GAIT CYCLE AND PATHOLOGICAL

GAIT

DR C.BALAJI MS ORTHO
 Definition:

Physiological Definition:
 It is a mechanism which
depends upon closely
integrated action of the
subjects, bones, muscles and
nervous system (including
peripheral and central nervous
system)
 Definition:
Mechanical definition;
 It is a series of rhythmic alternating motion

of arms, legs, and trunk that create forward

propulsion.
 Prerequisites of gait
There are (4) major criteria essential to walking.
Equilibrium:The ability to assume an upright posture and
maintain balance.

Locomotion:The ability to initiate and maintain rhythmic

stepping
Musculoskeletal Integrity:Normal bone, joint, and muscle
function

Neurological Control:Must receive and send messages

telling the body how and when to move.

(visual, vestibular, auditory, sensori-motor input)

 Forces for gait:

 Muscular force.
 Gravitational force.
 Forces of momentum.
 Ground reaction force.
 GAIT CYCLE
 GAIT CYCLE- time
interval or sequence
of motion occurring
between two
consecutive initial
contacts of same foot.
 GAIT TERMINOLOGIES
 Time and distances are two basic
parameters of motion.
1. Temporal variables
2. Distance variables
 TEMPORAL VARIABLES
1. Stance time
2. Single limb support time
3. Double support time
4. Swing time
5. Stride time
6. Step time
7. Cadence
8. speed
 DISTANCE VARIABLES
1. Stride length
2. Step length
3. Step width
4. Degree of toe out
 Single support time
Amount of time that spent during the period
when only one extremity is on the
supporting surface is a gait cycle
 Double support time
Amount of the time spent with both feet on
the ground during one gait cycle
 The time of double support may be

increased in elder patients and in those

having balance disorders
 The time of double support decreases

when speed of walking increases

 Stride duration
 Amount of time spent in
completion of one stride
or Gait cycle
 One stride duration for a
normal stride is 1 second.
 Changes occur in stride
length during normal,
slow, fast walking.
 Stride length
 Gait cycle is also called stride
 The linear distance between heel
strike of one extremity and when the
same extremity heel strike again
( time spent in a gait cycle of one
extremity)
 A stride include two steps, right and
left but stride length is not always
equal to length of two steps as there
may be unequal steps
 Stride length greatly varies among
individual because it is affected by
leg length, sex, age.
 Stride length decreases with increase
 Step length
Linear distance between two successive points of
the opposite extremities.
 Comparison of the right and left steps provides
an indication of gait symmetry, the more equal
are the step length more symmetrical will be the
gait
 Step duration
The amount of time spent in completion of
a single step.
 Its measurements is expressed as

sec/step
 When there is weakness or pain in an

extremity step duration may be

decreased on the effected side while
increased on the unaffected side
 cadence
The number of steps taken by a person per unit
time
Cadence=number of steps/sec or min
 Shorter step length will result in increase
cadence at a given velocity
 If cadence increases the double support time
decreases and vice versa
 Normal cadence , man=110 steps/min
 Normal cadence, woman=116 steps/min
 Walking velocity
 Is the rate of linear forward motion of the body
in a specific direction
 It can be measured as, cm/sec, meter/min or
miles/hour
 If the direction is not specified than term
walking velocity is called “walking speed”
Step width
 Step width, or width
of the walking base
 It is measured by the
linear distance
between the mid
point of the heel of
one foot and the
same point of the
other foot.
 Normal is 5-10cm
 Degree of toe out
It is the angle of foot placement(FP) and
may be found by measuring the angle
formed by each foot line of progression
and a line which intersect the center of
heel and second toe.
 Normal angle = 7 degree

