CHAPTER 11

ANALYSIS OF PATHOLOGICAL GAIT

By: Rica Mae R. Alimario
INTRODUCTION

 Gait analysis requires detailed knowledge of normal locomotion,

biomechanics, pathomechanics, and orthotic fitting and alignment. With this
foundation significant information about the px and the orthosis can be
obtained by careful observation and consideration of the walking.
 Walking pattern and characteristics may be analyzed by variety of methods.
Footprints may be recorded to obtain data of stride length, width of walking
base, symmetry of gait, and area of the foot in contact with the walking
surface.
INTRODUCTION

 Precise and detailed kinematic date can be obtained by using photographic

methods, video recording, electrogoniometry, while data concerning forces
and accelerations can be obtained by using force plates, strain gauges, and
acelerometers.
 The most convenient and practical procedures for gait analysis involves
careful observation by experienced clinicians who can identify gait deviations
and relate them to characteristics of normal gait.
GAIT DEVIATION
LATERAL TRUNK BENDING
Phase of gait: stance phase, primarily from foot-flat, until just after midstance/
Description: px leans toward the involved side when weight is borne on that side. If lateral trunk bending is
bilateral the px waddles.
How to observe: from behind or in front of the px.
Possible causes:
1. hip abductor weakness.

2. Hip dislocation, coxa vara, and slipped capital femoral apiphysis.

3. Hip pain

4. Perineal pressure

5. Involved limb relatively shorter

6. Compensation for abducted gait.

GAIT DEVIATION

HIP HIKING
Phase of gait: swing phase
Description: px elevates his pelvis on the affected side by action of the quadratus
lumborum, aided by lateral abdominals. Hiking aids in advancing the involved limb by
allowing increased rotation of the pelvis in the horizontal plane which imparts
increased pendular action to the limb.
How to observe: from behind or in front of the px.
Possible causes: the involved limb either is relatively longer or cannot be shortened at
the appropriate time.
GAIT DEVIATION

1. Increased ipsilateral length

a. Hip flexor or dorsiflexor weakness
b. Persistent extension in swing phase due to hip , knee, or ankle anklyosis or
spasticity
c. Worn plantar stop or weak spring in dorsiflexor spring assist.
2. Contralateral shortness
a. Hip flexion or knee flexion contracture
b. Skeletal shortening
3. Hamstring weakness, in slow walking.
GAIT DEVIATION
INTERNAL OR EXTERNAL LIMB ROTATION
Phase of gait: swing and stance phase
Description: excessive or inadequate rotation, either internal or external of the entire limb.
How to observe: from behind or in front of the px.
Possible causes:
1. Internal rotation
a. Bicep femoris weakness

b. spasticity

2. External roation
a. Quadriceps weakness

b. Inner hamstring weakness

c. spasticity
GAIT DEVIATION
CIRCUMDUCTION
Phase of gait: swing phase
Description: the limb follows a laterally curved path as it swings through
How to observe: from behind the px
Possible causes: in all stances the affected leg is functionally longer
1. Spasticity
2. Hip flexor weakness
3. Hamstring paralysis
4. Knee or ankle ankyloses
5. Dorsiflexors weakness
6. Plantar flexion contracture
7. Orthothic plantar flexion stop set in excessive plantar flexion, or weak spring n the dorsiflexor spring assist lets
the ankle drop into plantar flexion.
GAIT DEVIATION

Abnormal Walking Base

Phase of gait: swing and stance phase

Description: the space between the heel centers is significantly greater or less than
the normal 2-4 in. a wide base may be accompanied by exaggerated lateral
displacement of the pelvis, lateral trunk bending, or both. Too narrow a base is often
seen with internal limb rotation and excessive knee flexion.

How to observe: from behind the px.

