March 2015

GAIT
• Described as a translatory progression of the body as a whole, produced by coordinated, rotatory movements of body
segments
• Alternating movements of the lower extremities essentially support and carry along the HAT
• HAT (75%) = head & arms (25%) + trunk (50%)

FUNDAMENTAL PURPOSES / MAJOR TASKS OF GAIT

1) Maintenance of support of the HAT, that is, preventing collapse of the lower limb
2) Maintenance of upright posture & balance of the body
3) Control of the foot trajectory to achieve safe ground clearance & a gentle heel or toe landing
4) Generation of mechanical energy to maintain the present forward velocity or to increase forward velocity
5) Absorption of mechanical energy for shock absorption & stability or to decrease the forward velocity of the body
Subtasks of Gait
- Gait initiation & termination
- Stair-climbing
- Turning
- Obstacle crossing
- Negotiating a raised surface

Three Main Tasks in walking (according to the Rancho Los Amigos National Rehabilitation Centre)
- Weight Acceptance (WA): initial contact & loading response
- Single limb support: ambulation is most precarious
- Swing limb advancement: terminal stance & preswing
- Provides propulsive forces to move limb forward
- Swing phase: sufficient clearance of the foot from the floor

Traditional - describes components of gait cycle by naming the critical action associated
within each phase

Rancho Los Amigos - emphasizes functional task associated within each phase

PHASES OF GAIT CYCLE

Gait cycle - spans two successive events of the same limb
• Stance phase - 60% of gait cycle
- part of the foot in contact with the floor
• Swing phase - 40% of gait cycle
- foot is not in contact with he floor
• Two periods of double support - approx. value 11% for each limb x 2 = 22%
• Double support occurs as one leg is beginning its stance phase & the other leg is ending its stance phase
• Body is supported by only one limb for nearly 80% of the cycle

TRADITIONAL (STANCE PHASE) RANCHO LOS AMIGOS

HEEL Heel contacts the INITIAL Refers to the instant the foot of the leading extremity strikes
STRIKE ground CONTACT the ground

Beginning: Just after initial contact when body weight is

Plantar surface of the
LOADING being transferred onto leg & entire foot makes contact with
FOOT FLAT foot in contact with
RESPONSE the ground
ground
Ending: opposite foot leaves the ground

Point at which the body

Beginning: Opposite foot leaves the ground
MIDSTANCE passes over the weight- MIDSTANCE
Ending: Body is directly over the weight bearing limb
bearing leg

Heel leaves the ground,

Beginning: As the heel of weight bearing leg rises
while ball of the foot & TERMINAL
HEEL-OFF Ending: Initial contact of the opposite foot. The body has
toes remain in contact STANCE
moved in front of the weight-bearing leg
with the ground

Beginning: Initial contact and weight shifted onto the

Toes leave the ground, opposite leg
TOE-OFF PRE-SWING
ending stance phase Ending: Just before toes of weight bearing leg leave the
ground

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TRADITIONAL (SWING PHASE) RANCHO LOS AMIGOS

Beginning: The toes leave the ground

The swing leg begins to INITIAL
ACCELERATION Ending: The swing foot is opposite the weight-bearing
move forward SWING
foot and the knee is in maximum flexion

Beginning: The swing foot is opposite the WB foot

the swing (NWB) leg is
MIDSWING MIDSWING Ending: The swing leg has moved in front of the body
directly under the body
and the tibia is in a vertical position

The leg is slowing down in TERMINAL Beginning: The tibia is in a vertical position
DECELERATION
preparation for heel strike SWING Ending: Just prior to initial contact

Activity Key Points to Observe

Heel strike (T) • Stance phase begins
Initial Contact (RLA) • Task of weight acceptance
begins
• Double leg support begins
• Body at lowest point in cycle
• Head & trunk are upright throughout the cycle
• Ankle DF to neutral
• Knee extended
• Hip flexed
• Leg in front of the body
• Pelvis rotated forward ~ ipsilateral side
• Ipsilateral arm back, contralateral arm forward

Foot Flat (T) • Weight shift onto stance leg • Ankle PF putting foot on ground
Loading Response continues • Knee partially flexed absorbing shock
(RLA) • Double leg support ends • Hip moving into extension
• Body catching up with e.g.
• Ipsilateral arm swinging forward

Midstance • Body at highest point in cycle • Ankle slightly DF

(T & RLA) • Single leg support begins • Knee & hip continue extending
• Body passes over right foot
• Pelvis in neutral position
• Both arms parallel with body

