Observational Gait

Analysis

Identifying Key Events in the Gait Cycle

 Normal Gait
Four objectives must be accomplished for normal
gait to occur.
1. Leg supports body weight without collapsing
2. Balanced maintained (statically &
dynamically) during single support phase
3. Swing leg advance to take over supporting
role
4. Sufficient power for necessary limb
movements and trunk advancement
 Effectiveness Of Normal Gait
Depends on free joint mobility &
muscle action

Pathological conditions of:

muscle
bone
joints
sensory nervous system
central motor control
cardiopulmonary system

Alters mode and efficiency of

gait
During Normal Gait Cycle

Joints are:
• free to move
• possess optimal alignment
• depends on…
– fibrous tissue mobility
– articular cartilage smoothness
*Evaluated during static biomechanical examination
-also examine: plantar lesions, soft tissue abnormalities
 Keep In Mind...
• Step
• Stride
• Cadence
• Gait Cycle
Abnormal or subtle change in gait
– movement is forced due to weakness spasticity or
deformity
or
– movement is a compensation to correct for some other
problem which needs to be identified
Requirements for Observational Gait
Analysis
• Suitable site
– straight, level walkway
(length & width)
– line of progression
– lighting
• Patient attire
• Treadmill and video
• Observe
– posterior, anterior, lateral
– barefoot vs. wearing shoes
– with & without orthotics
 Observational Gait Analysis
Event: Head tilt at heel strike
Normal: Vertical Position
Significance of Deviation
• Tilts to short or long limb
• Tilts towards the raised shoulder
• Muscle tightness
• Habit
 Observational Gait Analysis
Event: Shoulder position during stance
Normal: Equal
Significance of Deviation
Shoulder drop due to
– Scolosis
– Short or long limb
– Trauma
– Occupational
 Observational Gait Analysis
Event: Arm swing during stance
Normal: Equal active arm swing
Significance of Deviation
No arm swing
– Need to stabilize the trunk
– Tight erect posture
Unilateral arm swing
– Greater arm swing on the side of
the short leg
– Limitation of motion in the opposite hip
– Occupational
 Evaluation of Short Leg
Palpate pelvic crest ASIS and PSIS
• Level the pelvic crest with know
thickness of material under short
side
 Observational Gait Analysis
Event: Pelvic hike in swing
Normal: None
Significance of Deviation
Used to assist ground
clearance if foot drop is
present
 Observational Gait Analysis
Event: Pelvic drop of opposite side during
stance
Normal: None
Significance of Deviation
If present:
• Weak hip abductors
• Tight hip adductors
 Observational Gait Analysis
Event: Pelvic drop of same
side in swing
Normal: None
Significance of Deviation
If present suspect:
• Opposite side hip abductor
weakness
• Loading a short limb
• Scolosis
 Observational Gait Analysis
Event: External hip rotation
Normal: Terminal stance and into swing
Significance of Deviation
Increased by:
• Muscle problem – gluteus maximus
• Foot fault contact – retroversion
• Compensation
• Excessive supination at contact
 Observational Gait Analysis
Event: Internal hip rotation
Normal: Contact into midstance
Significance of Deviation
Increased by:
• Tight medial musculature
• Foot contact fault – Anteversion
• Compensation
• Excessive pronation into propulsion
 Observational Gait Analysis
Event: Knee extension in stance
Normal: Fully extends in midstance
Significance of Deviation
If excessive consider:
Compensation for equinus
Weak quadriceps
Pain
 Observational Gait Analysis
Event: Knee flexion in stance
Normal: After contact and
midswing
Significance of Deviation
If excessive in stance or swing:
Hamstring contracture
Soleus weakness (stance only)
Quadriceps weakness (swing
only)
 Observational Gait Analysis
Event: Transverse plane position
of knee at end of contact
Normal: 3-5 internally rotated
Significance of Deviation
Internal:
• Internal femoral torsion or position
• Spastic or tight medial musculature
 Observational Gait Analysis
Event: Transverse plane position of knee
at end of contact
Normal: 3-5° internally rotated
Significance of Deviation
External:
• External femoral torsion or position
• Spastic or tight lateral musculature
 Observational Gait Analysis
Event: Frontal plane position
of the knee
Normal: Vertical +/- 2°
Significance of Deviation
Bow leg
• Coxa valga- genu varum
• Pediatric developmental
Knock Knee
• Coxa vara- genu valgum
• Pediatric developmental
 Observational Gait Analysis
Event: Frontal plane position of the tibia
Normal: Vertical +/- 2°
Significance of Deviation
• Tibial varum
• Blount’s disease
• Rickets
 Observational Gait Analysis
Event: Frontal plane position of the calcaneus
at heel strike
Normal: 2 - 4° inverted
Significance of Deviation
Excessive varus due to:
• Tibia varum
• Cavus foot type
• Plantarflexed 1st ray
• Narrow base of gait
• Abducted gait angle
 Sounds of Heel Strike