GAIT DEVIATION

Possible causes:
1. Wide base
a. Hip abduction contracture
b. Orthotic hip joint excessively abducted
c. Instability due to fear, proprioceptive deficit, generalized weakness of the lowerlimb, or any combination
thereof.
d. Perineal pain
e. Genu valgum
f. Leg length discrepancy
g. obesity

2. Narrow base
a. Spasticity
b. Orthotic hip joint adducted
c. Genu varum
GAIT DEVIATION

Excessive medial or lateral foot contract

Phase of gait: stance phase
Description: px bears excessive weight on the medial or lateral border of the foot at
any time during stance phase.
How to observe: from behind or in fornt of the px
Possible causes:
1. Medial contract
a. Invertor weakness
b. Eversion contracture
c. Pes valgus
d. Plantar flexion contracture
e. Genu valgum
GAIT DEVIATION

2. Lateral contact
a. Evertor weakness
b. Inversion contracture
c. Plantarflexion contracture
d. Talipes equinovarus
3. Either medial or lateral contact
a. Uneven wear of the shoe heel
b. Insufficient accommodation of the orthosis to tibial torsion, toe in/out, or both.
c. Orthotic ankle joint axis not horizontal.
GAIT DEVIATION
ANTERIOR TRUNK DEVIATION
Phase of gait: from the latter portion of swing until midstance.

Description: px inclines his trunk forward, this maneuver places the center of gravity anterior to the knee’s
axis rotation, thus counteracting any tendency of the knee to flex. He may also put his hand on his thigh to
stabilize the knees.

How to observe: from side of the px.

Possible causes:
1. Quadriceps paralysis combined c weakness of glutes maximus, gastrocnemius, or both.
2. Inadequate or absent knee lock on an above knee orthosis.
GAIT DEVIATION
POSTERIOR TRUNK BENDING

Phase of gait: primarily from heel strike to midstance; may continue until early in swing phase

Description: px hyperextends his upper trunk

How to observe: from the side of the px

Possible causes:

1. Hip extensors weakness

2. Knee ankyloses, spasticity or orthotic knee lock

3. Hip extensor spasticity

GAIT DEVIATION

LORDOSIS
Phase of gait: entire stance phase
Description: the lumbar curvature is exaggerated during weight bearing on the
involved limb. The upper trunk may also displace posteriorly. A static postural lordosis
is not considered a gait deviation unless the curvature increases during walking
How to observe: from the side of the px
Possible causes:
1. Hip flexion comtracture
2. Hip extensor or abdominal weakness
3. Ischial weight bearing orthosis
GAIT DEVIATION
HYPERXTEND KNEE
Phase of gait: between heel strike and heel off
Description: the normal knee does not extend fully during stance phase.
How to observe: fro the side of the px
Possible causes:
1. Quadriceps weakness
2. Capsular ligamentous laxity
3. Quadriceps spasticity
4. Plantar flexion contracture or spasticity
5. Orthotic plantar flexion stop set in excessive plantar flexion
6. Compensation for contralateral hip flexion or knee flexion contracture or skeletal shortening.
GAIT DEVIATION
EXCESSIVE KNEE FLEXION
Phase of gait: anytime during stance phase
Description: px knee may be flexed more than 2o deg. Between heel strike and foot flat, may abruptly flex
after midstance, causing the px to stumble, or may exhibit both alterations.
How to observe: from the side of the px
Possible causes:
1. Knee flexion or hip flexion contracture
2. Insufficient knee extension
3. Uncompensated quadriceps weakness
4. Ankle ankyloses, pes calcaneus, or orthotic plantar stop.
5. Plantar flexor weakness
6. Involved limb relatively longer
7. KAFO improperly aligned in flexion
8. Offset knee joint
GAIT DEVIATION
EXCESSIVE GENU VALGUM OR VARUM
Phase of gait: stance
Description: motion of the knee in the frontal plane normally averages a total of 11 deg. , during one gait
cycle. Relative tibial abduction is normally at its maximum just after heel strike. If frontal plane motion is
considerably more than 11deg., the knee will be subjected to increased stress, and the excessive
angulation will detract from the efficiency and appearance of the subject’s gait.
How to observe: from the front or back of the px
Possible causes:
1. Loss of structural integrity of the knee
2. Mediolateral hamstring or quadriceps power imbalance
3. Calcaneovarus/valgus.
4. Tibial or femoral shaft malalignment.
GAIT DEVIATION
INADEQUATE DRSIFLEXION CONTROL
Phase gait: between heel strike and foot flat; also during swing phase.
Description:
Stance. Forefoot drops to the floor in an uncontrolled, slapping manner at the beginning of stance phase.
Swing. Forefoot falls to clear the floor, dragging. The px may compensate by exaggerated hip and knee flexion. In
spastic px, hip flexion may facilitates reflex dorsiflexion.