 Angle of toe-out decreases as the

speed of walking increases

 PHASES
Stance : ipsilateral foot in contact with the
ground

Swing : ipsilateral foot in the air

STANCE SWING STANCE SWING

STANCE SWING
 PHASES
Stance phase
 It begins when the foot contacts the

ground and ends when the foot lifts off

from the ground.
(60% of normal cycle)
 Components

Heel strike ⇒ Initial Contact

 Foot flat ⇒ loading
response
 Mid Stances ⇒ Single Leg
Support
 Heel Off ⇒ Terminal
Stances
 Toe Off ⇒ Pre swing
 Stance Phase
 60% of gait cycle
 Closed kinetic chain during
weight-bearing, allows forces
from lower extremity to be
transmitted to ground,
producing movement
 Initial Contact
 Begins with foot touching surface.
 It is the beginning of stance phase.
 Contact should be through lateral
aspect of plantar surface
 Opposite limb is ending with toe-off
 Subtalar joint – supinated @ 5 degrees
 Talocrural joint – dorsiflexed
 Both limbs in contact with surface
( double leg support )
 Loading Response
 Response to absorption of
body weight by initiating
flattening of the foot
 Subtalar joint – pronates
 Unlocks midtarsal joints,
allowing foot to become flexible
 Tibial internal rotation
 Talocrural joint – plantarflexes
 Loading Response
 The loading response phase occupies about
10 percent of the gait cycle and constitutes
the period of initial double-limb support.
During loading response, the foot comes in
full contact with the floor, and body weight
is fully transferred onto the stance limb.
 Hip remains flexed
 Period lasts until double limb support has
ended
 Double leg support
 Midstance

 Mid-stance represents the first

half of single support, which
occurs from the 10- to 30-
percent periods of the gait cycle.
It begins when the contra-lateral
foot leaves the ground and
continues as the body weight
travels along the length of the
foot until it is aligned over the
forefoot.
 Midstance
 Subtalar joint – supinates
 Locks midtarsal joints, makes foot a
rigid lever
 Preparing for efficiency during
propulsion
 Talocrural joint – dorsiflexes
 Hip moves into extension
 Single leg support
 Terminal Stance

 Terminal stance constitutes the

second half of single-limb
support. It begins with heel rise
and ends when the contra-lateral
foot contacts the ground. Terminal
stance occurs from the 30- to 50-
percent periods of the gait cycle.
During this phase, body weight
moves ahead of the forefoot.
 Terminal Stance
 Body moves forward with weight shifting
over metatarsal heads until contralateral
limb provides new base of support
 Toes extended, tibia externally rotated
 Subtalar joint – supinated
 Hip and knee continue to flex
 Single leg support
 Preswing
 Pre-swing is the terminal
double-limb support period
and occupies the last 12
percent of stance phase,
from 50 percent to 62
percent
 Transitional period of double
support
 Limb is uploaded and
prepared to swing
 Begins with initial contact of
contralateral limb and ends
 The stance period consists of the first
five phases: initial contact, loading
response, mid-stance and terminal
stance.
JOINT MOTIONS STANCE PHASE
Sagittal Plane
JOINT POSITION & MUSCLES
INVOLVED
INTERVAL JOINT POSITION MUSCLE
ACTIVITY
Accelerati Hip Flexed Gluteus
on to Heel Maximus
Strike Hamstring
s
Gluteus
medius &
minimus
Knee Flexed Quadricep
s femoris
Ankle Neutral Anterior
crural
muscles
 JOINT POSITION & MUSCLES
INVOLVED
INTERVAL JOINT POSI MUSCLE
TION ACTIVITY

Heel Strike to Midstance Hip Neut Gluteus

ral medius
&
minimu
s
Knee Exte Quadric
nde eps
d femoris
Ankle Dors Gastroc
iflex nemius;
ed soleus
Tarsal Inve Tibialis
rted anterior
 JOINT POSITION & MUSCLES
INVOLVED
INTERVAL JOINT POSITIO MUSCLE
N ACTIVITY

Midstance to Toe Off Hip Extend -

ed
Knee Flexed Gastrocn
emius
Ankle Plantar Gastrocn
flexed emius;
soleus

Tarsal Everted Peroneus

longus
Peroneus
 Swing Phase
 Begins as soon as the toes leave the
surface and terminates when the limb
next makes contact with the surface
 Momentum gained at toe-ff helps carry
leg through the swing phase
 Three periods
Initial swing,
 mid swing,
 terminal swing.
 Initial Swing
 Begins at the point where toes leave
the ground and continues until knee
reaches its maximum range of flexion
(@ 60O)
 The initial one-third of the swing
period,
 62- to 75-percent periods of the gait
cycle
 Femur advances
 Ankle dorsiflexes, allowing toe
clearance
 Subtalar joint - pronation
 Midswing
 Mid-swing occurs in the second third
of the swing period, from the 75- to
85-percent periods of the gait cycle.
 This phase begins following
maximum knee flexion and ends
when the tibia is in a vertical
position.
 Thigh continues to advance, toe
clearance is ensured, propulsion
continues
 Talocrural joint – dorsiflexed to
neutral or slight dorsiflexion
 Terminal Swing
 In the final phase of terminal swing
from the 85- to 100-percent periods of
the gait cycle, the tibia passes beyond
perpendicular, and the knee fully
extends in preparation for heel
contact.
 Occurs from end of midswing to initial
contact period of the stance phase
 Trunk is erect
 Thigh decelerates for heel contact
 Knee extends to create step length for
heel contact
 Subtalar joint - supination
 The key determinants
Path of Center of Gravity