Heel-of (T) • Body moves ahead of foot • Ankle slightly DF, then begins to PF
Terminal Stance • Single leg support ends • Knee extending then beginning slight flexion
(RLA) • Hop hyperextending
• Body ahead of stance leg
• Pelvis rotating back ~ ipsilateral side
• Ipsilateral arm swinging forward

Toe-ff (T) • Task of leg advancement begins • Ankle PF

Preswing (RLA) • Double leg support begins and • Knee & hip are flexion
ends • Lateral pelvic tilt on right side
• Ipsilateral arm forward

Acceleration (T) • Swing phase (NWB) begins • Ankle beginning to DF

Initial swing (RLA) • Single leg support beings on • Knee & hip continue flexing
contralateral side • Leg is behind body but moving forward
• Pelvis beginning to rotate forward
• Ipsilateral arm swinging backward

Midswing • Leg shortens to clear floor • Ankle FG

(T & RLA) • Single leg support on
contralateral side continues
• Knee at maximum flexion & begins to extend
• Hip at maximum flexion
• Leg passing under and moving in front of body
• Pelvis in neutral position
• Arms parallel with body & moving in opposite directions

Deceleration (T) • Leg advancement task ends • Ankle continuing in dorsiflexion

Terminal Swing • Single support ends • Knee extended
(RLA) • Hip flexed
• Leg ahead of body
• Pelvis rotated forward ~ ipsilateral side
• Ipsilateral arm back, contralateral arm forward

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GAIT TERMINOLOGIES
Temporal Variables Distance Variables
Stance time
- the amount of time that ellipses • Stance time • Stride & Step time • Stride length
• Single-limb support time • Cadence • Step length
during the stance phase of one
• Double-limb support time • Speed • Step width
extremity in a gait cycle
• Swing time • Degree of toe-out
Single support time
- the amount of time that ellipses during the period when only one extremity is on the supporting surface in a gait
cycle
Double support time
- the amount of time spent with both feet on the ground during one gait cycle
- increased in elderly persons & in those with balance disorders
- decreases as the speed of walking increases
Stride length
- the rear distance between two successive events that are accomplished by the same lower extremity during gait
- two successive heel strikes are usually used
- decreases in elderly persons
- increases as the speed of gait increases
Stride duration
- the amount of time between it takes to accomplish one stride
- synonymous with gait cycle
- Normal adult: 1 stride last approx. 1 second
Step length
- the linear distance between two successive points of contact of opposite extremities
- measured from heel strike on one extremity to the heel strike of the opposite extremity
- the more equal the step length, the more symmetrical the gait
Step duration
- refers to the amount of time spent during a single step
- expressed in second per step
- Presence of pain: decreased on affected side & increased on unaffected/less painful side
Cadence
- number of steps taken by a person per unit of time (step frequency)
- shorter step length = increased cadence
- >180 steps per minute - period of double support disappear = RUNNING commences
- Men 110 steps per minute
- Women 116 steps per minute
Walking Velocity/Walking Speed
- the rate of linear forward motion of the body measured in meters per second, copper second, or miles per hour
Step width
- width of the walking base
- found by measuring the linear distance bet. the midpoint of the heel of one foot and the same point on other foot
- increases when there is an increased demand for side-to-side stability (elderly persons & small children)
- COG in toddlers & young children are higher than in adults
Degree of toe-out
- represents the angle of foot placement (FP) and may be found by measuring the angle formed by each foot’s
line of progression and a line intersecting the centre of the heel and the second toe
- decreases as the speed of walking increases
- 7o in men
Power generation
- accomplished when muscles shorten (concentric contraction)
Power absorption
- accomplished when muscles perform a lengthening contraction (eccentric contraction)
Ground Reaction Forces (GRF)
- forces being applied to the foot by the ground when a person takes a step
- equal in size (magnitude) but opposite in direction to the forces applied to the ground by the foot
- dependent on density of ground/surface
- the more equal the GRF if the ground/surface is level and solid
Center of Pressure
- point where the resultant of all the floor-foot forces act
Internal Moments - generated by the muscles, joint capsules, and ligaments
External Moments - from external forces like GRF & gravity

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DETERMINANTS OF GAIT

Pelvic Tilt
- 5o midstance
Knee Flexion
- 10o-15o flexion in midstance
Pelvic Rotation
- 8o = 4o forward + 4o backward (preswing & terminal stance)
- elevates COG
Hip-Knee-Ankle-Foot Interaction
- Heel strike to loading response
- hip & knee flex ->
- ankle PF -> lowering/shortening of lower extremity -> controlling rise of COG
- foot pronation ->
- After midstance
- hip & knee extend ->
- ankle PF -> lengthening of lower extremity -> lowering of COG
- foot supination ->
- to compensate for imbalance -> more muscles are recruited/contract -> more energy expenditure
Pelvic Shift
- 5 cm - 10 cm -> physiologic knee valgus