How to observe: from the side of the px; also listen for foot slap
Possible causes:
1. Dorsiflexor weakness
2. Worn plantar- flexion stop or weak spring in dorsiflexor spring assist
3. spasticity
GAIT DEVIATION
INSUFFICIENT PUSH OFF
Phase of gait: push off
Description: weight is borne primarily in the heel. The entire foot my leave the floor simultaneously, rather
than rolling from heel off through toe off.
How to observe: from the side of the px
Possible causes:
1. Plantar flexor weakness
2. Rupture of the Achilles tenson
3. Pes calcaneus
4. Metatarsal pain
5. Pes varus or valgus
6. Insufficient weight shift to the involved limb
7. Orthotic plantar flexion stop
8. Worn dorsiflexion stop.
GAIT DEVIATION

VAULTING
Phase of gait: stance phase on the uninvolved limb
Description: the px increases the vertical displacement of his center of gravity by
exaggerated plantar flexion of the stance phase ankle, bobbling up and down as he
walks
How to observe: from behind the px or from the side
Possible causes:
1. In all cases the swing phase limb is relatively longer. Any of the causes discussed previously
in relation to circumduction can also result in vaulting, but the following are particularly
associated with vaulting; hip flexor weakness, hip ankylosed in extension and knee lock.
GAIT DEVIATION

RHYTMIC DISTURBANCE
Phase of gait: swing and stance phase
Description: length of step and period of time spent on the involved limb differ from
that of the contralateral limb or from normal gait.
How to observe: from behind the px and from the side; also, listen for uneven
footsteps.
Possible causes:
1. Pain or fear of falling
2. Neurological deficiency
3. Inequality of leg length
4. Asymmetrical weakness of the lower limbs
5. Use of assistive device.
GAIT DEVIATION

OTHER, INCLUDING ABNORMAL ARM MOTION

Phase gait: swing and stance phase
May include:
1. Abnormal movements, such as movement tremor
2. Abnormal activity or posture of the upper limb. Forceful arm swing, shoulder
abduction, elbow flexion, wrist drop, lack of reciprocal, arm swing, or flailing may be
seen.
3. Abnormal activity of the head and neck. The px may gaze at the floor or to one side
while walking
4. Early fatigue
5. Very slow walking.
COMMON FUNCTIONAL DISORDER

SPASTIC HEMIPLEGIA
- Gait depend upon the severity of the cerebral involvement and the particular
adjustments utilized.
- Px strikes on his heel and forefoot simultaneously or, if spasticity is severe he
contacts only with the ball.
- Later in stance, the hemiplegic cannot regulate the extensor tension initiated by
weight bearing
- During swing phase, inadequate dorsiflexion control is still apparent.
COMMON FUNCTIONAL DISORDER

FLACCID PARALYSIS OF THE QUADRICEPS

-paralytic gait reflects the px inability to stabilize his knee early in stance
-contralateral leg is completing it’s push off
- Swing phase, especially in rapid ambulation, lack of quadriceps prevents the shank
from advancing promptly, allowing it to lag behind the thigh.
- Weakness is more apparent on climbing
- Running is impossible
- Rotating the limb externally also prevents jackknifing
- Px may hyperextend his knee at heel strike before swinging his unaffected leg.
COMMON FUNCTIONAL DISORDER

ARTHRITIS OF THE KNEE

-rheumatoid arthritis alters ambulation as the px respond to pain from hypertrophied
synovia and fluid effusion which distend the joint
- Knee flexion contracture requires additional dorsiflexion to allow heel placement.
- Throughout the stance, the flexed knee requires that the ankle be plantar flexed
don the foot can be reached the floor
- Lateral trunk bending accompanies the relative shortness of the involved, flexed
limb.
- Knee flexion also renders push off inadequate, due to the reduced limb length.
END. THANK YOU.