GAIT

BY
Dr. AMRIT KAUR (PT)
Lecturer, N.D.M.V.P college of physiotherapy
nashik
 GAIT

 Normal Gait
Series of rhythmical , alternating movements of
the trunk & limbs which result 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
 GAIT CYCLE
► The gait cycle consist of 2 phases for each foot

Stance (60 percent of the cycle )

 Begins when the heel of one leg strikes the ground and
ends when the toe of the same leg lifts off.

Swing (40 percent)

 Swing phase represents the period between a toe off on
one foot ad heel contact on the same foot.
► Time Frame:
A. Stance vs. Swing:
►Stance phase = 60% of gait cycle
►Swing phase = 40%
B. Single vs. Double support:
►Single support= 40% of gait cycle
►Double support= 20%
 Gait Cycle - Subdivisions
► A. Stance phase:
1. Heel contact: ‘Initial contact’.
2. Foot-flat: ‘Loading response’, initial contact of
forefoot on ground.
3. Midstance: greater trochanter in alignment w.
vertical bisector of foot
4. Heel-off: ‘Terminal stance’
5. Toe-off: ‘Pre-swing’
 Gait Cycle - Subdivisions
► B. Swing phase:
1. Acceleration: ‘Initial swing’
2. Midswing: swinging limb overtakes the limb in
stance
3. Deceleration: ‘Terminal swing’
 DISTANCE AND TIME
VARIABLES
► Temporal ► Distance
variables variables
1. Stance time 1. Stride length
2. Single limb support 2. Step length
time 3. Width of walking
3. Double limb support
time
4. Swing time
5. Stride and step time
6. Cadence
7. speed
► Step length
Distance between corresponding successive points of
heel contact of the opposite feet
► Stride length

Stride length is determined by measuring the linear

distance from point of heel strike of one lower
extremity to next heel strike of same extremity.
► Width of base of support

Side-to-side distance between the line of the two feet

► Degree of toe out
It is the angle formed by each foot’s line of progression
and a line intersecting the centre of the heel and
second toe.
KINEMATICS AND KINETICS OF GAIT

► Path of Center of
Gravity
 midway between the
hips
 Few cm in front of S2
 Least energy
consumption if CG
travels in straight line
Path of Center of Gravity
Path of Center of Gravity
 HEEL STRIKE TO FOOT FLAT
► Heel strike to forefoot loading
► Foot pronates at subtalar joint
► Only time (stance phase) normal
pronation occurs
► This absorbs shock & adapts foot
to uneven surfaces
► Ground reaction forces peak
► Leg is internally rotating
► Ends with metatarsal heads
contacting ground
 Sagittal plane analysis
Joint Motion GRF Mome- Muscle Contraction
nt

Hip Flexion Anterior flexion G.Maximus Isometric

30-25 Hamstring to ecentric
Add.magnus,
knee Flexion Anterior Extensi- quadriceps Concentric
0-15 To on to to ecentric
Posterior flexion
ankle Plantar- Posterior PF Tibialis anterior ecentric
Flexion Ex. digitorum
0-15 longus
Ex.hallucis
longus
 Frontal plane analysis
JOINT MOTION

Pelvis Forwardly rotated position

Hip Medial rotation of femur on pelvis

knee Valgus thrust with increasing valgus

Medial rotation of tibia
Ankle Increase pronation

Thorax posterior position at leading ipsilateral side

Shoulder Shoulder is slightly behind the hip at ipsilateral

extremity side
FOOT FLAT TO MIDSTANCE
 FOOT FLAT TO MIDSTANCE
(SAGITTAL PLANE)
Joint Motion GRF Moment Muscle Contractio
n
Hip Extension Anterior to Flexion G.maximus Concentric
25-0 posterior to to no
Flexion-0 extensi- activity
on
Knee Extension Posterior to Flexion Quadriceps Concentric
15-5 anterior to to no
15-5 extensi- activity
flexion on

Ankle 15 of PF to Posterior to PF to Soleus, Eccentric

5-10 of DF anterior DF gastronem-
ius, PF
 Frontal plane analysis
Joint Motion
Pelvis Ipsilateral side rotating backward to reach
neutral at midstance ,lateral tilting towards the
swinging extremity.
Hip Medial rotation of femur on the pelvis continue
to neutral position at midstance. adduction
moment continue throughout single support.
Knee There is reduction in valgus thrust and the tibia
begins to rotate laterally.
Ankle The foot begins to move in the direction of
supination from its pronated position at the end
of loading response. The foot reaches a neutral
position at midstance.
 Frontal plane analysis

Ankle The foot begins to move in the direction of

supination from its pronated position at
the end of loading response. The foot
reaches a neutral position at midstance.

