.

lil

MA,JOI(
BY

iN

i)ETEIIMINANTS

J.

B.

I)EC.

M.

SAUNDERS,

HOWARD

the

From

D.

M.Ii.,

MS.,

of A natomy

and

of Engineering,

College

ANI)

F.R.C.s.(EDIN.),

EBERHART,

Departments
The

NOItl\IAL

PATIIOL(

VERNE

SAN

T.

FRANCISCO,

Orthopaedic

INMAN,

*f

GAIT

M.D.,

AND

CALIFORNIA

Surgery,

University

)(ICAL

School

of California,

of

San

Medicine,

and

Francisco

INTRODUCTION

Human
locomotion
is a phenomenon
of the most extraordinary
complexity.
primaty
objective
of locomotion
may be simply
stated
as the translation
from
one point
to another
by means
of a bipedal
gait, its analysis
requires
the

Although
of the body
collection
of

the

an enormous

amount

of data

a complete
(lescription
kinetics
of the extremities
plete,
would
be of little
a concept
of locomotion
of the clinical
problems
ments

is a task

it is our

purpose

to

of locomotion

with

fuller
understanding
of the
the locomotor
mechanism.

greater

entire

cycle

consideration
details;
but

of events.

it is evident

of both
the
such knowledge,

kinematics
even

surgeon
unless
can be drawn
him.
However,
in

magnitude

locomotion,

and

difficulty

limit

ourselves

what
we have called
the primary
determinants
determinants
in relationship
to pathological
ciation
of these
fundamental
determinants,
disorders

the

involves
manifold

participate

of such

Therefore,

to follow

value
to the orthopaedic
from which
deductions
which
daily
confront

simultaneously

which

achievement,
expected.

in order

of locomotion
in all their

an

its early

in this

precision

and

to

which

paper

apply

exist

ideal

of

cannot

be

to

a consideration

of

and

to examine
these
that,
by an apprewill be able to analyze

corrective

between

worthy

attainment

of human
locomotion
gait.
It is our expectation
the orthopaedic
surgeon

interrelationships

an(l
if com-

it were integrated
to evolve
and applied
to the analysis
the synthesis
of all the dc-

although
that

that

the

measures
various

with

segments

of

METHODS

The
based

data

involves

present

the

aid

and

coordinate

axes
types

of

niques

of

employed

discussed

the

have

here;

but

were determined
mitted
the study
measurement

an interrupted-light
mitted
the
calculation
were

verse

t
VOL.

great
to

rotations
*

Infantile

with
found

Based

on

NO.

the

elsewhere
mentioned.

briefly

limb

papers

read

two

3. JULY

from

the

as

1953

the

and,

a function

the

sagittal

to that
employed
of velocity
and
accelerometers
of graphonumerical

segments

were

at the

Meeting

Joint

most

Group

Research

aided

Council,

Orthopaedic

by

grants

Advisory

of

Associations,
The

Committee

tech-

cannot
extremities

and

be

perBy

accelerations

also

This
in

obtained

method
perthe plane
of

to check

the

differentiation.

from

the

the

space,

were

by Marcy.
acceleration

determined

The

walkway
which
simultaneously.

plane

used

of
the

to obtain

of the

velocities

were

accurately

of the

details
of

of a glass
of space

in the

methods

Biomechanics

reasons

to

of recording,

displacements

of time,

Electrical
to

for

rates

information.

simplicity
The

and
respect

in order

desired

findings.

of these
consisted
in the three
planes

similar
components

and the National

Inc.,

One

the

as the

of

with

be employed
all

The

Displacements

accuracy.
inferior

factors

accuracy

be

calculated.

of the

A contribution
Paralysis,

35-A,

be

by such

body

is

of locomotion

directions,

in the

yield

of gait

a study

magnitudes,
must

will

described

will

technique
of the

by

but

and

determinants
Since

occurring

of methods

is dictated

displacements

were

forces

technique

by several
methods.
of the displacements

points

progression

one

fundamental

of the

and

a number
No

been

of the

of techniques.

measurement

data,

they

of the

of selected

data.

method

reduction

analysis

of a variety

rotations,

in space,
of

of a particular

ease

the

translations,

different

choice

the

with

recording

of the

three

which

obtained

the

change
the

upon

were

findings

The

by

the

London,
National

trans-

insertion
July

1, 1952.

