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Normal Gait

Definition

• Normal gait – series of rhythmical, alternating movements of the


trunk & limbs which results in the forward progression of the center
of gravity.

• One gait cycle – Period of time from one heel strike to the next heel
strike of the same limb
Prerequisites of gait
• Equilibrium
• Ability to assume an upright posture and maintain balance

• Locomotion
• Ability to initiate and maintain rhythmic stepping

• Musculoskeletal integrity
• Normal bone, joint and muscle function

• Neurological control
• How to move and when to move
Gait cycle
• Two major phases
• Stance (60%) and swing (40%)
• Single limb support (80%) , double limb support (20 %)
• Events in stance phase
• Initial contact
• Loading response
• Mid stance
• Terminal stance
• Pre-swing
• Events in swing phase
• Initial swing
• Mid swing
• Terminal swing
Initial contact
• Refers to the initial contact of the foot of leading
lower limb.
• Normally, pointed heel makes the first contact to the
ground
• Abnormal gait, possible for whole foot or toes to first
strike.

• Hip extensors ( g. maximus , hamstrings ) contract to


stabilize the hip
• Quadriceps contract eccentrically
• Tibialis anterior contracts eccentrically
Loading response
• Beginning of the initial double limb stance
• Occurs after initial contact until elevation of
opposite limb
• Bodyweight is transferred on to the supporting
limb

• Tibialis anterior contract eccentrically to control


plantar flexion moment
• Quadriceps contract to stabilize knee and counteract
flexion
Mid stance
• Initial period of single leg support.
• From elevation of opposite limb until both
ankles are aligned in coronal plane.

• Hip extensors and Quadriceps undergo


concentric contraction
Terminal stance

• Heel touches the ground


• Toe flexors ( F. Digitorum longus, F.
Hallucis longus) and tibialis posterior
contract
Pre swing
• Start of the second double limb stance in the
gait cycle.
• From initial contact of opposite limb to just
prior to elevation of ipsilateral limb.

• Hip flexors contract to propel advancing limb.


Initial swing
• Start of single limb support for opposite
limb
• From elevation of limb to point of maximal
knee flexion

• Hip flexors concentrically contract to advance


the swinging leg
Mid swing
• Following knee flexion to in which the position
of tibia is vertical

• Ankle dorsiflexors (T. Anterior, EHL, EDL) contract to


ensure foot clearance.
Terminal swing
• From point where tibia is vertical to just prior to initial
contact
• Hamstring muscles decelerate forward motion of the
thigh
Variables in gait
• Temporal variable
• Distance variable
Temporal variable
• Stance time
• Single limb support time
• Double limb support time
• Swing time
• Stride time
• Step time
• Cadence
• Speed
Distance variable
• Stride length
• Step length
• Step width
• Degree of toe out
Determinants of gait (Saunders et al 1953)
• Pelvic rotation
• Pelvic tilt
• Knee flexion in stance phase
• Ankle mechanism
• Foot mechanism
• Lateral displacement of body

• Minor determinants
• Neck movement
• Swinging of arm
Trendelenburg gait
Trendelenburg gait
• Any condition that distrupts the osseo-muscular mechanism between pevis
and femur
• Ex. Weak abductors (g. med, g.min)
• The abductors action in puling the pelvis downwards in stance phase
becomes ineffective and the pelvis drops on the opposite side causing
instability.
• To prevent this the bosy lurches on the same side.
• Unilateral

• Bilateral – waddling

• Causes:
• Weak abductors –superior gluteal nerve weakness, motor neuron disease,
poliomyelitis, muscular dystrophy,

• Defective fulcrum – congenital dislocation if hip, pathological hip dislocation

• Defective lever : fracture neck of femur, perthes disease, coxa vara


Positive Trendelenburg sign
• A positive test is one in which the pelvis drops on the contralateral
side during a single leg stand on the affected side.
High Stepping gait
High stepping gait

• Due to foot drop ( deep peroneal nerve )

• On attempt of heel strike, the toe drops to the ground

• To avoid this, patient flexes the hip and knee extensively to raise the
foot and slaps it on the floor forcibly
• Polio
• Multiple sclerosis
• Syphilis
• Guillain–Barré syndrome
• Spinal disc herniation
• Anterior Compartment Muscle Atrophy
• Deep peroneal nerve Injury
• Spondylolisthesis
Waddling gait
@myopathic gait
• Weakness of proximal ms of pelvic girdle

• Uses cicumduction to compensate for gluteal weakness


Causes
• Pregnancy
• Congenital hip dysplasia
• Muscular dystrophy
• Spinal muscular dystrophy
Short limb gait
• Shift to same side
• Pelvic tilt downward with dip
• Equal period on each time
• Supinate foot or toe walk
• Flex hip and hip on normal side
• Raise pelvis on normal side in swing phase-hip hiking- to clear ground
• Increase energy expenditure because excessive vertical rise and fall of
pelvis

• Complication
• Back pain
• Compensatory scoliosis and and decrease spinal mobility
• <1.5cm:pelvic tilt
• 1.5-5cm:equinus
• >5cm:patient dips body into that side
Causes
• LLD due to true shortening
Antalgic & Scissoring Gait
Antalgic Gait
Gait: The manner or style of walking. Dorlands Dictionary
Anti- + alge, "against pain“

The antalgic gait pattern in which a phase of the gait is shortened on the
injured side to alleviate the pain experienced when bearing weight.

Characteristics
• Marked short stance phase on one side.
Pain makes patient move off affected limb as quickly as possible.
• Step length may be short.
Scissoring Gait
A type of spastic paraparetic gait in which the muscle tone in the
adductors is marked.

It is characterized by hypertonia and flexion in the legs, hips and pelvis


accompanied by extreme adduction leading to the knees and thighs
hitting, or sometimes even crossing, in a scissors-like movement.

The opposing muscles (abductors) become comparatively weak from


lack of use