The document discusses normal gait patterns and phases, abnormalities, determinants, and examination. It notes that gait is divided into stance and swing phases. Stance is 60% and includes heel strike, foot flat, midstance, and toe off. Swing is 40% and includes acceleration, midswing, and deceleration. Gait abnormalities can occur due to weakness in the hip flexors, extensors, abductors, knee extensors, ankle dorsiflexors, and plantarflexors. Examination of gait identifies deviations caused by muscle weakness or spasticity.
The document discusses normal gait patterns and phases, abnormalities, determinants, and examination. It notes that gait is divided into stance and swing phases. Stance is 60% and includes heel strike, foot flat, midstance, and toe off. Swing is 40% and includes acceleration, midswing, and deceleration. Gait abnormalities can occur due to weakness in the hip flexors, extensors, abductors, knee extensors, ankle dorsiflexors, and plantarflexors. Examination of gait identifies deviations caused by muscle weakness or spasticity.
The document discusses normal gait patterns and phases, abnormalities, determinants, and examination. It notes that gait is divided into stance and swing phases. Stance is 60% and includes heel strike, foot flat, midstance, and toe off. Swing is 40% and includes acceleration, midswing, and deceleration. Gait abnormalities can occur due to weakness in the hip flexors, extensors, abductors, knee extensors, ankle dorsiflexors, and plantarflexors. Examination of gait identifies deviations caused by muscle weakness or spasticity.
The document discusses normal gait patterns and phases, abnormalities, determinants, and examination. It notes that gait is divided into stance and swing phases. Stance is 60% and includes heel strike, foot flat, midstance, and toe off. Swing is 40% and includes acceleration, midswing, and deceleration. Gait abnormalities can occur due to weakness in the hip flexors, extensors, abductors, knee extensors, ankle dorsiflexors, and plantarflexors. Examination of gait identifies deviations caused by muscle weakness or spasticity.
There are six determinants of the Gait Pelvic rotation - the pelvis rotates 4 degrees to each side which occurs during the period of double support elevating the nadir of the COG pathway curve to 3/8 inches
Pelvic tilt - occurs in the frontal plane where the
pelvis drops 5 degrees on the side of the swinging leg, shaving 3/16 inches from the apex of the COG curve
Knee flexion in stance phase - Knee flexion
lowers COG by 7/16 inches during midstance
Ankle foot coordination - smooth out the
pathway of COG
Knee ankle coordination - smooth out the
pathway of COG making it more sinusoidal
Lateral pelvic displacement - the valgus at the
knee decreases lateral sway reducing total horizontal excursion from 6 inches to less than 2 inches
What are the muscles active during normal Gait?
The principal muscles involved in gait are iliopsoas, gluteus maximus, gluteus medius, hamstrings, quadriceps, calf and pretibial muscles
Initial contact - During initial contact the GRF is
behind the hip and behind the knee.
Hip flexors (hip accelerator) - During the stance
phase the GRF is behind the hip and the trunk extends. The hip flexors contract eccentrically after midstance to allow slow truncal extension. Hip flexors including iliopsoas, pectineus, TFL, sartorius start contracting concentrically from terminal stance thru the swing phase but becomes quiite during the terminal stance.
Hip extensors (trunk stabiliser)
Hip abductors (hip stabilizer)
Knee extensors (leg stabiliser)
Ankle dorsiflexors (foot lifter)
Ankle Plantarflexors (leg/foot accelerator)
What are the gait Abnormalities in stance phase?
Heel strike in heel spur or bursitis patient may hop onto the involved foot to avoid heel strike and cause pain. patients with weak quads may walk with a gait where the patient has to push the knee manually into extension
Foot flat dorsiflexors elongate by eccentric
contraction and allows foot to flatten smoothly. patients with weak dorsiflexors may slap their foot down instead of letting it land smoothly. Patients with fused ankles may not be able to reach foot flat till later in midstance. In antalgic or painful gait pattern patient may not bear any weight for fear of pain and walk gingerly.
