Definition

 Rhythmic, cyclic movement of the limbs in

relation to the trunk resulting in forward
propulsion of the body.
 Gait is your manner, pattern, or style of
walking. An easy walking gait is normal and
healthy, but injury, illness, or muscle weakness
can cause pain or functional mobility loss that
affects your gait
NORMAL GAIT REQUIRES
 Normal functioning of musculoskeletal system of
lower limbs & spine.

 Good sensory feedback from propioceptive sensation

from feet and the joints.

 Visual ,labrinthine sensory inputs & co ordination

add smoothness, rhythm & elegance to the human
gait.
GAIT TERMINOLOGY
➢ Base of support
➢ Step length
➢ Stride length
➢ Gait cycle
➢ Cadence
➢ Walking velocity
➢ Double limb support
➢ Single limb support
➢ Ground reaction force vector
BASIC GAIT TERMS
Base of suppport:
 Distance between a person’s
feet while standing or during
ambulation.
 Provides balance & stability to
maintain erect posture.
 Normally 2-4 inches from
heel to heel.
Step length
 Linear distance along the line
of progression of one foot
travelled during one gait
cycle.

 Approximately 15 inches.
Stride length
 Linear distance in the plane of
progression between
successive point of foot to
floor contact of the same foot.

 Normally 27 – 32 inches.
Gait cycle
 Period of time from one heel strike to next heel strike of
the same limb
Cadence
 It is measured as the number of steps / sec or per
minute.

 Approximately 70 steps per minute.

 It may variable for person to person.

Double limb support
 During normal gait, for a moment , two lower extremities are
in simultaneous contact with the ground.

 During this period, both legs support the body weight.

 Happens between push off & toe off on same side and heel
strike & foot flat on the contra lateral side.
GAIT CYCLE COMPONENTS
1. Stance phase :60% of the gait cycle.
2. Swing phase :40% of the gait cycle.
STANCE PHASE
➢Heel strike

➢Foot flat

➢Midstance

➢Heel off

➢Toe off
Swing PHASE
➢ Acceleration

➢ Midswing

➢ Deceleration
Heel strike phase:

 Beginning of stance phase when

the heel contacts the ground.

 Begins with initial contact & ends

with foot flat

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.

16
Heel off:
 The point following midstance the heel of the

reference extremity leaves the ground.

17
Toe off
 The point following heel off when only the

toe of the reference extremity is in contact

with the ground.
HIP : STANCE PHASE
PHASE NORMAL MOVEMEMT NORMAL MUSCLE ACTION

Heel strike to foot 30* flexion Erector spinae,gluteus

flat maximus,hamstrings.

Foot flat to 30*flexion-(neutral) Gluteus maximus at beginning to

midstance oppose flexion movement, then
activity ceases as moment changes
from flexion to extension

Midstance to heel extension No activity

off

Heel off to toe off 10* hyperextension to neutral Iliopsoas,adductor

magnus,adductor longus
 KNEE : STANCE PHASE
PHASE NORMAL NORMAL MUSCLE ACTION
MOVEMEMT

Heel strike to foot flat 0*-15* flexion Quadriceps contracts initially to hold
knee in extension & then eccentrically
oppose the flexion movement to
controll amount of flexion.

Foot flat to midstance 15*flexion- Quadriceps contract in early part,&

5*extension then no activity is required

Midstance to heel off 5* of flexion-neutral No activity required

Heel off to toe off 0*-40* flexion Quadriceps required to control amount
of knee flexion
ANKLE & FOOT : STANCE PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTIVITY

Heel srike to foot flat 0*-15* plantar flexion Eccentric action of tibialis
anterior oppose plantar flexion
movement

Foot flat to midstance 15*plantar flexio-10*dorsi Gastronemius & soleus act

flexion eccentrically to oppose
dorsiflexion movement &
control tibial advance

Midstance to heel off 10*-15* dorsiflexion same as above

Heel off to toe off 15*dorsiflexion to 20* Gastronemius,soleus,peroneus

plantar flexion brevis & longus,flexor hallusis
longus contract to plantar flex
the foot
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.
Swing phase
Mid-swing:
 It occurs approximately when the reference

extremity passes directly under the body.