Foundation

on Artificial

of

for

Limbs.
543

544

J.

pins

the

into

B.

D1:C.

bones.

SI.

SAUNDERS,

High-speed

V.

T.

INMAN,

motion-picture

AND

H.

D.

EBERHART

photography

proved

to be

value
only, bUt it w-as useful
for the examination
of motions
of minor
instances
Cinertt(hiOg1aj)h
had a limited
usefulness.
The gravitational
were
studied
l)V means
of elect romyography
and
by the use of force
raphy
plate,

was

most
valuable
in (letermining
will be mentioned
in greater

which

the

ground

reactions

the

well as the center

determine
physical
segments,
level

and

the

walking

magnitu(les

of pressure
constants,

at

cadence

In

order

to

1)rCSeIit

to consi(ler

the

motion.

By

so (loing

weight

of the

body

The

mass
to

CENTER

moments

of inertia.

subject

investigated.

the
OF

GRAVITY

OF

THE

data

of the

body.

upon

the

This

point.

enables

us

individual

the

locomotion
in a somewhat
the fundamental
features

to avoid

segments

center

and

of gravity

idealized
concerned

since

limbs

rfhe

itself.

fashion
which
in the translation

as

are

for

BODY

we assume
be regarded,

abstract

at that

shears,

presented

conception,

an

force
from

were
devised
to
masses
of the

introduce

we

influencing

horizontal

of the

is concentrated

levei-s
or

and

of locomotion,
body
during

acting

at

torque,

of the phenomena
of gravity
of the

weightless
ating

force,

a simplified
concept
l)ehavior
of the center

the

forces

vertical

techniques
the relative

normal
TilE

venient

of

phase
of muscle
activity.
The
allowed
the direct
measuring

on the foot.
In addition
special
such
as the centers
of gravity,

calculation
the

the precise
detail
later,

of qualitative

magnitude.
In some
and muscle
forces
plates.
Electromyog-

may

for

the

to

limit

In

this

most

that

part

the

consideration

way,

the entire
therefore,
as

discussion
to

we

are

permits
the analysis
of the body
and

it is concycle
of

the

of

those

able

oper-

to treat

of

and synthesis
of
its energy
require-

ments.
which
gravity

Furthermore,
the
selection
of the center
of gravity
as a point
of reference
from
to depart
possesses
distinct
advantages
since the displacement
pattern
of the center
of
may be regarded
as constituting
the summation
or end result
of all forces
and motions

acting

upon

and

ConCcrfl((i

with

the translation

of the body

from

one

point

to another

body

has

been

the

familiar

during

locomotion.

static

Lnder
number

conditions,

of methods.

nique

of (louble

calculation

Its

the

suspension

from

center

and

volume

of gravity

contour

maps

of the

are all in reasonable

agreement.
In adult
of gravity
of the body
lies in the mid-line
about
55 per cent.
of the total
stature
With

reference

anterior
The

Displacement
The

down

company
vertical

is a smooth
a small
center

more
marked
has
after

upon
been

pathway

drawn.

correction

which

the

of
and

of a balanced
from

of

the

and

several

a
by

methods

that

ground
being

gravity

by
tech-

beam

these

it is estimated

the

center

corresponding
1.25 per cent.)

occupies

by

a position

the

subject

He

is photographed

for

parallax,

the

center

to
1

just

along

curve

at

approximately

as he walks
of

The

the

position

a wall

on

cameras
are

determined
THE

in the

JOURNAL

from

OF

often

be

of gravity

are

no
is

system
aspects

various
AND

of
1).

of gravity

a coordinate

BONE

seen

level

to it (Fig.

