Gait Analysis

How do you describe the normal gait pattern?

Gait is divided into stance and swing phases.
Stance phase is 60% of the gait cycle and swing
phases is 40

stance phase includes heel strike, foot flat,

midstance and toe off(push off)

Swing phase includes acceleration, midswing

and deceleration

Step length is approximately 15 inches and 2

steps form one stride

Width of the base is the distance between the

center of the two heels. This is usually 2 to 4
inches and a wider base is pathological

The center of gravity (COG) is 2 inches anterior

to S2 and it oscillates vertically 2 inches during the
normal gait.

The pelvis shifts 1 inch to the weight bearing

side during gait to center the weight over the hip.

The pelvis also rotates 40 degrees forward while

the hip joint on the extremity on stance phase acts
as the fulcrum for rotation

Gastroc soleus is the only muscle complex

active during quite standing

Cadence is defined as steps per minute and the

average cadence is 90 to 120 steps per minute
which cost 100 calories per mile.

What are different phases of the Gait cycle?

Initial contact (Heel strike) - 2%

Loading response (Foot flat) - 8%
Midstance ( Midstance) - 20%
Terminal stance (Heel off) - 20%

Preswing (Toe off) - 10%

Initial swing (Acceleration) - 10%
Midswing (Midswing) - 20%
Terminal swing (Deceleration) - 10%

What are the Gait Determinants?

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)

spastic calf muscles - toe walking

spastic dorsiflexors - heel walking