 It extends from end of acceleration to the

beginning of deceleration

23
 Swing phase
Deceleration
 It occurs after mid-swing

 when the referance extremity is

decelerating in preparation for heel
strike.

24
 HIP : SWING PHASE
PHASE NORMAL NORMAL MUSCLE ACTION
MOVEMENT

Acceleration to mid 20*-30* flexion Hip flexor activity to initiate swing

swing iliopsoas,rectus
femoris,gracilis,sartorius,tensor fascia
lata

Midswing to 30*flexion –neutral hamstrings

deceleration
 KNEE :SWING PHASE
PHASE NORMAL MOVEMENT NORMAL MUSCLE ACTION
Acceleration to 40*-60* flexion Little activity in quadriceps,biceps
mid swing femoris(short head),gracilis,
sartorius contract concentrically
Midswing 60*flexion-30* extension
Deceleration 30*-0* extension Quadriceps contract concentrically
to stabilize knee in extension in
preparation for heel strike
Ankle & foot : swing phase
PHASE NORMAL MOTION NORMAL MUSCLE ACTION

Acceleration to Dorsiflexion to neutral Dorsiflexors contract to bring the

midswing ankle in neutral & prevent toes
from dragging on the floor

Mid swing to Neutral dorsiflexion

deceleration
DIFFERENCE BETWEEN
WALKING AND RUNNING
Walking : Always a double support phase
no flight phase
Running
No double support phase, always flight phase
 BODY

PASSENGER UNIT LOCOMOTOR

UNIT

HEAD PELVIS
ARM LOWER
TRUNK LIMBS

FUNCTIONING
HAS NO ROLE . SYSTEM
GOES ALONG THE RIDE

STANCE SWING
PHASE PHASE
DETERMINANTS OF GAIT
I. Displacement of center of gravity (COG).

II. Factors responsible for minimizing

displacement of center of gravity.

CENTER OF GRAVITY
 It is an imaginary point at which all the weight of the
body is concentrated at a given instant.

 Center of gravity lies 2 inches in front of the second

sacral vertebra.

 Centre of gravity follows vertical displacement and

horizontal displacement
O V E R A L L D IS P L A C E M E N T
 Sum of vertical & horizontal
displacement Horizontal
plane
 Figure ‘8’ movement of Center of
Gravity as seen from Antero
Posterior
 These displacement require energy
“Greater the displacement more Vertical
plane
energy is needed”.
Factors responsible for minimizing
the displacement of centre of gravity
Major determinants:
 Pelvic Rotation (transverse plane)
 Pelvic Lateral Tilt (Obliquity)
 Knee Flexion During Stance
 Ankle Mechanism (Dorsiflexion)
 Ankle Mechanism (Plantarflexion)
 Step Width

Minor determinants:
 1. Neck movement.
 2. Swinging of arms.
 1. Pelvic rotation

Rotation of pelvis in Horizontal plane in swing phase, total of

8 degree
➢Decrease angle of hip flexion & extension
➢Enables a longer step length without further
lowering of Center of gravity
2. Pelvic tilt

•The pelvis slopes downwards laterally towards the leg which

is in swing phase
•Reduces the vertical movements of the upper body, and
thereby increases energy efficiency.
•Decrease the displacement of Center of gravity
 3. Knee flexion in stance

•As the hip joint passes over the foot during the support phase, there
is some flexion of the knee. This reduces vertical movements at the
hip.
•Decrease the displacement of Centre of Gravity
4. Ankle mechanism

•Lengthen the leg at heel strike

•Reduce the lowering of Centre of gravity, hence smoothen the
curve of Center of gravity.
5. Foot mechanism

•Lengthen the leg at toe off as ankle moves from dorsiflesion

to planter flexion
•Reduce the lowering of Centre of Gravity, hence smoothen
the curve of Centre of Gravity
Trunk and Arms
• The trunk, arms and shoulders also rotate to ensure
balance

• Upper limb swings opposite to stance leg to produce a

smooth balanced gait.
6. Lateral displacement of body

•In normal gait, width of walking base is narrow,

decrease the lateral displacement of Centre of Gravity
•Decrease muscular energy consumption due to decrease
lateral acceleration & deceleration
 Due to complex interaction of muscular activity & joints
motion in lower limb Centre of Gravity follows a smooth
sinusoidal curve.