 Center of Gravity(CG):
 midway between the
hips
 Few cm in front of S2

 Least energy
consumption if CG
travels in straight line
CG
 The key determinants

Vertical displacement
 Rhythmic up & down movement
 Highest point: midstance
 Lowest point: double support
 Average displacement: 5cm
 Path: extremely smooth sinusoidal curve
 The key determinants
Lateral displacement

 Rhythmic side-to-
side movement
 Lateral limit:
midstance
 Average
displacement: 5cm
 Path: extremely
smooth sinusoidal
curve
 Forward rotation
of the pelvis in the
horizontal plane
approx 5 to 8o on
the swing-phase
side
 Reduces the angle
of hip flexion &
extension
 The key determinants
Pelvic tilt

 5o dip of the
pelvis towards
the stance phase
(i.e. hip
adduction)

 Reduces the
height of the
apex of the
curve of CG
 The key determinants
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
 The key determinants
Foot & Ankle mechanism
 Lengthens the leg at toe-off as
ankle moves from dorsiflexion to
plantar flexion
 Smoothens the curve of CG
 Reduces the lowering of CG
Preferred Rate of Ambulation
 Free or comfortable walking speed
 Rate at which the normal individual is
most energy efficient
 Range: ~2.5 - 4.0 mph (cadence of ~75 -
120 steps per minute)
 Will vary from individual-to-individual
METHODS OF GAIT ASSESSMENT

1. Visual gait analysis 6. Electromyography

2. Timing of gait 7. Energy consumption
cycle 8. Accelerometers
3. Direct motion 9. Gyroscopes
measurements 10. Force platforms
systems 11. Kinematic systems
4. 12. Combined
Electrogoniometer kinetic/kinematic
s systems.
5. Pressure beneath
the foot
 Visual gait analysis

 It can be done by:

 Gait assessment by direct vision.
 Examination by video recording
 Timing of gait cycle

 Footswitches:

 Instrumented walkways - walkway

which is covered with an electrically
conductive substance, such as sheet
metal, metal mesh or conductive rubber.
Suitably positioned electrical contacts on
the subject’s shoes complete an electrical
circuit.
 Direct motion measurements systems

 measures the forward displacement of

the trunk, by means of a light string,
which is connected to the back of a belt
around the subject’s waist. As the
individual walks forwards, the string is
pulled through an instrument which
measures its motion
 This systems will give the mean speed of
walking and also the instantaneous speed
as it changes during the gait cycle.
 Electrogoniometers

 An electrogoniometer is a device for

making continuous measurements of the
angle of a joint.
 If measurements have been made from
two joints (typically the hip and the knee),
the data may be plotted as an angle-angle
diagram, also known as a ‘cyclogram’
 It can be assessed by
Potentiometer devices
Flexible strain gauges
Potentiometer devices
Flexible strain gauges
Electromyography

 Surface electrodes
 Fine wire electrodes
 Needle electrodes
 PATHOLOGICAL GAIT

Causes
 Muscle Weakness,
 Neurogenic Disorder
 Any Bony Abnormality.
 PATHOLOGICAL GAIT
Muscle Structural Neurogenic
Weakness deformities of disorders
the bone and
joint
Spastic Gait
Gluteus Medius Antalgic Gait (Scissor
Gait (Abduction Stiff Hip Gait Gait)
Short Leg Festinant Gait
Lurch) Gait Stamping Gait
Trendelenburg ( Ataxic
Gait Gait)
(Unstable Dystrophic Gait
Hip) Hemiplegic
Gluteus Gait
maximus (Flaccid
Gait )
 MISCELLANEOUS GAIT

 Alderman’s Gait
 Senile gait
 Hysteric gait
 Running gait
 Stair gait.
 Trendelenberg gait
CAUSES

 Weak Abductors: in poliomyelitis, muscular

dystrophies, motor neuron disorder.
 Fulcrum: Any pathology which disrupts the
normal acetabulo-femoral articulations e.g.,
CDH, Pathological dislocation of hip.
 Defective lever system: e.g fracture neck of
femur, perthes, coxa vara.
 Trendelenberg gait

 Usually unilateral
 Bilateral =
waddling gait
 Gluteus maximus lurch
 When there is weakness of gluteus
maximus muscle the stabilizing factor is
lost and the patient leans backwards at
the hip to passively extend it and keep
the CG over the stance leg.
 This causes backwards lurch in the
gluteal maximus gait. The patient walks
with protuberant abdomen. This type of
gait is seen in poliomyelitis.
 Quadriceps Gait
 Hand to Knee gait or five finger Quadriceps:
Quadriceps muscle is the principal extensor
of the knee joint.

