Gait

• Gait Cycle


  The interval between successive heel contacts of the same foot
• Gait Cycle


  1. Begins when the heel of the referenced (observed) extremity contacts the ground

  2. Ends when the heel of the same extremity contacts the ground again
• Phases of Gait Cycle


  • Stance phase
  • Swing phase
• Stance Phase


  • Interval in which the foot of referenced lower extremity is in contact with the ground
  • Constitutes 60% of gait cycle
  • A single gait cycle contains right and left stance phases
• Swing Phase


  • Interval in which the foot of referenced lower extremity is not in contact with the ground
  • Constitutes 40% of gait cycle
  • A single gait cycle contains right and left swing phases
• Double Support Time


  • Two periods in a gait cycle in which body weight is transferred from one foot to the other and both right and left feet are in contact with the ground at the same time
  • One period occurs early in stance phase of referenced extremity and the other occurs late in stance phase of the referenced extremity
  • Around 20% of gait cycle is spent in double limb support and 80% in single limb support
• Stride


  • Distance between successive points of heel contact of the same foot
  • Involves 2 steps (left and right)
  • Stride is equal to a gait cycle
  • Average distance: ~1.4 meters
• Step


  • Distance between the heel contact point of one foot and that of the other foot
  • Example: left step length is measured from point of right heel contact to point of left heel contact
  • Average distance: ~0.7 meters
• Velocity


  • Total distance traveled in a given amount of time
  • Average speed: ~1.3 meters per second
• Main challenges of gait


  • Maintaining upright posture
  • Maintaining equilibrium
  • Control of foot trajectory and ground clearance
  • Control of multiple body segments
• Main tasks in gait

  • Weight acceptance
  • Maintenance of stability during single leg support
  • Limb advancement (swing)
• Normal wear pattern on shoes

  • Increased wear over the lateral portion of the outer sole at the heel
  • Even wear along the area corresponding to the 1st, 2nd, and 3rd MTP joints
  • Even wear over the 1st, 2nd, and 3rd MT heads
• Antalgic Gait


  • Gait pattern seen when a patient has pain in one of their lower extremities
  • Reduce weight bearing on the affected limb
  • Decreased step length of the unaffected limb resulting in decreased stance time on the affected limb
  • Side flexion towards affected limb during stance if hip is the source of pain
  • Side flexion away from affected limb during stance if knee or ankle/foot are the source of pain
  • Reduced cadence
  • Cane held contralateral to affected limb
• Foot Drop


  • Ankle DF weakness results in abnormal compensatory gait patterns
  • Steppage gait: Patient cannot DF, results in excessive hip and knee flexion to clear the foot
  • Foot slap: Patient has weak or absent dorsiflexors and the foot slaps down on the ground
  • Circumduction of affected limb during swing to clear the swing leg
  • Hip hiking of affected limb during swing
• Abducted Lurch


  • Patient leans over the affected/weak hip to place the center of gravity over the hip
  • Compensatory technique for a gluteus medius muscle weakness
• Gluteus Maximus Gait


  Backward trunk lean or throwing the trunk backward after initial contact may be due to weakness of hip extensors (gluteus maximus)
• Parkinsonian Gait


  • Trunk, head, neck forward and flexed (kyphotic head forward posture)
  • Narrow base, small shuffling steps
  • Lack of arm swing and trunk rotation
  • Tend to fall forward and to increase speed (festination)
  • Episodes of freezing
• Ataxic Gait


  • Wide base of support due to poor balance
  • Arms held away from body in "high guard" to improve balance
  • Irregular stepping patterns (distance and direction)
  • Slow initiation of forward progression of limb which is suddenly flung forwards unexpectedly and slaps the ground on contact
  • Unsteady gait pattern with irregular, staggering movements
  • Veering to one side or the other
• Scissoring Gait


  • Legs cross midline due to spasticity of adductors
  • Most commonly seen in spastic cerebral palsy
• Knee Hyperextension


  • Due to weak knee extensors
  • Inability to take full weight on limb without hyperextending the knee to prevent buckling
• Hemiplegic Gait


  • Stance: Weak hip abductors resulting in Trendelenburg
  • Knee hyperextension due to quadriceps spasticity, loss of ankle DF ROM, poor proprioception/control, weak quadriceps OR knee flexion throughout stance due to knee flexion contracture, poor proprioception/control
  • Loss of heel strike due to ankle DF weakness, PF contractures
  • Varus foot in stance due to weak peroneals, hyperactive/spastic tibialis anterior, tibialis posterior, toe flexors, soleus
  • Decreased stance time on affected limb due to short contralateral step length

  Swing: Inadequate hip flexion for step due to hip weakness

  • Spastic adductors resulting in scissoring of affected limb
  • Poor foot clearance due to weak hip, knee or ankle dorsiflexors, spastic quadriceps,spastic PF's or PF contractures
• Trendelenburg Sign and Gait

  • Trendelenburg sign: when standing in single leg stance, the opposite pelvis (non-standing leg) drops
  • Trendelenburg gait: during gait, the weak abductors cause the contralateral side to dip
  • Compensated Trendelenburg: patient will side flex ipsilaterally over standing leg to compensate for weak glute medius and minimus
  • Causes: Gluteus medius and minimus weakness, Lesion in superior gluteal nerve – common during pregnancy
• Review Gait Cycle in Notebook