gait analysis

1. GAIT CYCLE AND
PATHOLOGICAL GAIT
MODERATOR :DR.PRAMOD B ITAGI
PROFESSOR & UNIT HEAD
DEPARTMENT OF ORTHOPAEDICS
MRMC GULBARGA
PRESENTER :DR.RAMACHANDRA

2. • INTRODUCTION
• NEUROLOGICAL CONTROL OF GAIT
• DIVISION OF GAIT CYCLE
• KINEMATICS
• DETERMINANTS OF GAIT
• MUSCLE ACTIVITY
• KINETICS OF GAIT
• BENEFITS OF GAIT ANALYSIS
GAIT CYCLE

3. INTRODUCTION:
A systematic approach to gait analysis i,e,
looking at trunk & each joint moving in all
three planes i,e. saggital,coronal &
transverse.
It can yield valuable information about
patient's condition & help in establishing a
treatment plan.

4. The earliest work on gait was done by
BORELLI in 1682.
The WEBBER brothers in Germany gave
first clear description of GAIT CYCLE
GAIT CYCLE
in1836.
In 1940 SCHERB from Switzerland
studied various muscle activity during
different parts of gait cycle,using treadmill
& later by EMG.

5. DEFINITION:
• The gait may be definied as forward
propulsion of body by lower limbs in a
systemic,coordinated semi-rotatory
movements of trunk, arm & head.

6. GAIT ANALYSIS
• The science of studying human gait is
GAIT ANALYSIS , which is done in terms
of
– Movement in space
– Metabolic energy
– Functional muscle patterns
– Interaction of forces

7. GAIT CYCLE
GAIT CYCLE
• The duration that occurs from the time
when the heel of one foot strikes the
ground to the time at which the same foot
contacts the ground again.
• Normally 1-2 sec.
• Two phases:
1.Stance phase-60%
2.Swing phase-40%

8. STANCE PHASE :
Defined as the time during which the limb
is in contact with the ground and
supporting the weight of the body.
SWING PHASE:
Defined as the time period during which
the limb is off the ground and advancing
forward,the body weight supported by
contralateral limb.

9. NEUROLOGICAL CONTROL OF GAIT
• Motor Cortex Voluntary modulation of
gait.
Eg:Alter in speed,change
in direction.
•Cerebellum
•Extrapyramidal
tract
Controlling Balance
Responsible for most
complex unconscious
pathways

10. Spinal Cord
Golgi Tendon Units
Muscle Spindle,
Joint
Reflex Stepping
Movements
Produce
neurologic
feedback & serve
as dampening
devices for
coordination of
gait.

12. TEMPORAL PARAMETERS
Distance and time measurements
calculated during gait analysis are referred
to as CADENCE PARAMETERS.
It includes

15. STANCE PHASE
1)Initial contact ( heel
strike)
• Heel contacts the ground
first
• Hip is flexed at 30
degrees.
• Knee is extended and the
ankle is neutral (or
slightly plantar flexed)

16. 2) Loading response
Occupies 10-15% of
gait cycle.
• Shock absorption is a
primary action.
• Ends with
contralateral toe off
• Knee flexes 15 deg
while ankle plantar
flexes 15 degrees.

17. 3) Midstance
• Occupies 15-20%.
• Body is directly over
weight bearing leg.
• Pelvis has ceased
rotating forward.
• Hip & knee full extension.
• Ankle is at neutral with
foot in ground contact.

18. 4) Terminal stance
• Occupies 20 -25%.
• Contralateral side of
pelvis rotates forward.
• Hip & knee remain in
extension.
• Foot is in neutral or
plantar flexed.

19. 5) Pre-swing
• Occupies 5-10%.
• Knee of weight bearing
limb flexes & prepares
for swing phase.
• Hip in neutral position.
• Knee flixion upto 35
degrees.
• Ankle plantar flexed at
20 degrees.

20. SWING PHASE
• 1) Initial swing
• Occupies 5-10%
• Begins at toe off and
continues until
maximum knee
flexion (60 degrees)
occurs
• Ankle moves up to 10
degrees plantar
flexion.

21. • 2) Mid-swing
• Occupies 20-30%
• Knee extension
occurs by reducing
flexion of initial swing
from 70 degr to 30
degr.
• The ankle & foot are
brought upto neutral
position.

22. 3) Terminal swing
• Occupis 5-10%
• Pelvis rotetes forward
hip flexion reaches 30
degr, knee extend to
near 0 degr.
• Ankle maintains
neutral position.

23. KINEMATICS
• It is definied as study of angular rotations
of each joint during movement.
• It can be observed & measured at
foot,ankle, knee & hip during gait cycle.
• Observed in three planes
Sagittal:hip flexion,extension
Coronal:hip abduction,adduction
Transverse:hip rotation,tibia,foot.