Midstance patients with subtalar arthritis, rigid
flat foot, fallen transverse arches complain of pain with midstance. In patients with weak quads the knees have more flexion and they are wobbly or unstable. The pelvis shifts upto 1 inch towards the weight bearing side normally. In gluteus medius weakening of the stance side, the pelvis may tilt
more than 1 inch. This is called gluteus medius
lurch or abduction lurch. In gluteus maximus weakness the patient must thrust his thorax posteriorly to maintain hip extension which is called gluteus maximus or extensor lurch
Push off if patient has arthritis of the
metatarsophalangeal joints or in case of fusion the patient may not push off by hyperextending the MTP joint. Instead patient may try to push off using the lateral forefoot. If you examine the shoe instead of transverse crease across the toes an oblique crease cutting across the toes and forefoot may develop What are the gait Abnormalities in swing phase? Acceleration dorsiflexors are active, shorten the extremity and help to clear the ground. In weak dorsiflexors patient may be rubbing the toes on the ground. The knee should reach a maximum flexion of 65 degrees.In weak hamstrings the knee may not flex and there will be problem in clearing the ground. The quadriceps start contracting before push off in preparation for the forward swing of the leg. In poor quad strength the patient has to rotate the pelvis anteriorly in an exaggerated motion to provide forward thrust for the leg
Midswing if dorsiflexors are weak then the
shoe may scrape the ground. To compensate patient may flex his hip excessively to bend the knee permitting the foot to clear the ground
Deceleration hamstrings contract to slow
down the swing and enable a heel strike smoothly. If hamstrings are weak heel strike may be
excessively harsh and knee may hyperextend
(back knee gait) What are the named Gait deviations? Antalgic gait - to reduce pain patients avoid weight bearing on the affected side characterised by a decrease in stance phase on the affected side
Trendelenburg Gait - there is contralateral
pelvic drop due to the failure of hip abductors to stabilize the pelvis during stance phase.
Gluteus lurch - in weak hip extensors patient
assumes a lordotic position to keep the COG behind the hip
Hemiplegic gait - The extensor tone makes the
limb on the affected side longer. so patient circumducts the leg for toe clearance.
Parkinson's gait or festinating gait - short quick
shuffling steps as if the patient is racing after the COG.
Quadriceps Gait or back knee gait - Weak quads
causes wobbliness of the knee at heel strike. Patient will lurch the trunk forward at heel strike and may strongly contract the ankle plantar flexors to shift the center of gravity forwards in front of the knee to force into extension of the knee.
Tibialis anterior Gait - if pretibial muscles are
weak but have antigravity strength then at heel strike you will hear the foot slap. If pretibial muscles are not antigravity then there is the high steppage gait.
What is the energy consumption of prosthetic gaits?
BKA ~ 20% Double BKA ~ 40% AKA ~100%
BKA - AKA ~120%
AKA-AKA ~200% Wheelchair ~9%
Describe the Physical examination of Gait to identify
muscle weakness? Cannot stand without walker or support; hip thrown front and trunk and pelvis thrown back called hip extensor gait - hip extensors (pelvis stabilizers)
Cannot advance the feet forward - hip flexors
(accelerators)
Trendelendburg's kind of gait - hip abductors
(pelvis stabilizers)
knee buckles and knee is hyperextended while
the trunkl lurches forward - quad weakness (shock absorbers)
snapping knee at the end of extension or genu
recurvatum - hamstring weakness (decelerators)
foot drop and cannot stand on heel dorsiflexors
stamping gait (heel does not raise but the whole
foot will) , Poor push off and cannot walk on toes plantar flexors
Describe the Physical examination of the Gait to
identify muscle spasticity? wide popliteal angle - hamstring tone (degree of knee flexion when hip is flexed to 90 degrees)