GAIT

DR. ANKITA KOTHARI

  MPT-2 YEAR
 Gait
Manner or style of walking.
It is the forward propulsion of the body by the lower
extremity with the coordinated rotated movements of the
body segment.

It is the activity,which occurs between the points of the

initial contact of the same extremity two times.

Gait Cycle :-
It consists of two phases.
1) Stance phase : the activity ,which occurs during the
foot having the contact with the ground.
In normal walking ,it contributes 60% of the gait cycle.

2) Swing phase : the activity , which occurs during the

foot when is not having the contact with the ground.
In normal walking , it contributes 40% of the gait
cycle.
Double limb support :-
 This is the period at which both the lower extremities
having contact with the ground.
 It is possible between heel off of the one extremity and
the heel strike or foot flat of another extremity.

Single limb support :-

 This is the period at which single limb contacts the
ground.
 It has seen in the mid stance phase.

Step length :-
 This is the distance between the heel strike of one
lower extremity to the heel strike of another extremity.
Stride length :-
 This is the distance between the heel strike of one
lower extremity to the heel strike of the same lower
extremity once again to the ground.

Step duration :-
 It is the time taken for completion of one step.

Stride duration :-
 It is the time taken for completion of heel strike of one
extremity to the heel strike of the same extremity
again.
 The stride duration and the gait cycle duration are
same.

Cadence :-
It is the no. of steps taken per minute.

Determination of Gait :-
There is the coordinated movement of the trunk,upper
limb,head to render the good gait pattern.
The components are :
1. Lateral pelvic tilt
2. Knee flexion
3. Knee,ankle foot interaction
4. Pelvic forward and backward rotation
5. Physiological valgus of knee

1. Lateral pelvic tilt :-

 During the midstance period the COG reaches
the peak level and the total body is supported
by one lower extremity.
 To reduce the COG level,opposite side,i.e swing
phase pelvic tilts laterally so that the COG
comes little down.

2. Knee flexion :-
 It is the another determinant which helps to
reduce the COG level during the midstance
period.

3. Knee,ankle foot interaction :-

  The knee, ankle-foot interaction prevent the
abrupt hike of the upward displacement of the
COG when the foot passes from the heel strike
to foot flat.
 To reduce that,there is some interaction
between the knee,ankle,foot takes place(knee
flexion,ankle plantar flexion,foot pronation)

4. Forward and backward rotation of pelvis :-

 It occurs in transverse plane and help to
minimize the hyper reduction of the COG.

5. Physiological valgus :-
 To overcome from the reduced BOS by the
physiological valgus,i.e. normally placed
limb,the lateral shifting of the body occurs to
shift the COG from one lower extremity to
another.

Causes for Gait impairment :-

1. Age
2. Sex
3. Occupation
4. Body structure
 5. Clothing,footwear
6. Psychological state of individual
7. Assistive devices

Diseased state :-
1. Neurological gait :-
a) Parkinson gait –
 Shuffling gait/festinant gait/festinating gait
 Patient adopts the flexed posture of
neck,trunk,hip and knee due to the rigidity
of the muscles.
 In this gait,heel strike is absent,so toe strikes
firsthence called as toe-heel gait.

b)Hemiplegic gait –
 The patient rotates the hip sideways during
the swing phase due to the hip flexor
tightness and places the foot in flattened
manner or toe first before heel strike.
 Upper limb is flexed in the affected side.

c) Ataxic gait –
  Cerebellar ataxia :
-Reeling gait or drunker gait.
-Patient sway here and there without
stability and balance.
 Sensory ataxia :
-The patient raises the foot in the air
and stamp on the floor slowly due to
the lack of kinesthetic sensation.

d)Scissoring gait –
 The legs are crossing each other while
walking due to the adductor tightness.
 The knee might may be flexed in the spastic
diplegia is called as ‘couch gait’.

2.Muscular weakness gait :-

a) Gluteus medius gait –
 One side gluteus medius paralysis results in
trendelenburg gait,both the side paralysis
results in duck walking.

b)Trendelenburg gait -
  During the swing phase of one lower extremity
the opposite side hip abductors help to prevent
the tilting of the pelvis of the swinging
extremity.
 Weakness or paralysis of right side gluteus
medius results in pelvic drop over the left side
while going for the swing phase.
 So the patient while walking bends his trunk
towards the paralyzed side i.e. opposite to the
dropping gait.

c) Duck walking gait –

 When both the abductors of the hip paralyzed
the patient bends his trunk laterally towards the
stance phase.
 To prevent the over dropping of the pelvis and
to clear the foot from the ground,this
adjustment made by the patient.

d)Gluteus maximus gait –

 The gluteus maximus causes posterior pelvic
tilting gait and shifting the COG towards the
stance hip.
  While walking forward and backward
movement of the trunk occurs is called as
‘rocking horse gait’.

e) High stepping gait (foot drop gait)-

 During heel strike,due to foot drop the toes
goes and contact the ground first,to avoid this
the patient flexes his hip and raises the foot and
slap on the floor forcibly.
 In some exception case,the patient started
walking with the draggingthe toes on the floor
without flexing hip and raising foot called as toe
‘dragging gait’.
3) Joint or muscular limitation gait :-

a) Toe tip gait –

 Foot remains in plantar flexion due to the
contracture of the plantar flexor or may be due
to paralysis of dorsiflexors so that the patient
walks on the toe tip and the ball of metatarsals.

b)Stiff knee gait –

 If the knee is stiff,the patient hikes his hip and
clears the foot from the floor and swing
 sideways with hip circumduction of abduction
to propel the limb forward to reach the heel
strike.
 This type of gait is called as ‘Circumduction gait
or hip abductor gait’.

4) Leg length discrepancy gait :-

 Also called as ‘equines gait’.
 When the leg length difference goes upto one
and half inch,it can be adjusted with slight
equines position,meanwhile if the shortening
is more than two inch leads to marked pelvic
tilt and equines deformity at the foot.
5) Painful or Antalgic gait :-
 When the patient has pain over the joint of
the lower extremity to avoid to stand on the
involved side.
 So the time taken for the stance phase on the
involved side shortens,and shortened step
length,shortened arm swing,shortened stride
length,increased velocity of steps also can be
noticed.
 The patient limps while transmitting weight
over the involved side so it may be called as
limping gait.