Observational Gait

Analysis

Identifying Key Events in the Gait Cycle

Normal Gait
Four objectives must be accomplished for normal
gait to occur.
1. Leg supports body weight without collapsing
2. Balanced maintained (statically &
dynamically) during single support phase
3. Swing leg advance to take over supporting
role
4. Sufficient power for necessary limb
movements and trunk advancement

Effectiveness Of Normal Gait

Depends on free joint mobility &
muscle action
Pathological conditions of:
muscle
bone
joints
sensory nervous system
central motor control
cardiopulmonary system
Alters mode and efficiency of
gait

During Normal Gait Cycle

Joints are:
free to move
possess optimal alignment
depends on
fibrous tissue mobility
articular cartilage smoothness
*Evaluated during static biomechanical examination
-also examine: plantar lesions, soft tissue abnormalities

Keep In Mind...
Step
Stride
Cadence
Gait Cycle
Abnormal or subtle change in gait
movement is forced due to weakness spasticity or
deformity
or
movement is a compensation to correct for some other
problem which needs to be identified

Requirements for Observational Gait

Analysis
Suitable site
straight, level walkway
(length & width)
line of progression
lighting

Patient attire
Treadmill and video
Observe
posterior, anterior, lateral
barefoot vs. wearing shoes
with & without orthotics

Observational Gait Analysis

Event:
Head tilt at heel strike
Normal: Vertical Position
Significance of Deviation

Tilts to short or long limb

Tilts towards the raised shoulder
Muscle tightness
Habit

Observational Gait Analysis

Event: Shoulder position during stance
Normal: Equal
Significance of Deviation
Shoulder drop due to
Scolosis
Short or long limb
Trauma
Occupational

Observational Gait Analysis

Event:
Arm swing during stance
Normal:
Equal active arm swing
Significance of Deviation
No arm swing
Need to stabilize the trunk
Tight erect posture

Unilateral arm swing

Greater arm swing on the side of
the short leg
Limitation of motion in the opposite hip
Occupational

Evaluation of Short Leg

Palpate pelvic crest ASIS and PSIS
Level the pelvic crest with know
thickness of material under short
side

Observational Gait Analysis

Event: Pelvic hike in swing
Normal: None
Significance of Deviation
Used to assist ground
clearance if foot drop is
present

Observational Gait Analysis

Event:

Pelvic drop of opposite side during

stance
Normal: None
Significance of Deviation
If present:
Weak hip abductors
Tight hip adductors

Observational Gait Analysis

Event:

Pelvic drop of same

side in swing
Normal: None
Significance of Deviation
If present suspect:
Opposite side hip abductor
weakness
Loading a short limb
Scolosis

Observational Gait Analysis

Event:
External hip rotation
Normal: Terminal stance and into swing
Significance of Deviation
Increased by:

Muscle problem gluteus maximus

Foot fault contact retroversion
Compensation
Excessive supination at contact

Observational Gait Analysis

Event:
Internal hip rotation
Normal: Contact into midstance
Significance of Deviation
Increased by:
Tight medial musculature
Foot contact fault Anteversion
Compensation
Excessive pronation into propulsion

Observational Gait Analysis

Event:
Knee extension in stance
Normal: Fully extends in midstance
Significance of Deviation
If excessive consider:
Compensation for equinus
Weak quadriceps
Pain

Observational Gait Analysis

Event: Knee flexion in stance
Normal: After contact and
midswing
Significance of Deviation
If excessive in stance or swing:
Hamstring contracture
Soleus weakness (stance only)
Quadriceps weakness (swing
only)

Observational Gait Analysis

Event: Transverse plane position
of knee at end of contact
Normal: 3-5 internally rotated
Significance of Deviation
Internal:
Internal femoral torsion or position
Spastic or tight medial musculature

Observational Gait Analysis

Event:

Transverse plane position of knee

at end of contact
Normal: 3-5 internally rotated
Significance of Deviation
External:
External femoral torsion or position
Spastic or tight lateral musculature

