GAIT

Dr. Madhukar
Assistant Professor
Department of Orthopaedics
SBMCH
CHENNAI

GAIT
Gait is pattern of movement of limbs
Observation of gait is important part of examination
of orthopaedic patient
Normal gait requires
Normal biomechanical functioning of musculoskeletal
system of limbs and spine
Good sensory feedback from proprioceptive sensations
from the feet and joints
Visual and labrynthine sensory inputs and coordination
for the smoothness, rhythm, grace and elegance of the
human gait
BIOMECHANICAL CONSIDERATIONS
Mechanics of propulsion

Antigravity support and stoppage

Centre of gravity should fall within the base of support
in all phases of walk for stability

Line of gravity should also pass through the joints of
the supporting leg

Normal swinging of arms contribute to elegance of the
walk paralysis of arm affects cadence of gait

GAIT STUDY TECHNIQUES
Observational gait analysis

Electromyography recording of muscles controlling
the joints

Energy consumption

Foot print studies

Knowledge of the mechanism of normal gait
essential to interpret abnormality in locomotor
system
GAIT OR WALK CYCLE
One complete walk cycle extends from the heel strike
of one leg to its next heel strike

Each leg alternately goes through a stance and swing
phase

Long stance phase 60%
Foot is on the ground
Supporting the body
Lasts from heel strike to toe off of one leg

Shorter swing phase 40%
Leg swings froward along with the forward movement of the
body
TERMINOLOGY
RLA (phases) Traditional (events)
Initial Contact Heel Strike
Loading response HS foot flat
Midstance FF midstance
Terminal stance Midstance heel off
Pre-swing Heel off toe off
Initial swing Toe off early accel.
Midswing Acceleration midswing
Terminal swing Midswing deceleration

GAIT CYCLE
STANCE PHASE
1. Heel strike first event heel strikes ground
2. Foot flat - whole foot is flat on ground
3. Mid-stance with the foot flat body swings
forward. Active extension of hip
4. Heel off heel lifted off the ground with active
extension of the hip and knee
5. Push off - the whole foot except the toes is raised
up as the calf muscles start pushing body up and
forward
6. Toe off in this last part, the toes also go off and
whole foot leaves the ground

STANCE PHASE
The heel strike and foot flat of one foot corresponds
to push off and toe off of other foot that is 1&2
stages of one leg with 5 &6 stages of the other leg

This span of time when both foot are on the ground
simultaneously period of double suppor.

Tor the moothness of walk the stance leg must
support the centre of gravity and provide active
extension of the hip and knee to help the swing leg
to clear the ground
SWING PHASE
1. Acceleration theis is the phase of acceleratrion
of the swinging leg by the hip flexors taking it ot
the front of the body

2. Mid swing leg continues to swing forward

3. Deceleration slowing down of the swing to get
the foot ready for the heel strike

CADENCE PARAMETERS
Step length: Distance between two feet during
double-limb support
Stride length: Distance one limb travels during
stance and swing phases
Step time: Time needed to complete one step
length
Cadence: Number of steps per minute
Walking velocity: Distance traveled per time
(m/sec)

RUNNING
Sequences are faster

Moment in the cycle when both feet are off the
ground
ABNORMAL GAIT
Painful hip gait
Stiff hip gait
Unstable hip gait
Trendlenberg gait
Gluteus medius gait
Gluteus maximus gait
Quadriceps gait
High stepping gait
Short leg gait
Scissoring gait

ANTALGIC GAIT
Painful condition in hip joint commonly
Can be in painful conditions of knee, ankle and foot
also
To minimise pain shortens the time duration of
stance phase on affected side
And quickly transfer weight to the opposite normal
side
Longer stance phase of normal side
Shorter stance phase on painful side

STIFF HIP GAIT
Ankylosed hip

Not able to flex at hip joint to clear ground in swing
phase

Lifts pelvis othe side and swings the pelvis with the
leg in circumduction and moves it forward
UNSTABLE HIP GAIT
Stability of hip in walking is provided by
Muscles and ligaments

Normal alignment of the line of gravity through the joint

The abductor muscles the power

Fulcrum at hip joint

Lever arm neck of femur

NORMAL BIOMECHANICS
Trendlenberg test

Anatomical disruption

Physiological disruption

Trendlenberg gait anatomical disruption

Glutes medius gait physiological disruption
GLUTEUS MAXIMUS GAIT
Anterior poliomyelitis

Gluteus maximus paralysed

Hip cannot extend

Patent lurches backwards to extend the hip
passively
QUADRICEPS GAIT
Quadriceps muscle paralysis

Anterior poliomyelitis

In late stance phase, the knee actively extended and
locked by power of quadriceps

With loss of quadriceps power, patient pushes his knee
backward by putting his hand over the front of the lower
thigh

Results in genu recurvatum later with associated
external rotation of foot for broad base support to
improve stability
HIGH STEPPING GAIT
Foot drop

Foot drops on the ground on heel strike and the
drops in the swing phase with a thud

For ground clearence hip is flexed more and this
causes high stepping gait
SHORT LEG GAIT
Obvious when shortening more than 2.5cm or 1
inch

Upto inch shortening masked by pelvic tilt

1 inch shortening masked by equinus of foot

>2 inch marked pelvic tilt and equinus deformity
SCISSORING GAIT
Spastic child

Bilateral adductor spasm at hip and equinus spasm
at ankle

Child needs support to walk

During swing phase the leg crosses opposite side