson gait
also known as Propulsive or shuffling
gait characterized with
• Stoop and stiff posture with the head and
neck in forward bending
• shuffling gait / forwardly flexed trunk,
lack of heel to toe gait, shorter step
lengths but higher cadence, decrease
trunk and pelvic rotation and arm
swingsAlso characterized with tremors of
the upper and lower limbs
• Parkinson Disease (PD) mainly due to
the deficiency of Dopamine but could also
be caused by CVA, head injuries and
poisonings-characterized by deficient of
Dopamine
• Patient is encourage to be as
independent as possible in ADLs for
proper care
HEMIPLEGIC (spastic )GAIT-
Caused by CVA, head injuries and
cerebral palsycharacterised with
Flexion synergy in upper limb and
extension synergy in the lower limb
and possibly with some of the other
pathological gaits already discussed
Rehabilitation should aim at
exercises to reduce flexion and the
synergyin the upper extremity,
extension synergy in the lower
extremity, sstrengthening exercises
and coordination exercises
SCISSORS GAIT-
SCISSORS GAIT- usually
caused by cerebral palsy, brain
abcess, & Spinal Cord injuries.
It is characterised with leg
flexed slightly at the hip and
knee and
Thigh hitting and crossing as
movement occurs
Rehabilitation should focus on
reducing overactivity of the
muscles e.g leg braces also can
be used

11. PATHOLOGICAL GAIT
Antalgic gait
• ANTALGIC GAIT-
Characterised with pain
during walking
• lots of diagnosis fall under
this category e.g. sprained
ankle or knee/hip
replacement
• reduced weight bearing on
the affected leg with decrease
step length & step time on
opposite side and patient
spend less time in stance on
involved side
Varieties of antalgic gait based
on the part of the body that is
affected
Midspinal and Bilateral Spinal Pain.
When pain is in the midline of the spine, i. the
gait pattern is guarded, symmetrical, slow,
with a short stride and restricted trunk
rotation and pelvic tilt.
ii. If paraspinal muscle spasm is present, the
patient will tend to lean backward throughout
the gait in compensation. However, if the
irritation is located at the
iii. posterior aspect of the spinal column (eg,
articular facets), the patient will tend to lean
forward throughout gait in an attempt to gain
relief by reducing weight on the sensitive area.
iv. Walking on the toes, as if walking on eggs,
is often seen in cases of lumbosacral or cervical
lesions to.
Unilateral; spinal pain
Unilateral Spinal Pain.
Walking in a stooped position with one hand
supporting the back is a frequent sign seen in
a lumbar lesion.
During both stance and swing in mild or
moderate irritations, the trunk usually leans
toward the affected side in compensation to
muscle splinting. However, in pronounced
intervertebral disc or sacroiliac lesions, the
lean is usually away from the site of irritation
to reduce pressure

12. PATHOLOGICAL GAIT
Hip Joint pain
• While the hip joint of one extremity is in the
stance phase and acts as the fulcum for rotation,
the other hip in the swing phase rotates about
40° forward. This hip rotation is seen in patients
suffering a stiff or painful hip.
• When a hip is painful, the gait is asymmetrical,
the base is widened during swing, the stance
phase is reduced on the affected side and made
longer on the unaffected side, the trunk is
thrown forward during stance to shift the center
of mass, and the affected hip is lifted so the limb
will clear the floor.
• The affected hip is quite fixed in flexion,
abduction, and rotated laterally to reduce joint
tension. As a consequence to the hip flexion, the
knee and ankle flex.
Knee Joint Pain
If a knee joint is effused,
with or without pain, 25°
flexion offers the largest
capsule volume, and thus
the least tension.
This flexion is
compensated by ankle
plantar flexion and an
absent heel strike, so that
the patient will walk on
the toes of the affected
side.
This guarded gait
minimizes quadriceps
function and thus reduces
knee compression.
Ankle Joint pain
• In any painful disorder of the ankle,
ankle motion will be guarded and the
most comfortable position will be
assumed.
• There is little, if any, plantar flexion
during footflat or heelstrike, or
dorsiflexion during heeloff.
• This will be compensated for by an
exaggerated knee flexion after heel
off and a restricted heel rise before
toeoff.
• The patient will reduce his base and
shift his trunk so that more weight
falls directly over the joint