Normal Gait Four objectives must be accomplished for normal gait to occur. 1. Leg supports body weight without collapsing 2. Balanced maintained (statically & dynamically) during single support phase 3. Swing leg advance to take over supporting role 4. Sufficient power for necessary limb movements and trunk advancement
Effectiveness Of Normal Gait Depends on free joint mobility & muscle action Pathological conditions of: muscle bone joints sensory nervous system central motor control cardiopulmonary system Alters mode and efficiency of gait
Keep In Mind... • Step • Stride • Cadence • Gait Cycle Abnormal or subtle change in gait – movement is forced due to weakness spasticity or deformity or – movement is a compensation to correct for some other problem which needs to be identified
Requirements for Observational Gait Analysis • Suitable site – straight, level walkway (length & width) – line of progression – lighting
• Patient attire • Treadmill and video • Observe – posterior, anterior, lateral – barefoot vs. wearing shoes – with & without orthotics
Observational Gait Analysis Event: Head tilt at heel strike Normal: Vertical Position Significance of Deviation • • • •
Tilts to short or long limb Tilts towards the raised shoulder Muscle tightness Habit
Observational Gait Analysis Event: Shoulder position during stance Normal: Equal Significance of Deviation Shoulder drop due to – Scolosis – Short or long limb – Trauma – Occupational
Observational Gait Analysis Event: Arm swing during stance Normal: Equal active arm swing Significance of Deviation No arm swing – Need to stabilize the trunk – Tight erect posture
Unilateral arm swing – Greater arm swing on the side of the short leg – Limitation of motion in the opposite hip – Occupational
Evaluation of Short Leg Palpate pelvic crest ASIS and PSIS • Level the pelvic crest with know thickness of material under short side
Observational Gait Analysis Event: Pelvic hike in swing Normal: None Significance of Deviation Used to assist ground clearance if foot drop is present
Observational Gait Analysis Event:
Pelvic drop of opposite side during stance Normal: None Significance of Deviation If present: • Weak hip abductors • Tight hip adductors
Observational Gait Analysis Event:
Pelvic drop of same side in swing Normal: None Significance of Deviation If present suspect: • Opposite side hip abductor weakness • Loading a short limb • Scolosis
Observational Gait Analysis Event: External hip rotation Normal: Terminal stance and into swing Significance of Deviation Increased by: • • • •
Muscle problem – gluteus maximus Foot fault contact – retroversion Compensation Excessive supination at contact
Observational Gait Analysis Event: Internal hip rotation Normal: Contact into midstance Significance of Deviation Increased by: • Tight medial musculature • Foot contact fault – Anteversion • Compensation • Excessive pronation into propulsion
Observational Gait Analysis Event: Knee extension in stance Normal: Fully extends in midstance Significance of Deviation If excessive consider: Compensation for equinus Weak quadriceps Pain
Observational Gait Analysis Event: Knee flexion in stance Normal: After contact and midswing Significance of Deviation If excessive in stance or swing: Hamstring contracture Soleus weakness (stance only) Quadriceps weakness (swing only)
Observational Gait Analysis Event: Transverse plane position of knee at end of contact Normal: 3-5 internally rotated Significance of Deviation Internal: • Internal femoral torsion or position • Spastic or tight medial musculature
Observational Gait Analysis Event:
Transverse plane position of knee at end of contact Normal: 3-5° internally rotated Significance of Deviation External: • External femoral torsion or position • Spastic or tight lateral musculature
Observational Gait Analysis Event:
Frontal plane position of the knee Normal: Vertical +/- 2° Significance of Deviation Bow leg • Coxa valga- genu varum • Pediatric developmental
Observational Gait Analysis Event: Frontal plane position of the tibia Normal: Vertical +/- 2° Significance of Deviation • Tibial varum • Blount’s disease • Rickets
Observational Gait Analysis Event:
Frontal plane position of the calcaneus at heel strike Normal: 2 - 4° inverted Significance of Deviation Excessive varus due to: • Tibia varum • Cavus foot type • Plantarflexed 1st ray • Narrow base of gait • Abducted gait angle
Sounds of Heel Strike Listen…pounding? If excessive pounding this will indicate lack of shock absorption Look for shock waves up the leg
Observational Gait Analysis Event:
Frontal plane position of the calcaneus at heel strike Normal: 2 - 4° inverted Significance of Deviation Vertical or valgus due to: • Genu valgum • Calcaneal valgum • Internal femoral torsion • Internal tibial torsion • Weak anterior group • Inability to resupinate
Navicular Position- Sagittal View • Pronation - talar head adducts against navicular, decreasing distance from ground • Supination - talar head abducts, increasing distance from ground • Can be related to Medial longitudinal arch angle
Observational Gait Analysis Event: Angle of gait during stance phase Normal: 10-15 ° abducted Significance of Deviation Abducted gait due to: – External hip rotation – External tibial rotation – Fully compensated MTJ – Pronated foot at heel off
Observational Gait Analysis Event: Angle of gait during stance phase Normal: 10-15 ° abducted Significance of Deviation Adducted gait due to: – Internal hip rotation – Internal tibial torsion – Tight medial hamstring – Metatarsus adductus
Observational Gait Analysis Event:
Base of gait during the stance phase Normal: 4” in width between subsequent heel strike Significance of Deviation Narrow base due to: – Tibia varum – Increase in cadence, running, and jogging
Observational Gait Analysis Event:
Base of gait during the stance phase Normal: 4” in width between subsequent heel strike Significance of Deviation Broad base due to: – – – –
Genu valgum Instability of the trunk Pediatric Geriatric
Observational Gait Analysis MTJ – Midstance & propulsion - key for foot stability Metatarsal heads – FFL- anterior view - 5th met. head contacts first, followed in sequence by the others – Propulsion - reverse - 5th leaves first • 1st MPJ - lateral view - df TOE POSITION – contact - dorsiflexion – midstance - plantargrade
Observational Gait Analysis Event: Normal:
Time of heel lift 60-70% of stance phase, when opposite limb has passed the support limb Significance of Deviation Premature heel lift due to: – Short or spastic posterior group, ankle block – Associated with the limited midtarsal ROM
Observational Gait Analysis Event: Normal:
Time of heel lift 60-70% of stance phase, when opposite limb has passed the support limb Significance of Deviation Delayed heel lift due to: – Moderate to severe MTJ compensation – Short stride
Observational Gait Analysis Event:
Frontal plane motion of the foot to the support surface during propulsion Normal: Lateral side of the foot raises earlier than medial side Significance of Deviation Inverted gait due to: – – – – –
Forefoot varus Forefoot valgus Rigid plantarflexed 1st ray Functional hallux limitus Adducted gait angle
Observational Gait Analysis Event:
Frontal plane motion of the calcaneus at heel lift Normal: Vertical moving into inversion Significance of Deviation Vertical or valgus – Pronated STJ
Observational Gait Analysis Event:
Direction of weight flow through hallux at toe off Normal: moves through the long axis of the hallux Significance of Deviation Medial side of hallux due to: – – – –
Pronated STJ and MTJ Abducted gait FHL Hallux rigidus
