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 StrikeLoading response → HS → foot flatMidstance → FF → midstanceTerminal stance → Midstance → heel offPre-swing → Heel off → toe offInitial swing → Toe off → early accel.Midswing → Acceleration → midswingTerminal swing → Midswing →

deceleration

GAIT CYCLE

STANCE PHASE

1. Heel strike – first event heel strikes ground2. Foot flat - whole foot is flat on ground3. Mid-stance – with the foot flat body swings

forward. Active extension of hip4. Heel off – heel lifted off the ground with

active extension of the hip and knee5. 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 ½ inch shortening masked by pelvic tilt

1 ½ 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