Thorax Ipsilateral side moving forward to neutral.

shoulder Moving forward

MIDSTANCE TO HEEL OFF
 MIDSTANCE TO HEEL OFF
(sagittal plane analysis)

Joint Motion GRF Moment Muscl Contract-

e ion
Hip Extension 0 Posterior Extension Hip Eccentric
to flexors
hyperexten
sion of 10-
20

Knee Extension 5 Posterior Flexion to No

degree of to extension activity
flexion to 0 anterior
degree
Ankle PF:5 degree Anterior DF Soleus Eccentric
of DF to 0 PF to
degree. concentric.

Toes Extension: Flexor

o-30 degree hallicus
of longus and
hyperextens brevis
-ion. Abductor
digiti quinti,
interossei,
lumbricals
 MIDSTANCE TO HEEL OFF
(frontal plane analysis)

Joint Motion
Pelvis Pelvis moving posteriorly form neutral position
Hip Lateral rotation of femur and adduction

Knee Lateral rotation of tibia

Ankle – Supination of subtalar joint increases

foot
Thorax Ipsilateral side moving forward

Shoulder Ipsilateral shoulder moving forward.

HEEL OFF TO TOE OFF
 HEEL OFF TO TOE OFF
(sagittal plane analysis)
Joint Motion GRF Moment Muscle Contraction

Hip Flexion :20 Posterior Extension iliopsoas concentric

degree of to neutral Adductor
hyperextensi- magnus
on to 0 Adductor
degree. longues
Knee Flexion :o- Posterior Flexion Quadrice Ecentric to
30degree of ps no activity
flexion
Ankle PF :0-20 Anterior DF Gastronemius. Concentri
degree of PF soleus, peroneus c to no
brevis, peronius activity
longus.

Toes Extension: 50- Flexor hallucis Close

(MTP) 60 of longus chain
hyperextension. Adductor hallicus resonse
to
Abductor digiti
increasing
minimi
PF at the
Flexion digitorum ankle.
brevis and hallicus
brevis, inrossei,
lumbricals
 HEEL OFF TO TOE OFF
(frontal plane analysis)
Joint Motion

pelvis Contralateral side moving forward unless

contralateral heel touches the ground.
Hip Abduction occur, lateral rotation of femur

Knee Inconsistent lateral rotation tibia

Foot / Weight is shifted to toes and at toe off only the first
ankle toe is in contact., supination of subtalar joint.
Thorax Translation on the ipsilaterior side.

Shoulder Moving forward.