 It reduce the significant energy consumption of

ambulation.
GAIT IN CHILDREN (<2years)
 Gait of small children differs from that of adult

 The walking base is wider.

 The stride length & speed are lower & the cycle time
shorter(higher cadence).
 Small children have no heel strike, initial contact being made
by flat foot.

 There is very little stance phase and knee flexion.

 The whole leg is externally rotated during the swing phase.

 There is an absence of reciprocal arm swinging.

GAIT IN ELDERLY
 The age related changes in gait takes place in decade
after m 70yrs.

 There is a decreased stride length, increased cycle

time(decreased cadence).

 Relative increase in duration of stance phase of gait

cycle.

 The speed almost always reduced in elderly people.

 Reduction in total range of hip flexion & extension,

 Reduction in swing phase and knee flexion

Function of the 6 determinants of gait:

1) Increase the efficiency and smoothness of gait.

2) Decrease the vertical and lateral displacement of
center of gravity.

3) Decrease the energy expenditure.

4) Make gait more graceful.

 GAIT ANALYSIS

KINEMATIC KINETIC GAIT

GAIT ANALYSIS ANALYSIS

QUALITATIVE QUANTITATIVE
KINEMATIC GAIT
KINETIC GAIT ANALYSIS
ANALYSIS

 Describe the movement  Determine the force that

pattern without regard for the are involved in the gait.

force involved in producing
the movement
Gait analysis
 Observational method- naked eye examination

 Photographic method- television , video, movie analysis

 Force plate study method-ground reaction force method

 Electromyographic study (EMG)

 Electrogoniometric study

 Energy expenditure/requirement method

 Multichannel funtional electrical stimulation

method(MFES)
Clinical gait analysis
1. Observational gait data:(Qualitative)
Clinician watches patients walk
Advantage:
1. Require little or no instrumentation
2. Inexpensive
3. Yield general description of gait variables
 Clinical gait analysis

2. Gait parameters (Quantitative)

• The gait parameter measurement are made by

timing progress over a 16m walkway & identifying

events by means of foot switch system.

• These instrument identify the part contacting the

ground with data transmitted by telemetry.
•Photographic methods are most
accurate.
•After film development, each frame
is analysed using vanguard motion
analyser and sonic digitizer.
4. Force plate data
 It represent the ground reaction force of walking
generated by force plate
• Therapiest observe the patient and walking
pattern.
Electrogoniometer
 It is used to study
the joints during
gait.
5. Energetics

 Deals with measurement of oxygen consumption

during a specific task

 Oxygen uptake is inversely related to the efficiency of

gait.
PATHOLOGICAL GAIT
➢ Scissoring gait ➢ Knock knee gait
➢ In toeing gait ➢ Genu recurvatum gait
➢ Out toeing gait ➢ Short limb gait
➢ High stepping gait ➢ Quadricep gait
➢ Circumduction gait ➢ Gluteal medius gait
➢ Waddling gait ➢ Gluteal maximus gait
➢ Trendelenberg gait ➢ Stiff hip gait
➢ Drunkers gait
➢ Festinant gait
➢ Antalgic gait
ANTALGIC GAIT
 Gait pattern in which stance phase on affected side is
shortened due to pain in the weight bearing limb.