Observational Gait Analysis

Event:

Frontal plane position

of the knee
Normal: Vertical +/- 2
Significance of Deviation
Bow leg
Coxa valga- genu varum
Pediatric developmental

Knock Knee
Coxa vara- genu valgum
Pediatric developmental

Observational Gait Analysis

Event:
Frontal plane position of the tibia
Normal: Vertical +/- 2
Significance of Deviation
Tibial varum
Blounts disease
Rickets

Observational Gait Analysis

Event:

Frontal plane position of the calcaneus

at heel strike
Normal:
2 - 4 inverted
Significance of Deviation
Excessive varus due to:
Tibia varum
Cavus foot type
Plantarflexed 1st ray
Narrow base of gait
Abducted gait angle

Sounds of Heel Strike

Listenpounding?
If excessive pounding this will indicate
lack of shock absorption
Look for shock waves up the leg

Observational Gait Analysis

Event:

Frontal plane position of the calcaneus at

heel strike
Normal:
2 - 4 inverted
Significance of Deviation
Vertical or valgus due to:
Genu valgum
Calcaneal valgum
Internal femoral torsion
Internal tibial torsion
Weak anterior group
Inability to resupinate

Navicular Position- Sagittal View

Pronation - talar head adducts against
navicular, decreasing distance from ground
Supination - talar head abducts, increasing
distance from ground
Can be related to Medial longitudinal arch
angle

Observational Gait Analysis

Event:
Angle of gait during stance phase
Normal: 10-15 abducted
Significance of Deviation
Abducted gait due to:
External hip rotation
External tibial rotation
Fully compensated MTJ
Pronated foot at heel off

Observational Gait Analysis

Event:
Angle of gait during stance phase
Normal: 10-15 abducted
Significance of Deviation
Adducted gait due to:
Internal hip rotation
Internal tibial torsion
Tight medial hamstring
Metatarsus adductus

Observational Gait Analysis

Event:

Base of gait during the stance

phase
Normal: 4 in width between subsequent
heel strike
Significance of Deviation
Narrow base due to:
Tibia varum
Increase in cadence, running, and jogging

Observational Gait Analysis

Event:

Base of gait during the stance

phase
Normal:
4 in width between subsequent heel
strike
Significance of Deviation
Broad base due to:

Genu valgum
Instability of the trunk
Pediatric
Geriatric

Observational Gait Analysis

MTJ
Midstance & propulsion - key for foot stability
Metatarsal heads
FFL- anterior view - 5th met. head contacts first,
followed in sequence by the others
Propulsion - reverse - 5th leaves first
1st MPJ - lateral view - df
TOE POSITION
contact - dorsiflexion
midstance - plantargrade

Observational Gait Analysis

Event:
Normal:

Time of heel lift

60-70% of stance phase, when
opposite limb has passed the
support limb
Significance of Deviation
Premature heel lift due to:
Short or spastic posterior group, ankle block
Associated with the limited midtarsal ROM

Observational Gait Analysis

Event:
Normal:

Time of heel lift

60-70% of stance phase,
when opposite limb has
passed the support limb
Significance of Deviation
Delayed heel lift due to:
Moderate to severe MTJ
compensation
Short stride

Observational Gait Analysis

Event:

Frontal plane motion of the foot to the

support surface during propulsion
Normal:
Lateral side of the foot raises
earlier than medial side
Significance of Deviation
Inverted gait due to:

Forefoot varus
Forefoot valgus
Rigid plantarflexed 1st ray
Functional hallux limitus
Adducted gait angle

Observational Gait Analysis

Event:

Frontal plane motion of the

calcaneus at heel lift
Normal: Vertical moving into inversion
Significance of Deviation
Vertical or valgus
Pronated STJ

Observational Gait Analysis

Event:

Direction of weight flow through

hallux at toe off
Normal:
moves through the long axis of the
hallux
Significance of Deviation
Medial side of hallux due to:

Pronated STJ and MTJ

Abducted gait
FHL
Hallux rigidus