24. SAGITTAL PLANE:
• The pelvis is tilted anteriorly approx.15
degrees.
• Minimal motion of anterior tilt.
• When Hamstrings are tight,pelvis
assumes posterior tilt.
• The hip is flexed at initial contact &
extends during stance phase.
• The hip continues to flex during swing
phase.

25. • The Knee at initial contact,knee flexes
approx.15 degrees & acceptance of body
weight through knee flexion.
• The Knee extends passively during swing
phase.
• Deviations range from hyperextension of
knee in stanse phase if heel cord is tight,to
flexion in stanse phase due to tight
hamstrings,to inability to flex knee in swing
phase due to inappropriate rectus femoris.

26. Ankle sagittal plane kinematics starts with a
neutral ankle at initial contact.
Rocker 1(heel)
• Heel strikes ground
• Then ankle plantar
flexes 5 to 10
degrees.
• Receives body weight
at heel

27. Rocker 2 ( ankle)
• Ankle dorsiflexes
• Tibia moves forward
• Transfers the body
weight to fore foot

28. Rocker 3 ( fore foot)
• Ankle plantar flexes
• Heel rises for push off

29. CORONAL PLANE:
• Hip
- Pelvic obliquity seen.
- Pelvic rise must be
accoumpanied by a
contralateral fall,so in
stance phase
hemipelvis drops
slightly.

30. TRANSVERSE PLANE:
• It measures rotation.
• FOOT
PROGRESSION
ANGLE: is the angle
foot makes with path
the subject is walking

31. DETERMINANTS OF GAIT
Pelvic Rotation:
• In normal gait,pelvis rotates 8 degrees
within transverse plane of body i,e. 4
degrees forward on swing leg & 4 degrees
posteriorly on stance leg.

32. Pelvic List:
• Pelvic rotates within the frontal plane of
body during gait, k/as Pelvic List.
• Leads to adduction of weight bearing limb
& abduction of non weight bearing limb
thereby improving effeciency of hip-
abductor mechanism.

33. KneeFlexion In Stance Phase:
• The knee should remain flexed during all
components of stance phase(except heel
strike) to prevent exceessive vertical
displacement of center of gravity.
• Reduces vertical displacement of center of
gravity as of body is carried forward over
stance limb.

34. Foot and Ankle Motion:
• Smooths out path of centre of graity when
coupled with knee motion.
Knee Motion:
Smooths out path of centre of graity when coupled
with foot & ankle motion.

35. Lateral Displacement of Pelvis:
• Reduces lateral movement of centre of
gravity toward stance foot during gait
cycle.

36. MUSCLE ACTIVITY
• Concentric contraction- - muscle
shortens on stimulation, generates power
and accelerates body forward.
-gastrosoleus contracts to lift the
heel off the ground
-iliopsoas contracts flexing the hip
and pulling the stance phase limb
off the ground

37. • Eccentric contraction- muscle lengthens
on stimulation, 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
-gastrosoleus-contracts eccentrically
through the stance phase controlling
rate of dorsiflexion of ankle.

38. KINETICS OF GAIT
• It is the study of forces that produces a
change in motion.
• It is concerned with internal forces
developed within body by muscular action
as well as forces acting in body.
External forces includes:
• Centre of gravity
• Ground reaction forces

39. Centre of gravity:
• It is imaginary point at which all weight of
body is concentrated at a given instant.
• The body of gravity lies two inches in front
of SECOND SACRAL VERTEBRA.
• It follows up & down movements as well
as side to side.
• Due to complex interaction of muscular
activity & joint motion in lower extremity it
follows a SMOOTH SINUSOIDAL
CURVE.

40. Ground reaction forces:
• It is a line represents the direction &
magnitude of force encountered by the
body at heel strike.
• The length of vector is proportionate to the
magnitude of force.
• The ground reaction force horizontal &
vertical can be measured by force
plateforms(force plates).

41. GAIT IN YOUNG
• Main ways in which gait of small children
differs from that of adult are as follows:
• The walking base is wider.
• The stride length & speed are lower & the
cycle time shorter(higher cadence).
• Small children have no heel strike,initial
contact being made by flat foot.

42. • There is very little stance phase knee
flexion.
• The whole leg is externally rotated during
the swing phase.
• There is an absence of reciprocal arm
swinging.
• The above list will change to adult pattern
by age of 2 to 4yrs.

43. GAIT IN ELDERLY
• The age related changes in gait takes
place in decade from 60 to 70yrs.
• There is a decreased stride length,
increased cycle time(decreased cadence).
• Relative increase in duration of stance
phase of gait cycle.

44. • An increase in walking base.
• The speed almost always reduced in
elderly people.
• Reduction in total range of hip flexion &
extension,a reduction in swing phase knee
flexion & reduced ankle plantar flexion
during the push off.