 There is corresponding increase in stance phase on

unaffected side

 Common causes: Osteoarthritis, Fractures, tendinitis,

Inflammation in affected limb.
TRENDELENBERG GAIT
 Any condition which distrupts the osseo-muscular
mechanism between pelvis and femur
 Weak abductors (power),acetabulo femoral articulation
defect(fulcrum),defective lever system causes trendelenberg
gait.
 Here the abductor action in pulling the pelvis downwards in
stance phase becomes ineffective and the pelvis drops on the
opposite side causing instability.
 To prevent this body lurches on the same side.
Trendelenberg gait
 Usually unilateral
 If bilateral = waddling gait
 Causes :
1. Weak abductors :poliomyelitis . muscular dystrophies,
motor neuron disease
2. Defective fulcrum: Congenital dislocaion of hip(CDH),
pathological dislocation of hip
3. Defective lever : Fracture neck of femur, Perthes disease,
Coxa vara.
Circumduction gait
 In hemiplegic patients

 To avoid the foot from

scrapping the ground, the hip
and the lower limb rotates
outward.
High stepping gait
 Due to foot drop
 On attempt of heel strike, the toe drops to the ground
first.
 To avoid this the patient
flexes the hip and knee
extensively to raise the
foot and slaps it on the
floor forcibly.
Scissoring gait
 Here one leg crosses directly over the other with each
step due to adductor tightness.
 Seen in Cerebral palsy
Drunkers or reeling gait
 Patient tends to walk irregularly on wide base, swinging
sideways without stability and balance.

 Caused due to cerebellar lesion.

 With unilateral lesion of cerebellum, balance is lost towards the

side of the lesion.
Genu recurvatum gait
 In Paralysis of hamstring muscles the knee goes in for
hyper extension while transmitting the weight in mid
stance phase.
 Seen in poliomyelitis
Short limb gait
 Shortening less than 1.5 cm compensated by pelvic tilt, and
shortening upto 5 cm compensated by equinus.

 Shortening more than 5 cm the patient dips his body on that

side.
Festinant gait
 Seen in Parkinson's disease
 Steps are short that the feet barely clears the ground.
Quadriceps gait
 Normally the knee is locked by the quadriceps contraction
while transmitting weight to the lower limb during
midstance.
 Hence patient with weak quadriceps stabilizes his knee by
leaning forward on the affected side & pressing over lower
thigh by his Ispilateral hand or fingers.
Gluteus maximus gait(BACKWARD
LURCH)
 Due to weakness in gluteus maximus
muscle, while the body propels
forward during midstance
phase,trunk is lurched posterior

to effect posterior pelvic and

shifting the centre of gravity

towards stance hip.

 Seen in poliomyelities & above knee amputation with
prosthesis.
Stiff hip gait
 When the hip is ankylosed, it is not possible
to flex at the hip joint during walking to
clear the ground in the swing phase.
 Hence the person with stiff hip, lifts

the pelvis on that side and swings the leg with

the pelvis in circumduction and moves it
forward.
STAMPING/ATAXIC GAIT:

 It occurs in sensory ataxia in which there is loss of sensation

in lower extremity due to disease processes in peripheral
nerves, dorsal roots, dorsal column of spinal cord.

 Due to absence of deep position sense,the patient constantly

observes placing of his feet.

 Hip is hyperflexed & externally rotated & forefoot is

dorsiflexed to strike ground with a Stamp.
 Seen in peripheral neuritis &
brain stem lesion in
children, tabes dorsalis in
adults.
 Alderman’s gait:

• Seen in Tuberculosis of spine in lower dorsal and upper

lumbar vertebra.

• Patient walk with head and chest thrown backward and

protuberant abdomen and legs thrown wide apart.
 GAIT TRAINING
 AIM:
 To achieve safe, easy, effortless normal gait pattern.
Non ambulatory phase
1. Asses and improve the range of movement

2. Treat contractures

3. Improve the cardio respiratory status

4. Shadow walking

5. Assisted device
Ambulatory phase
1. Support by orthotic & prosthesis
2. Parallel bar walking
3. Encourage reciprocal arm swinging
4. Follow other forms of walking
➢ Turning
➢ Side walk
➢ back walk
➢ Squatting
➢ Getting up
➢ Walking on uneven rough surface
Dr. Kavita Meena