ANALYSIS OF GAIT

C.NAGESWARI, PRINCIPAL,
SHRI INDRA GANESAN INSTITUTE OF MEDICAL SCIENCE
COLLEGE OF PHYSIOTHERAPY, TRICHY
 INTRODUCTION

• Gait, Ambulation, Walk.

• How the joint and the muscles integrated to maintain upright posture and
produce motion of the body to ambulate.
• Knowledge of kinematics and kinetics of normal ambulation for
analysing, identifying and correcting the abnormalities of gait.
• DEFINITION: Translatory progression of the body as a whole, produced
by coordinated, rotatory movements of the body segments.
SAGGITAL AND FRONTAL VIEW
 GAIT INITIATION
• Begins with erect standing posture with an activation of tibialis anterior and
vastus lateralis muscle combine with the inhibition of gastrocnemius muscle.
• Bilateral concentric contraction of Tibialis Anterior produce sagittal torque inclines the body
anteriorly from the ankles.
• Abduction of swing hip occurs along with contraction of TA & Vl which produce the coronal torque
that propel the body towards the supported limb.
• COP (Center of Pressure) moves ant & medially towards the supported limb.
• The gait initiation end when the stepping or the swing estimate
lift off the ground.
• Duration 0.64 secs (Either right or left).
 GAIT CYCLE
Phases of gait cycle
• Gait cycle have two events in same limb.
• Stance phase 60% / Swing phase 40%.
• Also there is two phase of double limb support in a gait cycle (22%).
• The Two terminologies for the further division of this major phases is used.
1. Traditional
2. Rancho Los Amigos(RLA)
 STANCE PHASE
TRADITIONAL RLA

1. HEEL STRIKE OR HEEL CONTACT 1. INITIAL CONTACT

2. FOOT FLAT 2. LOADING RESPONSE

3. MID STANCE 3. MID STANCE

4. HEEL OFF 4. TERMINAL STANCE

5. TOE OFF 5. PRE SWING

 SWING PHASE
TRADITIONAL RLA

1. ACCELERATION 1. INITIAL SWING

2. MID SWING 2. MID SWING

3.DECELARTION 3. TERMINAL SWING

GAIT CYCLE
GAIT CYCLE
 SWING PHASE

Pre swing
• Occupies 50-60% range of gait cycle
• Period of double limb support
• Goal is to prepare the limb of swing
• Initial contact of opposite limb marks beginning of pre swing
 GAIT TERMINOLOGY

Temporal variables
• Stance time
• Single support time Distance variables
• Double support time  Stride length
• Stride duration  Step length
• Step duration  Width
• Swing duration  Degree of toe out
• Cadence
• Speed
 Temporal variables
• Stance time
– The amount of time that elapses during the stance
phase of one extremity in a gait cycle (0.6 sec)
• Single support time
– Time that elapses during the period when only one
extremity is on supporting surface in a gait cycle
• Double support time
– Amount of time spend with both feet on the ground
during one gait cycle.
 Temporal variables
• Stride duration
– Amount of time to accomplish one stride.
• Step duration
– Amount of time to accomplish a single step.
• Cadence
– Number of steps taken by a person per unit of
time
cadence = number of steps/time
100 to 110 Steps per minute(Approx.)
Velocity ( Speed)
Rate of linear forward motion of the body
Meter/ sec (or) meter/minute (or) miles/hour
 Distance variables
 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.
 Step length
 stance between corresponding successive points of heel
contact of the opposite feet
 Distance variables
 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 center of the heel and second
toe.
 Kinematics of gait
• JOINT MOTION
– Measuring trajectories of lower extremities and joint angles
– Equipment – Stroboscopic photography, cinematography and
Electro goniometres and recently computerised motion
analysis system.
– Less sophisticated observation, video taping.
 SAGITTAL PLANE JOINT ANGLES
• HIP: Achieves max flexion (20 deg) around initial
contact at 0% gait cycle and its most extended position(-
20 deg) at about 50% of gait cycle between heel off and
toe off.
• During swing phase the hip reaches its maximum flexion
(60 deg) at 70% of gait cycle
• KNEE: is straight (0 deg) at initial contact and nearly
straight again just before heel off at 40% of cycle. A small
knee flexion (15 deg)occurs at 10% of gait cycle.
• ANKLE: Maximum dorsiflexion of (7 deg) at
approximately hell off, 40% of gait cycle and reaches
maximum plantar flexion (-25 deg) at Toe off, 60% of
cycle.
 FRONTAL PLANE JOINT ANGLES
• At 20% of stance cycle, the pelvis contralateral side drops about 5
deg, which results in adduction of hip.
• The hip abduct smoothly about 5 deg during toe off and return to
neutral at initial contact.
• Knee remains more or less neural.
• Ankle everts from 5 deg of inversion to 5 deg of eversion in early
stance and inverts about 15 deg during push off.
 TRANSVERSE PLANE JOINT ANGLE
• The Hip externally rotates until approx. mid swing, and then internally rotates
to near neutral before initial contact.