Listen…pounding?
If excessive pounding this will indicate
lack of shock absorption
Look for shock waves up the leg
 Observational Gait Analysis
Event: Frontal plane position of the calcaneus at
heel strike
Normal: 2 - 4° inverted
Significance of Deviation
Vertical or valgus due to:
• Genu valgum
• Calcaneal valgum
• Internal femoral torsion
• Internal tibial torsion
• Weak anterior group
• Inability to resupinate
Navicular Position- Sagittal View
• Pronation - talar head adducts against
navicular, decreasing distance from ground
• Supination - talar head abducts, increasing
distance from ground
• Can be related to Medial longitudinal arch
angle
 Observational Gait Analysis
Event: Angle of gait during stance phase
Normal: 10-15 ° abducted
Significance of Deviation
Abducted gait due to:
– External hip rotation
– External tibial rotation
– Fully compensated MTJ
– Pronated foot at heel off
 Observational Gait Analysis
Event: Angle of gait during stance phase
Normal: 10-15 ° abducted
Significance of Deviation
Adducted gait due to:
– Internal hip rotation
– Internal tibial torsion
– Tight medial hamstring
– Metatarsus adductus
 Observational Gait Analysis
Event: Base of gait during the stance
phase
Normal: 4” in width between subsequent
heel strike
Significance of Deviation
Narrow base due to:
– Tibia varum
– Increase in cadence, running, and jogging
 Observational Gait Analysis
Event: Base of gait during the stance
phase
Normal: 4” in width between subsequent heel
strike
Significance of Deviation
Broad base due to:
– Genu valgum
– Instability of the trunk
– Pediatric
– Geriatric
 Observational Gait Analysis
MTJ
– Midstance & propulsion - key for foot stability

Metatarsal heads
– FFL- anterior view - 5th met. head contacts first,
followed in sequence by the others
– Propulsion - reverse - 5th leaves first
• 1st MPJ - lateral view - df
TOE POSITION
– contact - dorsiflexion
– midstance - plantargrade
 Observational Gait Analysis
Event: Time of heel lift
Normal: 60-70% of stance phase, when
opposite limb has passed the
support limb
Significance of Deviation
Premature heel lift due to:
– Short or spastic posterior group, ankle block
– Associated with the limited midtarsal ROM
 Observational Gait Analysis
Event: Time of heel lift
Normal: 60-70% of stance phase,
when opposite limb has
passed the support limb
Significance of Deviation
Delayed heel lift due to:
– Moderate to severe MTJ
compensation
– Short stride
 Observational Gait Analysis
Event: Frontal plane motion of the foot to the
support surface during propulsion
Normal: Lateral side of the foot raises
earlier than medial side
Significance of Deviation
Inverted gait due to:
– Forefoot varus
– Forefoot valgus
– Rigid plantarflexed 1st ray
– Functional hallux limitus
– Adducted gait angle
 Observational Gait Analysis
Event: Frontal plane motion of the
calcaneus at heel lift
Normal: Vertical moving into inversion
Significance of Deviation
Vertical or valgus
– Pronated STJ
 Observational Gait Analysis
Event: Direction of weight flow through
hallux at toe off
Normal: moves through the long axis of the
hallux
Significance of Deviation
Medial side of hallux due to:
– Pronated STJ and MTJ
– Abducted gait
– FHL
– Hallux rigidus