 Due to the weakness of quadriceps muscle,

the affected limb is put forwards in
stepping, with the body leaning towards it
anteriorly. The patient gradually learns to
stabilize his knee by directly transferring his
body weight over the lower thing, through
his ipsilateral hand.
 High Stepping Gait

 Ankle dorsiflexors act during

the swing phase of the cycle.
 The weakness of this group of
muscles causes foot drop.
 During walking the foot slap
in the ground on heel strike and
then drops in the swing phase.
To prevent this the patient
flexes the hip and knee
excessively in order to clear the
ground.
 Calcaneal Gait
 It occurs due to the weakness of the
gastrocnemius-soleus muscle group.
 As a result, reduced foot propulsion
occurs during the toe-off period of the
stance phase and patient walks on his
broadened heel with a tendency of
rotating the foot outwards.
 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
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 spasticity (mid-stance)
Knee flexor weakness (end-stance)
 Short Leg Gait
 Produces a limp depends on the degree
of shortening.
 A limb length discrepancy of 1 to 1½ inch
is compensated by the tilt of the pelvis,
which is demonstrated by a low shoulder,
low iliac crest and low ASIS.
 Another methods to compensate
shortening is to put the foot and ankle at
the affected side into equinus position
and the hip and knee of normal limb in
flexion.
 Festinant Gait

 The steps are short so that the

feet barely clearly the floor.
 If the patient is pushed backwards
or forwards, compensatory flexion
or extension fails to occur and
patient is forced to make a series
of propulsive or retropulsive steps
with forwards locomotion, the
steps become successively more
rapid, as if trying to catch up with
the center of gravity
 It is seen in Parkinson’s disease
 Stamping ( Ataxic) Gait
 Due to the absence of deep position
sense, the patient constantly observes the
placing of his feet. The hip is hyperflexed and
externally rotated and forefoot is dorsiflexed to
strike the ground with “Stamp”.
 Occurs in sensory ataxia in which there is loss
of sensation in the lower extremity due to
disease processes in the peripheral nerves,
dorsal column of spinal cord, e.g., peripheral
neuritis and brain stem lesion in children,
tabes dorsalis in adults
 Dystrophic Gait
It is seen in muscular dystrophies
where marked muscular weakness of the
trunk muscles and proximal muscles of
the limb occurs.

Patient walks with the feet widely

separated and lifted off the ground with
difficulty and the body is inclined first to
one side and then the other.
 Hemiplegic (Flaccid) Gait

 In a hemiplegic gait, the shoulder is

adducted and the elbow and wrist are
flexed.
 The patient swings the paraplegic leg
outwards and aheads in a circle
(Circumduction) to avoid the foot
scraping the ground
 Miscellaneous
 Alderman’s Gait: it is seen in tuberculous
spine of lower dorsal and upper lumbar
vertebrae. The patient walks with head
and chest thrown backwards and
protuberant abdomen and walks with
legs thrown wide apart.
 Crutch Stance
 The correct stance with crutches is with the head up,
the back straight with shoulder depressed, not
hunched,
the axillary pads of the crutches gripped between the
upper arms and the side walls of the chest 2 inches
below the anterior axillary fold, the crutch tips 6
inches out from the tips of the toes.

 The palms of the hands on top of the handgrips, the

body weight taken mainly on the hands and the
elbows in the position of 30 degrees of flexion.
 Crutch Walking - Patterns of
Gait

There are four

different
patterns of gait

 Swinging crutch
gaits
 Four point crutch
gait
 Two point crutch
gait
 Three point crutch
 Swinging Crutch Gaits

2 types
1. Swing to crutch gait -
the patient advances
the crutches and the
swings his body to the
crutches.

2. Swing through crutch

gait - the body is swing
through beyond the
crutches.
Four point Crutch Gait
 The four
points are
two crutch
tips and two
limbs.
 The sequence
of events are
right crutch,
left foot, left
crutch and
right foot.
Two Point Crutch Gait
 This type of gait is
used when the
patients balance is
good.
 The sequence of
events are right
crutch and left foot
simultaneously, left
crutch and right
foot simultaneously.
Three Point Crutch Gait
 By using the three point
crutch gait, the amount
of body weight taken by
a foot can vary from
none to partial or full.

 The sequence of
events are both
crutches and the
weaker lower limb
together, the stronger
lower limb.