45. BENEFITS OF GAIT ANALYSIS
• To diagnose mechanisms responsible for
gait disorders.
• To asses degree of disability.
• To evaluate the improvement resulting
from teratment.
• Evaluation of the rate of deterioration in
progressive disorders that affects gait.
• Quantification for clinical & research.

46. PATHOLOGIC GAIT
• Divided into neurovascular or
musculoskeletal etiologies
• LIMPING:In this,patient avoids weight
bearing on affected side as far as
possible. i,e. diminished stance phase.
• It denotes a painful condition of affected
side.

47. • LURCHINNG:In this patient prolongs
stance phase to improve the stability.
• It denotes variable failure of abduction
mechanism.
Abnormal gait may be due to:
• MUSCLE WEAKNESS
• STRUCTURAL DEFORMITIES OF BONE &
JOINT
• NEUROLOGICAL DISORDERS
• MISCELLANEOUS

48. MUSCLE WEAKNESS CAUSING
PATHOLOGIC GAIT:
GLUTEUS MEDIUS GAIT(Abduction Lurch):
• Gluteus Medius is principal abductor of hip
joint along with obturator internus &
piriformis.
• The weakened Gluteus Medius forces
patient to lurch towards involved side to
place centre of gravity over hip.
• This is called Gluteus Medius Gait.

49. TRENDELENBURG GAIT:
• The stability of hip during walking provided
by bony components of joint,muscles &
around joint & normal alignment of centre
of gravity.
• any disruption in the osseo muscular
mechanism between pelvis & femur leads
to lost of stability of hip joint.
• The action of abductor in pulling
downwards in stance phase become
ineffective.

50. • As a result patient
lurches on affected
side & pelvis drops on
opposite side of hip.
• seen in polio,CDH,
perthes disease,coxa
vara,muscular
distrophies.

51. GLUTEUS MAXIMUS LURCH:
• Gluteus maximus is the chief extensor &
lateral rotator of hip.
• Normally when body moves forward in mid
stance phase,the hip is extended by
gluteus maximus tilting pelvis backwards
to retain centre of gravity over supporting
leg.

52. • When there is weakness of gluteus
maximus muscle the stabilizing factor is
lost & patient leans backwards at hip to
passively extend it & keep centre of
gravity over stance leg.
• This causes backward lurch in gluteus
maximus gait.
• Patient walks with protruberant abdomen.
• Seen in poliomyelities & above knee
amputation with prosthesis.

53. QUADRICEPS GAIT:
• Quadriceps muscle is the principal
extensor of the knee joint.
• Due to weakness of quadriceps muscle,
the affected limb is put forward in stepping
with the body leaning toward it anteriorly.
• Patient gradually learns to stabilize his
knee by directly transferring his body
weight over lower thigh,through his
ipsilateral hand.

54. • Weakness of
quadriceps is most
apparent during
heelstrike through the
stance phase.
• The limp affects all
phases of gait cycle.
• Extension at femur
results in flexion of
the trunk & an
extension movement
at knee.

55. CALCANEAL GAIT:
• It occurs due to
weakness of the
gastrocnemius-soleus
muscle group.
• As a result,reduced
foot propulsion occurs
during toe off period
of the stance phase &
patient walks on his
broadened heel with a
tendency of rotating
foot outwards.

56. WEAKNESS OF HIP FLEXORS:
• The patient will have difficulty in initiating
swing through.
• To compensate for this specific muscular
weakness patient externally rotates leg &
uses hip adductors for swing through.
• This circumduction of hip exaggerates
energy expenditure & produces extreme
trunk & pelvis motion.

57. HIGH STEPPING GAIT:
• Ankle dorsiflexors act during the swing
phase of cycle.
• The weakness of this group of muscles
causes foot drop.
• During walking foot slap in ground on heel
strike & then drops in swing phase.
• To prevent this patient flexes hip & knee
excessively in order to clear the ground.

59. STRUCTURAL DEFORMITIES OF
BONE & JOINT
ANTALGIC GAIT:
• Any pathology in lower extremity which
causes during weight bearing result in
antalgic gait.
• To minimize pain on weight bearing,
person shortens time duration of stance
phase on painful side & quickly transfers
weight on normal leg.
• Longer stance on normal leg & shorter
stance on painful leg.

61. STIFF HIP GAIT:
• When the hip is
ankylosed, it is not
possible to flex at hip
joint walking to clear
the ground in stance
phase,hence person
with stiff hip lifts pelvis
on that side & swings
leg in circumduction
to take the forward
step.

62. SHORT STEP:
• A limb length discripancy of 1 to 1.5 inch is
compensated by tilt of the pelvis,which is
demonstrated by a low shoulder,low iliac
crest & low ASIS.
• Another method to compensate
shortening is to put foot & ankle at the
affected side into equinus position & hip &
knee of normal limb in flexion.