 DETERMINANTS OF GAIT
► Six optimizations used to minimize
excursion of CG in vertical & horizontal
planes
► Reduce significantly energy consumption of
ambulation
► The six determinants are
 Lateral pelvis tilt
 Knee flexion
 Knee, ankle and foot interactions
 Forward and backward rotation of pelvis
 Physiological valgus of knee
 DETERMINANTS OF GAIT
1) Pelvic rotation:
 Forward rotation of the pelvis in the horizontal
plane approx. 8o on the swing-phase side
 Reduces the angle of hip flexion & extension
 Enables a slightly longer step-length w/o further
lowering of CG
(2) Pelvic tilt:
 5 degree dip of the swinging side (i.e. hip
adduction)
 In standing, this dip is a positive Trendelenberg sign
 Reduces the height of the apex of the curve of CG
(3) Knee flexion in stance phase:
 Approx. 20o dip
 Shortens the leg in the middle of stance phase
 Reduces the height of the apex of the curve of
CG
(4) Ankle mechanism:
 Lengthens the leg at heel contact
 Smoothens the curve of CG
 Reduces the lowering of CG
(5) Foot mechanism:
 Lengthens the leg at toe-off as ankle moves
from dorsiflexion to plantarflexion
 Smoothens the curve of CG
 Reduces the lowering of CG
► Physiological valgus of knee
Reduces the base of support, so only little lateral
motion of pelvis is necessary.
 FACTORS AFFECTING GAIT
► Age
► Gender
► Assistive devices
► Disease states
► Muscle weakness or paralysis
► Asymmetries of the lower
extremities
► Injuries and malalignments
 GAIT EXAMINATION
► Take a history
► Couch examination
► Static examination
► Allow patient time to relax
► Reasonable length walkway - gait pattern
changes before & after turn
► Various systematic ways
► Look for the obvious!
 COUCH EXAMINATION
► Observe deformities & lesions
► Check ROM’s
► Check muscle tightness/strength
► Neurological & vascular assessment
 STATIC EXAMINATION
► Feetnon-weight bearing (hanging) with
weight bearing
► Standing from front
 Shoulders, hips, knees, feet
 From behind
 Shoulders, hips, calcaneus
 GENERAL POINTS
► Is the gait fast or slow?
► Is it smooth?
► Does the patient appear
relaxed & comfortable or
pained?
► Is it noisy?
FEET
 FEET
► Is the 1st MPJ functioning properly?
► Are the toes bearing weight?
► When is the heel lifting?
► Is toe off through the hallux?
► Does the swing phase appear normal?
► Are the feet too close or is the base of gait
wide?
 LEGS
► Are the knees pointing forwards?
► Is there genu valgum or varum?
► Is there tibial varum present?
► Do they appear internally or externally
rotated?
► Knees from the side – are they fully
extending?
HIPS & BODY
 HEAD & SHOULDERS
► Are the shoulders level?
► Do the arms swing equally?
► Does the head & neck appear normal?
 Gait: Major points of observation. 
6.Pelvic 
1.Cadence
a. Anterior or posterior tilt
a. Symmetrical
b. Hike
b. Rhythmic
c. Level
2.Pain
7.Knee
a. Where
 a. Flexion, extension
b. When
b. Stability
3.Stride
8.Ankle 
a. Even/uneven
a. Dorsiflexion
4.Shoulders b. Eversion, inversion
Dipping. Elevated, 9.Foot 
depressed, protracted,
retracted a. Heelstrike
10.Base 
5.Trunk
a. Stable/variable
a. Fixed deviation
b. Wide/narrow
b. Lurch
 COMMON GAIT
ABNORMALITIES
► Antalgic Gait
• Gait pattern in which stance phase on
affected side is shortened
• Corresponding increase in stance on
unaffected side
• Common causes: OA, Fx, tendinitis
 Lateral Trunk bending/
Trendelenberg gait
► Usually unilateral
► Bilateral = waddling gait
► Common causes:
A. Painful hip
B. Hip abductor weakness
C. Leg-length discrepancy
D. Abnormal hip joint
 Functional Leg-Length
Discrepancy
► Swing leg: longer than stance leg
► 4 common compensations:
A. Circumduction
B. Hip hiking
C. Steppage
D. Vaulting
 Increased Walking Base
► Normal walking base: 5-10 cm
Common causes:
►Deformities
►Abducted hip
►Valgus knee

Instability
►Cerebellar ataxia
►Proprioception deficits
 Inadequate Dorsiflexion
Control/foot drop gait
► In stance phase (Heel contact – Foot flat):
Foot slap
► In swing phase (mid-swing):
Toe drag
 Causes:
 Weak Tibialis Ant.
 Spastic plantarflexors
 Excessive knee extension
► Loss of normal knee flexion during stance
phase
► Knee may go into hyperextension
► Genu recurvatum: hyperextension deformity
of knee
Common causes:
 Quadriceps weakness (mid-stance)
 Quadriceps spasticity (mid-stance)
 Knee flexor weakness (end-stance)
 Others pathological gaits
► Arthrogenic gait ( stiff hip or knee)
► Contracture gait
► Gluteus maximus gait
► Planter flexor gait
► Scissors gait
 Neurological gait
► Ataxicgait
► Parkinsons gait
► Hemiplegic gait
► Spectic diplegic
► Myopatic gait
► Hyperkinetic gait
 RUNNING GAIT
► Require greater balance, muscle
strength, ROM than normal walking.
► Difference b/w running and walking
► Reduced BOS
► Absence of double support
► More coordination and strength
needed
► Muscle must generate higher energy
bout to raise HAT higher than in
normal walking.
► Divided into flight and support phase.
 STAIR GAIT
► Ascending and
descending stairs
is a basic body
movement
required for ADL

► Stair gait involved

stance and swing
phase
 kinematics
► STANCE ► SWING PHASE(36%)
PHASE(64%)
• Foot clearance
• Weight acceptance • Foot placement
• Pull up
• Forward continuance
SIMILARITIES & DIFFERNCES BETWEEN
LEVEL GROUND GAIT AND STAIR GATE
► Similarities to Walking
Double support periods
Ground reaction forces have double peak
Cadence similar
Support moment is similar (always positive with
two peaks)
 Differences with Walking
► More hip and knee flexion
► Greater Rom needed
► Peak forces slightly higher
► Centre of pressure is concentrated under
metatarsals, rarely near heel
► Step height and tread vary from stairway to
stairway
► Railings may be present
 ……….. THANK

YOU ….