HIP, KNEE, & ANKLE ROM NEEDED FOR NORMAL WALKING

• Hip ROM: approximately 20o extension to 20o flexion
• Knee ROM: from straight 0o to 60o flexion
• Ankle ROM: from 25o PF to 7o DF
• If these joint ranges are not available, a gait pattern would be expected to show considerable deviation from the norm

ADDITIONAL DETERMINANTS OF GAIT

• Vertical displacement of the COG
- normal amount of sic placement is approximately 2 inches
• Horizontal displacement of the COG
- Side-to-side displacements usually about 2 inches
- This displacement is greater during the single support phase - midstance
• Width of walking base
- Lines drawn though the successive midpoints of heel contact (initial contact)
- This distance would rang from 2-4 inches
• Lateral Pelvic Tilt
- This occurs when weight is taken off the leg at toe-off (preswing)

GAIT ANALYSIS

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Initial Loading Midstance Terminal Preswing Initial Midswing Terminal

Contact Response Stance Swing Swing

HIP 30o F 15o F 0 10 20 5 25 30

EXTENSION FLEXION

A A P P P
GRF (FLEX) (FLEX) (EXTEND) (EXTEND) (EXTEND)

KNEE 0o E 20o F 15o F 0o E 40o F 60o F 30o F 0o E

FLEXION EXTENSION FLEXION EXTENSION

A P A A P
GRF (EXTEND) (FLEX) (EXTEND) (EXTEND) (FLEX)

ANKLE 0o 15 oPF 5o DF 15o DF 20o PF 0o 0o 0o

PF DF PF DF

P P A A A
GRF (PF) (PF) (DF) (DF) (DF)
MUSCLES

• control movement when in the same motion with GRF

• counter movement when in the opposite motion with GRF
HIP
• Gluteus minimus
- towards midstance -> decrease activity
- from midstance -> increase activity
• Adductors
- to control contralateral leg after double support
- control abductors -> hip dropping is gravity assisted (5o)
- swing phase -> controlled by hip rotators
KNEE
• Pes Anserinus
- semimembranosus, gracilis, sartorius
- insert at anteromedial knee (goose goot)
- isometric contraction/action
FOOT
• Loose pack - PF, pronation -> accommodation to the surface
• Close pack - DF, supination -> make foot solid on push off -> gain more momentum
• supinated form swing (but neutral) until initial contact -> solid base to land on the surface

TRUNK -> Flex hip - lumbar rotate opposite (erector spinae on same side)
UPPER EXTREMITY -> Bring arm back - abductor, extensors ( no need for active flexors)

STAIR CLIMBING
• Greater ROM & more points of instability
• Linger stance phase 64
- Weight acceptance
- Pull up -> phase of instability
- Weight continuance
• Foot clearance
• Foot placement - toe first - start with a flexible foot
• Climb up -> mostly concentric
• Climb down -> mostly eccentric

RUNNING
• no more double support
• 100-125 hip flexion
• increase GRF = increase muscle control
AGE-RELATED GAIT PATTERNS
• Walking patterns of young children and elderly adults have characteristic differences from the walking pattern of
younger adults

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Young children
• Tend to walk with a wider walking base
• Cadence is faster
• Stride length is shorter
• Initial contact with the floor is with a flat foot, as opposed to heel strike
• Greater horizontal displacement - walk with a wider base
• Tend to take more steps that are shorter and choppy in a faster period of time
• Little or no reciprocal arm swing
*developing children have gait deviation -> normal due to underdeveloped system

Elderly individuals
• Tend to walk slower, spending more time in stance phase
• Linger periods of double support
• Take shorter steps, thus, vertical displacement is low
• Greater horizontal displacement - walk with a wider base
• Fewer, or slower, automatic movements - a factor increasing the chance of stumbling or falling

ABNORMAL (ATYPICAL) GAIT

GLUTEUS MAXIMUS GAIT

• Inferior gluteal nerve is injured
• Trunk quickly shift posteriorly at heel strike (initial contact)
• Body’s COG will shift posteriorly over the gluteus maximus moving the line of force posterior to the hip joints
• “rocking horse” gait
• Posterior lurching

GLUTEUS MEDIUS GAIT

• Superior gluteal nerve is injured
• Individual shifts the trunk over the affected side during stance phase
• Trendelenburg gait
• Lateral lurching
• Bilateral weakness -> side to side movement resulting to Wobbling Gait or “Chorus Girl Gait”