63. NEUROLOGICAL DISORDERS
HEMIPLEGIC/FLACCID GAIT:
• In a hemiplegic gait,the shoulder is
adducted & the elbow & wrist are flexed.
• The pateint swings the paraplegic gait
outwards & aheads in a circumduction to
avoid foot scraping ground.
• It is seen in cerebrovascular disease.

64. • SCISSORING/SPASTIC GAIT:
• This gait is characteristic of gait of a
spastic child with marked b/l adductor
spasm at hip & equinus in the ankle.
• The child needs support to walk & leg
goes into marked adduction in swing
phase so that the foot with equinus goes
across to opposite side.
• Such repeated crossing of leg whle
walking gives scissoring appearance
called as scissor gait.

66. FESTINANT GAIT:
• The steps are short so that feet barely
clear floor.
• If patient is pushed backward or forward,
compensatory flexion or extension fails to
occur & patients is forced to make a series
of propulsive or retropulsive steps with
forward locomotion.
• Steps become successively more rapid as
if trying to catch up with centre of gravity.
• Seen in Parkinson's disease.

68. STAMPING/ATAXIC GAIT:
• It occurs in sensory ataxia in which there
is loss of sensation in lower extremity due
to disease processes in peripheral nerves,
dorsal roots, dorsal column of spinal cord.
• Due to absence of deep position
sense,the patient constantly observes
placing of his feet.
• Hip is hyperflexed & externally rotated &
forefoot is dorsiflexed to strike ground with
a Stamp.

69. • Seen in peripheral
neuritis & brain stem
lesion in children,
tabes dorsalis in
adults.

70. DRUNKARDS/REELING GAIT:
• The patient tends to walk irregularly on a
wide base sways from side to side with
tendency of falling with each step.
• It is seen in lesion of cerebellum, lesion
connecting pathway to & from the
cerebellum.

71. CHOREFORM GAIT:
• In this patient will be having chorea in
upper limbs & has a unstable gait.
• Seen in patients having extrapyramidal
symptoms.

72. MISCELLANEOUS GAIT
ALDERMAN'S GAIT :
• Patient walks with head & chest thrown
backwards & protuberant & walks with
legs thrown wide apart.
• Seen in Tuberculosis spine of lower dorsal
& lumbar vertebrae.

73. HYSTERICAL GAIT:
• Patient walks in a bizzare as if going to fall
on every step but seldom falls and walks
cautiously.
KNOCK KNEE GAIT:
• The patient flexes his hip slightly the knee
joint opposes each other, the ankle & feet
are kept apart with tendency of toe in.

74. SENILE GAIT:
• Changes in gait & difficulty with balance
occurs with aging.
• Elderly man develops forward of upper
portion of trunk with flexion of arms &
knees.
• Decreasing arm swing & shortening of
step length.

75. CRUTCH WALKING-PATTERNS OF GAIT
There are 4 patterns of gait:
• Swinging crutch gait - in paraplegics
• Four point crutch gait - in unsteady pts.
• Two point crutch gait - pts.balance good
• Three point crutch gait

76. Swinging crutch gait :
• There are two types of swinging crutch
gaits, the swing to crutch gait & swing
through crutch gait.
• These gaits are when body weight can be
taken through both lower limbs together
but patient is incapable of moving lower
limbs individually due to paralysis.
• The lower limbs are moved by trunk
muscles acting on the pelvis.

77. Swing Through Crutch
Gait:
• In this body is swing
through beyond the
crutches.
• Fastest gait,requires
functional abdominal
muscles.

78. Swing to Crutch Gait:
• In this pt. advances
the crutches & then
swings his body to the
crutuhes.
The sequence of
events:
• both crutches both
lower limbs.

79. Four point crutch gait:
• It is used when all or part of body weight can
be taken on each foot.
• Pt. is unsteady & requires a wide base of
support.
• As pt's balance improves he may progress
to two point crutch gait.
• The four points are two crutch tips & two
limbs.
Sequence of events:
• right crutch left foot left crutch right
foot.

81. Two point crutch gait:
• When two point crutch gait is used,the
amount of body weight taken on both feet
is reduced.
• This type of gait used when pts. balance is
good.

82. Sequence of events:
• Right crutch & left foot
simultaneously f/by
• left crutch & right foot
simultaneously.

83. Three point crutch gait:
• In this gait, the amount of body weight
taken by a foot can vary from none to
partial or full.
• This gait is commonly taught to
orthopaedic patients who may have one
painful or weak limb which cannot support
the whole body weight & one lower limbs
which can.

84. • Both crutuhes support weaker lower limb,
while the stronger limb takes whole body
weight without any support from the
crutches.
Sequence of events:
• Both crutches & the weaker lower limb
together, the stronger lower limb.

86. DHANYAVAAD
DR.RAMACHANDRA