2. The ‘gait’ may be defined as the forward propulsion of
body by the lower limbs in a systematic, coordinated
semi-rotatory movements of the trunk, arm and head.
A normal gait must be rhythmic and soundless, having
springiness in the feet which work alternatively in a
definite cyclic order.
3. The basic unit of measurement in gait analysis is the
gait cycle.
a normal gait cycle is divisible into two phases for
each extremity:
i. The stance phase, and
ii. The swing phase.
4. Subdivision of phases
Stance phase – Swing phase -
1) Heel strike 1)Acceleration
2) Foot flat 2) Mid-swing
3) Mid-stance 3) Deceleration
4) Heel off
5) Toe off
5.
6. COMPARISON OF GAIT TERMINOLOGY
Traditional pattern –
1. Heel strike
2. Foot flat
3. Mid-stance
4. Heel off
5. Toe off
6. Acceleration
7. Mid-swing
8. Deceleration
Rancho Los Angious (RLA) -
1. Initial contact
2. Loading response
3. Mid-stance
4. Terminal stance
5. Pre-swing
6. Initial swing
7. Mid-swing
8. Terminal swing
7.
8.
9. STANCE PHASE
Heel strike phase:
Begins with initial contact & ends with foot flat
It is beginning of the stance phase when the heel
contacts the ground.
Foot flat:
It occurs immediately following heel strike
It is the point at which the foot fully contacts the floor.
Mid stance:
It is the point at which the body passes directly over
the supporting extremity
10. Heel off:
the point following midstance at which time the heel of
the reference extremity leaves the ground.
Toe off:
The point following heel off when only the toe of the
reference extremity is in contact with the ground.
11. SWING PHASE
Acceleration phase:
It begins once the toe leaves the ground & continues
until mid-swing, or the point at which the swinging
extremity is directly under the body.
Mid-swing:
It occurs approx. when the extremity passes directly
beneath the body, or from the end of acceleration to
the beginning of deceleration.
Deceleration:
It occurs after mid-swing when limb is decelerating in
preparation for heel strike.
12. RLA PHASES OF GAIT
Initial contact
It refer to the initial contact of the foot of leading lower
limb.
Normally the heel pointed first to contact.
In abnormal gait it is possible to either whole foot or toes
rather than the heel to strike.
Load response
Begins at initial contact & ends when the contra lateral
extremity lifts off the ground at the end of the double-
support phase.
It occupies about 11% of gait
Mid-stance phase (RLA)
Begins when the contra-lateral extremity lifts off the
ground at about 11% of the gait cycle
Ends when the body is directly over the supporting limb at
about 30% of the gait cycle.
13. Terminal stance (RLA)
Begins when the body is directly over the supporting limb
at about 30% of the gait cycle
Ends just before initial contact of the contra-lateral
extremity at about 50% of the gait cycle.
Pre-Swing (RLA)
It is the last 10% of stance phase and begins with initial
contact of the contra-lateral foot (at 50% of the gait cycle)
and ends with toe-off (at 60%).
Initial swing (RLA)
Begins when the toe leaves the ground & continues until
max knee flexion occurs.
Mid-Swing (RLA)
Encompasses the period from maximum knee flexion until
the tibia is in a vertical position.
Terminal swing (RLA)
Includes the period from the point at which the tibia is in
the vertical position to a point just before initial contact.
14.
15. In normal walking the foot placed on the ground in an
angle taken from the centre of heel to second toe- ‘toe
out’ or ‘foot angle’ and it is on an average 7degree.
The distance between the heel strike of one lower limb
to the heel strike of the other lower limb is denoted as
“step length’’.
The distance between the heel strike of one lower limb
to the next heel strike of the same lower limb is
denoted as “ stride length”.
The time taken for completion of heel strike of one
lower limb to the next heel strike of same lower limb (
i.e. completion of one gait cycle) is denoted as “ stride
duration”.
16.
17.
18. In normal walking Linear distance between the mid
points of the two feet varies from 5 to 10 cm and is
known as “width of base support”.
