May 30, 2024

Gait is defined as a rhythmic, cyclic movement of the limb in relation to the trunk resulting in forwarding propulsion of the body.

Normal Gait of a person: 8000-10000 steps average person walks in a day on average

Walking

Series of rhythmical, alternating movements of the trunk and limbs which resulting in the forward progress of the center of gravity

Series of controlled falls

One foot is always on the ground

Jumping

Both feet are in the air and on the ground at some point in time

Both feet are on air

Jumping

In the gait cycle, there is a period in which no foot is in contact with the ground (Double float)

Period in which no foot will be in contact with the ground

Stance: 40%

Float: 15%

Swing: 30%

Float: 15%

Two phases:

  • Stance (60-65%)
  • Swing (35-40%)

Gait Cycle

Stance PhaseSwing Phase
Heel StrikeAcceleration
Foot flatMid-swing
Mid StanceDeceleration
Heel Off
Toe Off

Stance phase

Initial contact: Heel strike: Double support =10%

Load response: Foot flat

Mid stance: Single leg stance

  • Single support: 40%
  • Terminal Stance: Heel off
  • Pre swing: Toe off

Swing phase

Initial swing——–Mid swing——–Terminal swing

Parameters of Gait

  • Base width: 5-10 cm (In unstable gait; Increase in base width)
  • Step Length: 35-41 cm
  • Stride length: 70-82 cm
  • Heel-toe angle: 70 degrees
  • Lateral pelvic shift: 2.5 – 5 cm (Pelvic list)
  • Verticle pelvic shift: 5 cm
  • Pelvic rotation: 8 degrees
  • 4 degrees forward on the swing phase
  • 4 degrees backward on the stance leg
  • Cadence: 90-120 steps/ minute

Centre of gravity of a Normal Person

Midway between hips

5 cm in front of S2

Moves vertically and horizontally along with gait

Figure of 8 movements of CG as seen in AP view

How to explain?

  • Bipedal (Yes/ No)
  • Aided or Unaided (Uses crutches, walker or not)
  • Stable or Unstable ( Lurching towards right/ left side)
  • Coordinated (is he able to walk in a single line)
  • Painful or not

Observe Gait

  • From front
  • From behind
  • From side
  • From proximal to distal
  • Watch pelvis to the lumbar spine
  • Watch movements in the trunk and upper limb
  • Compare right and left when observing a person’s gait pattern

Abnormal Gait:

Limping: Avoids weight-bearing as far as possible (short stance phase)

Lurching: Variable failure of abduction mechanism

Pathological Gait

  • Stability and stance
  • Sufficient foot clearance during swing
  • Appropriate swing phase repositioning of the foot
  • Adequate step length
  • Energy conservation

Common Orthopedics Gait

Antalgic Gait

Pain anywhere from a foot to hip

The patient avoids bearing weight on an affected limb:

  • Reduced stance phase
  • Short step length
  • Shortened stride length
  • Shortened Reciprocal arm swing
  • Increase the velocity of speed

Shortened stance phase (avoid talking weight on the same side)

Arthogenic (Stiff hip and circumduction)

Can’t flex hip and knee joint

To clear the ground clearance

The entire leg is lifted higher and circumduction of the pelvis

Rotation of pelvis on verticle axis + Flexion at hip(Limb propulsion)=> Normally

Loss of flexion at the hip is compensated by exaggerated rotation of the pelvis

Trendelenberg Gait

Also called Abduction lurch

Gluteus medius weakness

Something is wrong with the adductor mechanism

3S- Strong Side Sags

Lurch and List on the affected side

In bilateral gait: Wobbling gait (Chorus girl swing)

Positive Trendelenberg

  • 2D: Dislocation + Destruction of Head of the femur
  • 2B: Breaking and bending
  • 1P: Adductor paralysis

No painful limp (Indicative of underlying proximal muscle weakness or hip instability)

The stance phase is equal between involved and uninvolved sides

There is an excessive lateral list in which the thorax is thrust laterally to keep CG over the stance leg

During swing: Listing of the trunk towards the affected side and pelvic drop on opposite side

Usually due to congenital, developmental, or muscular disorders

If bilateral Waddling gait is seen.

Short Limb Gait

Patient lurch to the affected side and pelvic drop on the same side

Whole-body dips down on the affected side

Pelvic drop on the same side

  • Shortening < 4 cm (compensated by hyperextension of knee and equinus at an angle)
  • Shortening > 4 cm

The patient dips his body on that side due to marked pelvic tilt and equinus also increases.

Flexion at the hip for ground clearance

Intoeing Gait

Increased anteversion

Causes of Intoeing gait are discussed here.

  • Familial
  • Metatarsal adductors
  • Tibial bowing
  • Tibial torsion
  • Femoral anteversion

High Stepping/ Foot drop/ Equinus gait

Weak dorsiflexors

Knee lifted high and foot slapped on the ground

During heel striking attempt, toe drop on the ground first

To avoid this (clear ground), the Patient flex hip and knee and raises the foot, and slap it on the floor, forcefully

In some cases:- the patient starts walking by dragging toes on the ground with/without making any attempt to flex the hip and knee

Stiff Knee Gait

Normally knees go into flexion in the early stages of the swing phase

The patient has to raise the affected side pelvis to clear foot from the ground

Swing sidewise will cause circumduction of gait to reach heel strike

Waddling gait

When the abduction mechanism of both hips is disturbed

Examples:

Ataxic gait

Poor sensation

Poor muscle coordination

Wide based

Feet are slapped against the ground heel then toes

Gait is irregular, jerky, and weaving

Gluteal Maximus/ Kings/ Rocking horse gait

The backward lurch of the trunk at the heel strike

Quadriceps Gait (Five-finger quadriceps)

Forward flexion of the trunk

Equinus

Knees in extension or use hand above knee joint

Scissor gait

Gait in Cerebral palsy

Draws knee together and swing of the hip

Knees in flexion: Crouch gait

Spasticity: Adductor spasm

Muscle Action while the patient walks

Most muscle action is eccentric while it contracts

MuscleActionFunction
Gluteus medius (Abductor lurch)EccentricControls pelvic tilt
Gluteus Maximus (Hyperextension lurch)ConcentricPowers hip extension
IliopsoasConcentricPowers hip flexion
Hip adductorsEccentricControl lateral sway
Hip AbductorsEccentricControls pelvic tilt
Quadriceps (Back knee gait/lurch)EccentricStabilize knee at heel strike
Hamstring EccentricControl rate of knee extension
Tibialis anterior (Foot drop/ slap)ConcentricDorsiflex ankle at seeing
EccentricSlows plantar flexion rate during heel strike
Gastrocnemius- SoleusEccentric/concentricSlows dorsiflexion rate
Muscle action and function

Windlass mechanism

Windlass mechanisms

During toe-off: Gastrocnemius soleus complex has a concentric contraction

In addition, foot progress from heel strike to toe-off

Following changes occurs in the foot to convert from a flexible shock absorber to a rigid propellant:

The plantar fascia which attaches to the plantar medial heel and runs the length of the arch to the bases of each proximal phalanx is tightened as the MTP joint extends

Windlass mechanism

This longitudinal arch is accentuated

So, when the foot is at rest there is some mobility between the bones of the midfoot allowing flexibility, but during push off= Plantar fascia is tightened as toe dorsiflex

Brings tarsal bones together and locks them into a rigid column

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