gait

1. HOD:DR.K.PRAKASAM M.S.ORTHO,D.ORTHO,DSc(HON)
PRESENTOR: Dr.THOUSEEF A MAJEED

2. Definition
 Rhythmic, cyclic movement of the limbs in
relation to the trunk resulting in forward
propulsion of the body.

3. NORMAL GAIT REQUIRES
 Normal functioning of musculoskeletal system of
lower limbs & spine.
 Good sensory feedback from propioceptive sensation
from feet and the joints.
 Visual ,labrinthine sensory inputs & co ordination
add smoothness, rhythm & elegance to the human
gait.

4. GAIT TERMINOLOGY
Base of support
Step length
Stride length
Gait cycle
Cadence
Walking velocity
Double limb support
Single limb support
Ground reaction force vector

5. BASIC GAIT TERMS
Base of suppport:
 Distance between a person’s
feet while standing or during
ambulation.
 Provides balance & stability to
maintain erect posture.
 Normally 2-4 inches from
heel to heel.

6. Step length
 Linear distance along the line
of progression of one foot
travelled during one gait
cycle.
 Approximately 15 inches.

7. Stride length
 Linear distance in the plane of
progression between
successive point of foot to
floor contact of the same foot.
 Normally 27 – 32 inches.

8. Gait cycle
 Period of time from one heel strike to next heel strike of
the same limb

9. Cadence
 It is measured as the number of steps / sec or per
minute.
 Approximately 70 steps per minute

10. Double limb support
 During normal gait, for a moment , two lower extremities are
in simultaneous contact with the ground.
 During this period, both legs support the body weight.
 Happens between push off & toe off on same side and heel
strike & foot flat on the contra lateral side.

11. GAIT CYCLE COMPONENTS
1. Stance phase :60% of the gait cycle.
2. Swing phase :40% of the gait cycle.

12. STANCE PHASE
Heel strike
Foot flat
Midstance
Heel off
Toe off

13. Swing PHASE
Acceleration
Midswing
Deceleration

14. Heel strike phase:
 Beginning of stance phase when
the heel contacts the ground.
 Begins with initial contact & ends
with foot flat

15. Foot flat:
 It occurs immediately following heel
strike
 It is the point at which the foot fully
contacts the floor.

16. Mid stance:
 It is the point at which the body passes
directly over the supporting extremity.
16

17. Heel off:
 The point following midstance the heel of the
reference extremity leaves the ground.
17

18. Toe off
 The point following heel off when only the
toe of the reference extremity is in contact
with the ground.

19. HIP : STANCE PHASE
PHASE NORMAL MOVEMEMT NORMAL MUSCLE ACTION
Heel strike to foot
flat
30* flexion Erector spinae,gluteus
maximus,hamstrings.
Foot flat to
midstance
30*flexion-(neutral) Gluteus maximus at beginning to
oppose flexion movement, then
activity ceases as moment changes
from flexion to extension
Midstance to heel
off
extension No activity
Heel off to toe off 10* hyperextension to neutral Iliopsoas,adductor
magnus,adductor longus

20. KNEE : STANCE PHASE
PHASE NORMAL
MOVEMEMT
NORMAL MUSCLE ACTION
Heel strike to foot flat 0*-15* flexion Quadriceps contracts initially to hold
knee in extension & then eccentrically
oppose the flexion movement to
controll amount of flexion.
Foot flat to midstance 15*flexion-
5*extension
Quadriceps contract in early part,&
then no activity is required
Midstance to heel off 5* of flexion-neutral No activity required
Heel off to toe off 0*-40* flexion Quadriceps required to control amount
of knee flexion

21. ANKLE & FOOT : STANCE PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTIVITY
Heel srike to foot flat 0*-15* plantar flexion Eccentric action of tibialis
anterior oppose plantar flexion
movement
Foot flat to midstance 15*plantar flexio-10*dorsi
flexion
Gastronemius & soleus act
eccentrically to oppose
dorsiflexion movement &
control tibial advance
Midstance to heel off 10*-15* dorsiflexion same as above
Heel off to toe off 15*dorsiflexion to 20*
plantar flexion
Gastronemius,soleus,peroneus
brevis & longus,flexor hallusis
longus contract to plantar flex
the foot

22. Swing phase
Acceleration phase:
• It begins once the toe leaves the ground &
continues until mid-swing, or the point at
which the swinging extremity is directly
under the body.