“Cadence” is the number of steps taken per minute
which varies on several factors mainly the step length,
speed of walking, sex, body built, obesity, surface on
which walking is done, etc.
Stance time:
It is the amount of time that elapses during the stance
phase of one extremity in a gait cycle.
Single-support time:
It is the amount of time that elapses during the period
when only one extremity is on the supporting surface in
a gait cycle.
19. Double-support time:
During normal gait, for a moment, the two lower
extremities are in simultaneous contact with the
ground.
This happen between push-off and toe-off on one side
and between heal strike and foot flat on the
contralateral side.
During this period, both legs support the body weight,
and this is known as “double support”.
The period of this double support is inversely
proportional to the cadence of the gait.
22. There are numerous causes of abnormal gait.
There can be great variation depending upon the
severity of the problem.
If a muscle is weak, how weak is it?
If joint motion is limited, how limited is it?
In ‘limping’ the patient avoids weight bearing on the
affected side as far as possible (diminished stance
phase).
Limping denotes a painful condition on the affected
side.
In lurch, the patient prolongs the stance phase to
improve the stability.
Lurching denotes variable failure of abduction
mechanism.
23. Abnormality in gait may be
caused by
1. Pain
2. Joint muscle range-of-motion (ROM) limitation
3. Muscular weakness/paralysis
4. Neurological involvement (UMNL/ LMNL)
5. Leg length discrepancy
24. Types of abnormal gait
Due to pain –
Antalgic or limping gait – (Psoatic Gait)
Due to neurological disturbance –
Muscular paralysis – both
• Spastic (Circumduction Gait, Scissoring Gait, Dragging or Paralytic
Gait, Robotic Gait[Quadriplegic]) and
• Flaccid (Lurching Gait, Waddling Gait, Gluteus Maximus Gait,
Quadriceps Gait, Foot Drop or Stepping Gait,)
Cerebellar dysfunction (Ataxic Gait)
Loss of kinesthetics sensation (Stamping Gait)
Basal ganglia dysfunction (Festinating Gait)
25. Due to abnormal deformities –
Equinus gait
Equino-varous gait
Calcaneal gait
Knock & bow knee gait
Genu-recurvatum gait
Due to Leg Length Discrepancy (LLD) –
Equinus gait
26. ANTALGIC GAIT-PAINFUL GAIT:
Due to pain anywhere
from foot to hip, the
patient avoids bearing
weight on the affected
limb.
Reduced stance phase,
shortened step length,
shortened stride length,
shortened reciprocal arm
swing, increased velocity
of steps.
27. SCISSORING GAIT
One leg crosses directly over the other with each step
like crossing the blades of a scissor.
It results from spasticity of bilateral adductor muscle of
hip.
Example: cerebral diplegia
28. IN –TOEING GAIT
It usually results due to metatarsus adductus, tibial
bowing with tibial torsion or persistent femoral
anteversion.
Usually resolves by 8 years of age.
29. OUT-TOEING GAIT
The normal range for out-toeing is from 0 to 30*.
In most infants/toddlers this out-toeing resolves
spontaneously.
When it associated with lateral tibial torsion, it can
become worse with growth and may need surgical
correction.
30. HIGH STEPPING (STEPPAGE) OR
FOOT-DROP GAIT; EQUINUS GAIT
During the heel strike
attempt, the toes drop on
the ground first (due to
foot drop). To avoid this
and to clear the ground,
the patient flexes the hip
and knee excessively,
raises the foot and slap it
on the floor forcibly.
In few cases the patient
starts walking with
dragging the toes on the
ground without making
any attempt to flex the
hip and the knee and raise
the foot to clear the
ground- dragging gait.
31. TOE WALKING GAIT
By the age of 3 years heel strike pattern of gait must be
established.
If toe walking is persisting beyond 3 years, it s/b taken
as abnormal and pathology s/b searched/investigated
for.