• The Knee joint remains relatively neutral throughout most of the gait cycle.

• The Ankle has three rapid reversals of rotations from about 40% of gait cycle
until initial contact, and reach a maximum external rotation at about foot flat.
 DETERMINANTS OF GAIT
Determinants of gait or factor responsible for minimizing the displacement of
center of gravity.
Definition: Determinant is a various movement occurs in the body including
pelvis, knee and ankle to maintain center of gravity of the body in a horizontal
plane and ensure the smoothing pathway of gait.
Six Determinants of gait
1) Pelvic rotation.
2) Pelvic tilting.
3) Knee flexion in stance phase.
4) & 5) Foot and knee mechanism.
6) lateral displacement of the body.
 1) PELVIC ROTATION
• In normal pattern of walking:
• The pelvis rotates alternatively to right and to left in relation to the line of progression in
transverse plane about the vertical axis
• .The average magnitude of this rotation is approximately four degrees (40 ) on either side
of the central axis. The total equal "8" degrees.
• Associated hip movement: Internal and external rotation during stance phase.
• Function: Pelvic rotation during normal gait decreases the vertical displacement of COG
3to8 inches
 2) PELVIC TILTING
In normal pattern of walking: The pelvis tilts downward on swing leg (0n the side which is
opposite to that of weight bearing leg) along the frontal plane around saggital axis. The maximum
tilting is at mid-swing.
• The average magnitude: The average of the angular displacement is (5 0) five degrees.
• Associated hip movement: There are relative hip adduction in stance phase and hip abduction in
the swing phase.
• Function: Pelvic tilting helps to decrease vertical displacement of center of gravity 1to 8 inch.
 3)KNEE FLEXION IN THE STANCE PHASE
• In normal pattern of walking: At initial contact, the knee is almost (0 ±50). At loading
response, the knee begins the first excursion of flexion after the heel strike ( = 150 – 200)
• It has 3 functions:
1) Shock absorption.
2) Minimize displacement of COG.
3) Decrease energy expenditure.
• At mid-stance the extension of knee
reaches 5 deg in flexion.
• At terminal stance, the knee joint reaches
0o of extension to start the first excursion
of knee extension.
• At pre-swing, the knee joint flexes up to
10o flexion to start the second excursion of
knee flexion.
 4) & 5) FOOT AND KNEE MECHANISM
• In normal pattern of walking: Early in the stance phase:
• The foot is dorsiflexed while the knee is almost fully extended. So, the extremity is at
its maximum length and the center of gravity reaches its lowest point in a downward
displacement. Late in the stance phase:
• The foot is plantar flexed while the knee is in the beginning of flexion. That will
maintain the center of gravity in its beginning of progression with minimum
displacement.
 6) LATERAL DISPLACEMENT OF BODY AND COG
In normal pattern of walking:
• The center of gravity is displaced laterally over the weight – bearing extremity twice during the cycle of
motion in the horizontal plane.
• The motion is produced by the horizontal shift of pelvis and relative adduction of hip.
• The maximum lateral displacement is lateral at mid-stance on the side of weight bearing leg (4.5 cm
each stride).

Function of the 6 detrminants of gait:

1)Increase the efficiency and smoothness of
pathway of gait.
2) Decrease the vertical and lateral displacement
of center of gravity to two inches excursion.
3) Decrease the energy expenditure.
4) Make gait more graceful.
 KINETIC ANALYSIS OF GAIT
• Kinetic analysis is performed to understand the forces acting on the joints, the
moment produce by the muscle crossing the joints, and the energy requirement of
gait.
• here they separate the body parts into segments, and analyse segment by segment
from distal to proximal with the position markers in motion analysis technology.
• also we need to know the external force acting on the body during walking, these are
Inertia, Gravity, and the GRF.
• The strength of the force couple (two equal force in opposite direction to the axis)
produce the rotation of the object is called torque or moment of force.
• the internal moment generated by the muscles, joint capsule and ligament to
counteract the external forces.
• For example: when the weight is on the forefoot during late stance, an
internal plantarflexor moment produce by calf muscle will oppose the
external dorsiflexion moment caused by GRF and other external forces.
 ABNORMAL GAIT
• There are many causes for abnormal gait
• Permanent or temporary May be due to stroke or simply ankle sprain.
• Most of the abnormal gait falls under the following catagories:
– Muscular weakness/Paralysis
– ROM limitation
– Neurological involvement
– Pain
– Limb length discrepancy
 ANATALGIC GAIT
• This is a compensatory gait pattern adopted in order to remove
or diminish the discomfort caused by pain in the LL or pelvis
Characteristic features:
• Decreased in duration of stance phase of the affected limb
(unable of weight due to pain)
• There is a lack of weight shift laterally over the stance limb and
also to keep weight off the involved limb
• Decrease in stance phase in affected side will result in decrease
inswing phase of sound limb
ANATALGIC GAIT
 GLUTEUS MAXIMUS GAIT
• The gluteus Maximus acts as a restraint for
forward progression.
• The trunk quickly shifts posteriorly at heel
strike. (Initial contact)
• This will shift the body’s COG posteriorly
over the gluteus Maximus, moving the line
of force posterior to the hip joints.
• With foot in contact with floor,
this requires less muscle strength to maintain
the hip in extension during stance phase.
• This shifting is referred to as a
“Rocking Horse Gait” because of the extreme
backward0 forward movement of the trunk.
 GUTEUS MEDIUS GAIT
• It is also known as the “Trendelenberg gait” or “Lurching gait” when one side affected.
• The individual shifts the trunk over the affected side during stance phase.
• When right gluteus medius or hip abductor is weak it cause two things.
1. The body leans over the left leg during stance phase of the left leg and,
2. 2. right side of the pelvis will drop when the right leg leaves the ground & begins
swing phase
 WADDLING GAIT
• Shifting of the trunk over the affected side is an attempt to reduce the
amount of strength required of the gluteus medius to stabilize the pelvis.
• Bilateral paralysis, waddling or duck gait.
• The patient lurch to both sides while walking.
• The body sways from side to side
on a wide base with excessive
Shoulder swing.
• E.g.. Muscular dystrophy.
 QUADRICEPS GAIT

• Quadriceps action is needed

during the heel strike & foot
flat when there is a flexion
movement acting at the knee.
• Quadriceps weakness/
paralysis will lead to buckling
of the knee during gait & thus
loss of balance.
• Patient can compensate this if
he has normal hip extensor &
plantar flexors.
 GENU RECURVATUM GAIT
• Hamstrings are weak, 2 things may
happen
• During stance phase, the knee will go
into excessive hypertension, referred to
as “genu recurvatum” gait.
• During the deceleration (terminal swing)
part of swing phase, without the
hamstrings to slow down the swing
forward of the lower leg, the knee will
slap into extension.
 HEMIPLEGIC GAIT
• With spastic pattern of hemiplegic leg
• Hip into extension, adduction & medial rotation
• Knee in extension, though often unstable.
• Ankle in drop foot with ankle plantar flexion and inversion (equinovarus), which is present
during both stance and swing phase.
• In order to clear the foot from the ground the hip & knee should flex. But the spastic muscles
wont allow the hip & knee to flex for the floor clearance.
• So the patient hikes hip & bring the affect leg by making a half circle i.e. cricumducting the leg.
• Hence the gait is known as “Circumductory Gait”.
 SHORT SHUFFLING GAIT
Normal function at basal ganglia are :
• Typical example fro basal ganglia lesion is parkinsonism.
• Because of rigidity, all the joint will go for a flexion position
with spine stooping forward.
• This posture displaces the COG anteriorly.
• So in order to keep the COG within the BOS, the patient will
increase the number of small shuffling steps.
• Due to loss of voluntary control over the movement, they
loses balance & walks faster as if he is chasing the COG.
• So it is called as “Festinate Gait”.
• Since his shuffling steps, it is otherwise called as “Shuffling
gait”.
 FOOT DROP OR SLAPPING GAIT
• This is due to dorsiflexor weakness caused by
paralysis of common peroneal nerve.
• There wont be normal heel strike, instead the
foot comes in contact with ground as a whole
with a slapping sound.
• So it is also known as “Slapping gait”
• Due to plantar flexion of the ankle, there will be
relatively lengthening at the leading extremely.
• So to clear the ground the patient lift the limb
too high.
• Hence the gait gets its another name i.e. “High
Stepping Gait”.
 CALCANEAL GAIT
• Results from paralysis plantar flexors causing
dorsifelxor contracture.
• The patient will be walking on his heel (heel
walking)
• It is characterized by greater amounts of
ankle dorsiflexion & knee flexion during
stance & a shorter step length on the affected
side.
• Single-limb support duration is shortened
because of the difficulty of stabilizing the tibia
on the knee.