23. Swing phase
Mid-swing:
 It occurs approximately when the reference
extremity passes directly under the body.
 It extends from end of acceleration to the
beginning of deceleration
23

24. Swing phase
Deceleration
 It occurs after mid-swing
 when the referance extremity is
decelerating in preparation for heel
strike.
24

25. HIP : SWING PHASE
PHASE NORMAL
MOVEMENT
NORMAL MUSCLE ACTION
Acceleration to mid
swing
20*-30* flexion Hip flexor activity to initiate swing
iliopsoas,rectus
femoris,gracilis,sartorius,tensor fascia
lata
Midswing to
deceleration
30*flexion –neutral hamstrings

26. KNEE :SWING PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTION
Acceleration to
mid swing
40*-60* flexion Little activity in quadriceps,biceps
femoris(short head),gracilis,
sartorius contract concentrically
Midswing 60*flexion-30* extension
Deceleration 30*-0* extension Quadriceps contract concentrically
to stabilize knee in extension in
preparation for heel strike

27. Ankle & foot : swing phase
PHASE NORMAL MOTION NORMAL MUSCLE ACTION
Acceleration to
midswing
Dorsiflexion to neutral Dorsiflexors contract to bring the
ankle in neutral & prevent toes
from dragging on the floor
Mid swing to
deceleration
Neutral dorsiflexion

28. DIFFERENCE BETWEEN
WALKING AND RUNNING
Walking : Always a double support phase
no flight phase

29. Running
No double support phase, always flight phase

30. BODY
PASSENGER UNIT LOCOMOTOR
UNIT
HEAD
ARM
TRUNK
PELVIS
LOWER
LIMBS
HAS NO ROLE .
GOES ALONG THE RIDE
FUNCTIONING
SYSTEM
STANCE
PHASE
SWING
PHASE

31. DETERMINANTS OF GAIT
I. Displacement of center of gravity (COG).
II. Factors responsible for minimizing
displacement of center of gravity.

32. CENTER OF GRAVITY
 It is an imaginary point at which all the weight of the
body is concentrated at a given instant.
 Center of gravity lies 2 inches in front of the second
sacral vertebra.
 Centre of gravity follows vertical displacement and
horizontal displacement

33. Center ofGravity

34. Biomechanics
 Rhythmic up & down
movement
 Highest point= midstance
 Lowest point=double
support
 Average displacement-5 cm
Vertical displacement Horizontal displacement
 Rhythmic side to side
movement
 Lateral limit=midstance
 Average displacement-5 cm
Hz plane
Vt plane

35. OVERALL DISPLACEMENT
 Sum of vertical & horizontal
displacement
 Figure ‘8’ movement of Center of
Gravity as seen from Antero
Posterior
 These displacement require energy
“Greater the displacement more
energy is needed”.
Horizontal
plane
Vertical
plane

36. Factors responsible for minimizing
the displacement of centre of gravity
Major determinants:
 Pelvic Rotation (transverse plane)
 Pelvic Lateral Tilt (Obliquity)
 Knee Flexion During Stance
 Ankle Mechanism (Dorsiflexion)
 Ankle Mechanism (Plantarflexion)
 Step Width
Minor determinants:
 1. Neck movement.
 2. Swinging of arms.