Gait resulting from QUADRICEPS WEAKNESS/PARALYSIS

• Individual may lean the body forward over the quadriceps muscles at the early part of stance phase
• Hip extensors and ankle plantar flexors pull the knee into extension in a closed-chain action at heel strike (initial
contact)
• The person may primarily push on the anterior thigh, during stance phase, holding the knee in extension

EQUINUS GAIT
• common in Talipes Equinovarus (clubfoot)
• Weight bearing is primarily on the dorsolateral or lateral edge of the foot
• Pelvis & femur are laterally rotated to compensate for tibial & foot medial rotation
• Pt. may walk on toes (Digitigrade Gait)
• Unguligrade - tiptoe walking

STEPPAGE (stance gait) or DROP FOOT GAIT (swing phase)

• Due to weak or paralysed dorsiflexors
• Foot slap -> weak TA & pretibial dorsiflexors
• Foot drop -> paralysed dorsiflexors -> increased hip flexors
• Patient lifts the knee to avoid dragging of the toes
• At initial contact -> foot slaps on ground (loss of control of DF muscles)

GENU RECURVATUM GAIT

• Knee hyperextension gait
• Weak knee extensors
• Polio

WADDLING GAIT
• Commonly seen with muscular and other types of dystrophies because there is diffuse weakness of many muscle
groups
• Person stands with the shoulders behind the hips
• Increased lumbar lordosis, pelvic instability and Trendelenburg gait
• Little or no reciprocal pelvis and trunk rotation occur

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HIP FLEXION CONTRACTURE
• Involved hip is unable to go into hip extension and hyperextension during the midstance and push-of phase
• To compensate, the person will commonly assume the salutation or greeting position
• The involved leg may also simultaneously flex the knee when it normally would be extended

VAULTING GAIT
• Contractures of the knee in extension makes the affected extremity unable to shorten during the swing phase
• The person must rise up on the toes of the uninvolved leg in a vaulting gait
• Hip hiking on the affected side
• Circumduct the affected extremity during swing phase

HEMIPLEGIC/NEUROGENIC/FLACCID GAIT
• Extension synergy in the involved lower extremity
• Hip goes into extension, adduction, and medial rotation
• Knee is in extension
• Ankle plantar flexion and inversion (equinovarus)
• Involved upper extremity may typically be in a flexion synergy
• No reciprocal arm swing
• Stoke Gait
PARKINSONIAN GAIT
• Posture of the lower extremities & trunk tends to be flexed
• Shuffling or short rapid steps (march a petits pas)
• Elbows are partially flexed another is little or no reciprocal arm swing
• Stride length is greatly diminished and the forward heel does not swing beyond the rear foot
• Arms are held stiffly & do not have normal movement
• During gait, patient may lean forward & walk progressively faster

ANTALGIC GAIT
• Self-Protective & is the result of injury to the pelvis, hip, knee, ankle & foot
• Avoidance of WB on the affected side -> shortening the stance phase
• Swing phase of the good leg is decreased
• Rapid and shortened step length of the uninvolved side 

Painful region is supported by the hand and the other arm is outstretched

ARTHOGENIC GAIT
• Results from stiffness, laxity, or deformity that is painful or not
• Elevated pelvis, leg circumlocution on the involved & exaggerated plantarflexion of the opposite limb

ATAXIC GAIT
• Has poor sensation or lacks of muscle coordination (like when drunk)
• Cerebellar ataxia -> poor balance (stagger or lurch), wide base, & all movements are exaggerated
• Sensory Ataxia -> feet will slap the ground

CONTRACTURE GAIT
• Exhibit contracture
• Hip flexion contracture -> increased lumber lordosis and extension of the trunk combined with knee flexion to get the
foot on the ground
• Knee flexion contracture -> excessive ankle dorsiflexion from late swing phase to early stance on the uninvolved leg
and early heel rise on the involved side in terminal stance

PLANTARFLEXOR GAIT
• Loss of plantar flexors -> decrease or absence of push-off
• Stance phase & length are decreased

PSOATIC GAIT
• Weakness of posts major muscle; seen in patients with conditions affecting the hip (Legg-Calve-Perthes Disease)
• Manifested by FABER of the hip

SHORT LEG GAIT

• Painless osteogenic gait
• Pt. demonstrate a lateral shift to the affected side with pelvis tilting down
• Unaffected limb demonstrated excessive flexion or hip hiking

SCISSORS GAIT (NEUROGENIC or SPASTIC GAIT)

• Result from spastic paralysis of the hip adductor muscles
• Seen in spastic paraplegics
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