Usual causes of persistent ( beyond 3 year) toe-walking
are:
1. Cerebral palsy- spastic diplegia
2. Muscular dystrophies
3. Residual polio deformities
4. Post burn contractures
5. Post infective ( in calf muscles / regions) contracture
6. Spinal cord tumours
7. Idiopathic- it is the most common.
32.
33. SPASTIC GAIT (HEMIPLEGIC GAIT
OR CIRCUMDUCTION GAIT)
Here the spastic muscles
do not allow the hip and
knee to be flexed enough
for the foot to clear the
ground.
So the person rotates the
hip sideways during the
swing phase and places
the foot in flattened
manner or places the toes
first before heel strike.
34. Gradually due to
contracture of the planter
flexures, heel strike can
not be possible.
On the affected side, the
upper limb is usually
flexed.
35. HELICOPOD GAIT
A gait in which legs and feet are thrown in half circles
as in hemiplegia.
36. LATHYRIATIC GAIT
In lathyriasis there is a combination of spasticity,
hyperabduction and dragging of lower limb elements in
gait
37. WADDLING GAIT OR DUCK
GAIT
When there is disturbance in the abduction mechanism of
the hip, there is increased lordosis.
While walking the body sways from side to side on a wide
base. Therefore, the patient lurches on both sides while
walking like a duck.
Examples:
1. In b/l congenital dislocation of hip
2. Osteomalacia
3. Pregnancy
4. Myopathy
5. Paralysis of abductors of hips
38.
39. TRENDELENBURG’S GAIT
It may be U/L or B/L.
B/L Trendelenburg’s Gait
is almost like the
waddling gait.
When unilateral patient
lurches on the affected
side and the pelvis drops
on the opposite side of
hip.
Examples: CDH, fracture
of femoral neck, polio
paralysis.
40. DRUNKERS OR REELING GAIT
Here the patient tends to
walk irregularly on a wide
base, swinging sideways
without stability and
balance with tendency of
falling with each step (
seen in cerebellar
incoordination, or in
drunken states).
41. FESTINANT GAIT OR FESTINATING
GAIT OR SHORT SHUFFLING GAIT
Due to rigidity of muscles the patient adopts the
stooping posture (flexed neck, trunk, hip & knee), in
which the centre of gravity falls anteriorly.
Here the patient, with stooping body, is propelled
forward quickly in successions as if trying to catch up
with the centre of gravity.
Examples : parkinsonism, Wilson’s disease, cerebral
atherosclerosis.
42.
43. STAMPING GAIT
Occurs in sensory ataxia, e.g. tabes dorsalis,
syringomyelia, DM, leprosy.
The patient raises his feet abnormally high and jerk
them forward to strike the ground slowly with a stamp
due to lack of kinesthetics.
It look like space walk.
44. KNOCK KNEE GAIT
While walking, the patient flexes the hips slightly, the
knee points appose each other, and the ankle and feet
are kept apart with tendency of toe-in.
45. GENU RECURVATUM GAIT
In paralysis of the hamstring muscles (e.g. in polio) the
knee goes in hyperextension while transmitting weight
in the midstance phase.
46. CALCANEAL GAIT
Result from paralysis plantar flexors causing dorsiflexor
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 & the knee
47. QUADRICEPS GAIT
Quadriceps action is needed during 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.
Compensation:
With quadriceps weakness, the individual may lean
forward over the quadriceps at the early part of stance
phase, as weight is being shifted on to the stance leg.
Normally, the line of force falls behind the knee, requiring
quadriceps action to keep the knee from buckling.
By leaning forward at the hip, the COG is shifted forward
& the line of force now falls in front of the knee.
This will force the knee backward into extension.
48. Another compensatory
manoeuvre to use is the
hip extensors & ankle
plantar flexors in a closed
chain action to pull the
knee into extension at
heel strike (initial
contact).
In addition, the person
may physically push on
the anterior thigh during
stance phase, holding the
knee in extension.
50. GLUTEUS MAXIMUS GAIT
The gluteus maximus act 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 backward-forward movement of
the trunk.