37. 1. Pelvic rotation
Rotation of pelvis in Horizontal plane in swing phase, total of
8 degree
Decrease angle of hip flexion & extension
Enables a longer step length without further
lowering of Center of gravity

38. 2. Pelvic tilt
•The pelvis slopes downwards laterally towards the leg which
is in swing phase
•Reduces the vertical movements of the upper body, and
thereby increases energy efficiency.
•Decrease the displacement of Center of gravity

39. 3. Knee flexion in stance
•As the hip joint passes over the foot during the support phase, there
is some flexion of the knee. This reduces vertical movements at the
hip.
•Decrease the displacement of Centre of Gravity

40. 4. Ankle mechanism
•Lengthen the leg at heel strike
•Reduce the lowering of Centre of gravity, hence smoothen the
curve of Center of gravity.

41. 5. Foot mechanism
•Lengthen the leg at toe off as ankle moves from dorsiflesion
to planter flexion
•Reduce the lowering of Centre of Gravity, hence smoothen
the curve of Centre of Gravity

42. Trunk and Arms
• The trunk, arms and shoulders also rotate to ensure
balance
• Upper limb swings opposite to stance leg to produce a
smooth balanced gait.

43. 6. Lateral displacement of body
•In normal gait, width of walking base is narrow,
decrease the lateral displacement of Centre of Gravity
•Decrease muscular energy consumption due to decrease
lateral acceleration & deceleration

44.  Due to complex interaction of muscular activity & joints
motion in lower limb Centre of Gravity follows a smooth
sinusoidal curve.
 It reduce the significant energy consumption of
ambulation.

45. GAIT IN CHILDREN (<2years)
 Gait of small children differs from that of adult
 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.
 There is very little stance phase and knee flexion.
 The whole leg is externally rotated during the swing phase.
 There is an absence of reciprocal arm swinging.

46. GAIT IN ELDERLY
 The age related changes in gait takes place in decade
after m 70yrs.
 There is a decreased stride length, increased cycle
time(decreased cadence).
 Relative increase in duration of stance phase of gait
cycle.
 The speed almost always reduced in elderly people.
 Reduction in total range of hip flexion & extension,
 Reduction in swing phase and knee flexion

47. Function of the 6 determinants of gait:
1) Increase the efficiency and smoothness of gait.
2) Decrease the vertical and lateral displacement of
center of gravity.
3) Decrease the energy expenditure.
4) Make gait more graceful.

48. GAIT ANALYSIS
KINEMATIC
GAIT ANALYSIS
QUALITATIVE QUANTITATIVE
KINETIC GAIT
ANALYSIS

49. KINEMATIC GAIT
ANALYSIS
KINETIC GAIT ANALYSIS
 Describe the movement
pattern without regard for the
force involved in producing
the movement
 Determine the force that
are involved in the gait.

50. Gait analysis
 Observational method- naked eye examination
 Photographic method- television , video, movie analysis
 Force plate study method-ground reaction force method
 Electromyographic study (EMG)
 Electrogoniometric study
 Energy expenditure/requirement method
 Multichannel funtional electrical stimulation
method(MFES)

51. Clinical gait analysis
1. Observational gait data:(Qualitative)
Clinician watches patients walk
Advantage:
1. Require little or no instrumentation
2. Inexpensive
3. Yield general description of gait variables

52. Clinical gait analysis
2. Gait parameters (Quantitative)
• The gait parameter measurement are made by
timing progress over a 16m walkway & identifying
events by means of foot switch system.
• These instrument identify the part contacting the
ground with data transmitted by telemetry.

53. •Photographic methods are most
accurate.
•After film development, each frame
is analysed using vanguard motion
analyser and sonic digitizer.

54. 4. Force plate data
 It represent the ground reaction force of walking
generated by force plate

55. Electrogoniometer
 It is used to study
the joints during
gait.

56. 5. Energetics
 Deals with measurement of oxygen consumption
during a specific task
 Oxygen uptake is inversely related to the efficiency of
gait.

57. PATHOLOGICAL GAIT
Scissoring gait
In toeing gait
Out toeing gait
High stepping gait
Circumduction gait
Waddling gait
Trendelenberg gait
Drunkers gait
Festinant gait
Antalgic gait
Knock knee gait
Genu recurvatum gait
Short limb gait
Quadricep gait
Gluteal medius gait
Gluteal maximus gait
Stiff hip gait

58. ANTALGIC GAIT
 Gait pattern in which stance phase on affected side is
shortened due to pain in the weight bearing limb.
 There is corresponding increase in stance phase on
unaffected side
 Common causes: Osteoarthritis, Fractures, tendinitis

59. TRENDELENBERG GAIT
 Any condition which distrupts the osseo-muscular
mechanism between pelvis and femur
 Weak abductors (power),acetabulo femoral articulation
defect(fulcrum),defective lever system causes trendelenberg
gait.
 Here the abductor action in pulling the pelvis downwards in
stance phase becomes ineffective and the pelvis drops on the
opposite side causing instability.
 To prevent this body lurches on the same side.

60. Trendelenberg gait
 Usually unilateral
 If bilateral = waddling gait
 Causes :
1. Weak abductors :poliomyelitis . muscular dystrophies,
motor neuron disease
2. Defective fulcrum: Congenital dislocaion of hip(CDH),
pathological dislocation of hip
3. Defective lever : Fracture neck of femur, Perthes disease,
Coxa vara.

61. Circumduction gait
 In hemiplegic patients
 To avoid the foot from
scrapping the ground, the hip
and the lower limb rotates
outward.

62. High stepping gait
 Due to foot drop
 On attempt of heel strike, the toe drops to the ground
first.
 To avoid this the patient
flexes the hip and knee
extensively to raise the
foot and slaps it on the
floor forcibly.

63. Scissoring gait
 Here one leg crosses directly over the other with each
step due to adductor tightness.
 Seen in Cerebral palsy

64. Drunkers or reeling gait
 Patient tends to walk irregularly on wide base, swinging
sideways without stability and balance.
 Caused due to cerebellar lesion.
 With unilateral lesion of cerebellum, balance is lost towards the
side of the lesion.

65. Genu recurvatum gait
 In Paralysis of hamstring muscles the knee goes in for
hyper extension while transmitting the weight in mid
stance phase.
 Seen in poliomyelitis

66. Short limb gait
 Shortening less than 1.5 cm compensated by pelvic tilt, and
shortening upto 5 cm compensated by equinus.
 Shortening more than 5 cm the patient dips his body on that
side.

67. Festinant gait
 Seen in Parkinson's disease
 Steps are short that the feet barely clears the ground.

68. Quadriceps gait
 Normally the knee is locked by the quadriceps contraction
while transmitting weight to the lower limb during
midstance.
 Hence patient with weak quadriceps stabilizes his knee by
leaning forward on the affected side & pressing over lower
thigh by his Ispilateral hand or fingers.

69. Gluteus maximus gait(BACKWARD
LURCH)
 Due to weakness in gluteus maximus
muscle, while the body propels
forward during midstance
phase,trunk is lurched posterior
to effect posterior pelvic and
shifting the centre of gravity
towards stance hip.

70.  Seen in poliomyelities & above knee amputation with
prosthesis.

71. Stiff hip gait
 When the hip is ankylosed, it is not possible
to flex at the hip joint during walking to
clear the ground in the swing phase.
 Hence the person with stiff hip, lifts
the pelvis on that side and swings the leg with
the pelvis in circumduction and moves it
forward.

72. 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.

73.  Seen in peripheral neuritis &
brain stem lesion in
children, tabes dorsalis in
adults.

74. Alderman’s gait:
• Seen in Tuberculosis of spine in lower dorsal and upper
lumbar vertebra.
• Patient walk with head and chest thrown backward and
protuberant abdomen and legs thrown wide apart.

75. GAIT TRAINING
 AIM:
 To achieve safe, easy, effortless normal gait pattern.
Non ambulatory phase
1. Asses and improve the range of movement
2. Treat contractures
3. Improve the cardio respiratory status
4. Shadow walking
5. Assisted device

76. Ambulatory phase
1. Support by orthotic & prosthesis
2. Parallel bar walking
3. Encourage reciprocal arm swinging
4. Follow other forms of walking
 Turning
 Side walk
 back walk
 Squatting
 Getting up
 Walking on uneven rough surface