center

the

in

of progresthe

different
in

in the

of gravity

parallel

of the
which

bobbing

plane
may

center

downward

of step

center

of this

body

displacement

synchronized

displacements

form

or fence

out

of the

of loco-

and
in the

is walking

of gravity

his

pastime.
walks

by

The

on a wall

childhood

the

the

is a feature

upward

objectively
he

displacement

against

line

and

when

the

curve.

of chalk

body

in the

is fixed,

noticeable

reflect

recording

of the

subjectively

vision

very

a wavy
of this

body

center

seen

described

scribbles

the

be

or sinusoidal

elaboration

females,

displacement

may

a piece

methods
an

the

fluctuations

holding

of gravity

It

on

undulating
boy

laboratory
than

The

and

use

results

at a distance
from
(individual
variations

downward

all.

of a person,

These

plane.

when
The

head

of others.

sion
his

to
objects

of the

the

The

determined
experimental

of Gravity

and

is familiar

males

column,

(enter

upward

rhythmic

body.

by

vertebra.

sacral

of distant

and

vertebral

of the

which

fluctuation

the

the

second

the

to

motion
up

to

of the

was found
in cadavera
in living
subjects
by

position

and,

axes
JOINT

and

SURGERY

DETERMINANTS

IN

NORMAL

AND

--

PATHOLOGICAL

r.

GAIT

1!

..,

1In

1inc

Tine
gravity

ielt

ic

dna vn on i tin
of ti
hO(lV.

I e( I

SiIHtSOi(lItl
(1

t he

posit

of

gravit

left

Fhie

eight

Ui(l

of

t he

t he

t iflie

(P1st

er of gra\it

iii

I he

when

pont
larit

At 50 per

y falls

to it s loest

hien

bot

(lescent

-hearing

ext

35-A.

from

deviations
NO

3,

innx

the

ical
are

of eight,

figure

perfect

(to

is also

to

remit

the
V.

the

so wit hiotit

curve

to

and

of

horizontal

projected
occupying
are

1953

extremes

almost

the

displacements

on

the

coronal

in

is smoot

lily

undulating

approximately
equal.

of

plane,

thiey

a two-inch

the

are

associat

same
he

center

when
than

of which

corre-

his

head,

horizontal

as

plane.
curve,

Wit

hi I lie

the
sup-

wit bout
irregumagnit
tide of the

right

one and
to left.

center

of gravity

square,

of

the

is walking

iofl

The

found

in

minima

)es a sinusoidal

left

from

and

height

the

deviation

of doul)le

displacement,

in the

y (tescrih

is at
the

cycle,

is followed

of humping

laterally

of gravit

and

fear

corre-

linib

inteival

cuive

when
the

neglected.

of the

of the

a tunnel

(lisplace(l

right

level

then
one

each

opposite

vertical

lv shorter

through

t lie center

j)it5S

the

be

maxima

in form
to thiat
of tine vertical
displacement.
in normal
Irvel
walking
is approximately

displacement
measured

horizontal
VOL.

eight

vent

ho(lv

t lie

the

foot,

and

is about

((le,

I o t he

bet veen

below

nay

the

t lie
from

same

limb

middle

As

maximum

its

of t he

they

or the

thiit

of mot

right

t inic.

( )f

Ii iegtilri.r
ion

; the

gioufl(l.

is slight

hie could
of clearance.

of progression,

it is similar

and

height,
inch
of t he

slightly

to walk

if lie were

the

At

a person

siiioot

males

linb

cent

I mat e

a(lult
of

corresponds

with

tint e evenly

lies

words,

standing
one-half

alternately

the

always

(cut

)i

(let ermilie(l
rike

that

i)er

supporting

position

rtct

irregularities.

other

of gravity

; I his
(unit

if any

so I hat,

plane

in

t o fltict

body
in

which

combined

are

foiiil

is

hi few

to his
nearly

level

Ii feet
it

of the

o I he

When
are

75

it cn ol

cycle

the

first

snall

so

trl

l)hIi5e.

center

as

aie

25

swing

inches

at

of t lie

live

horizontal

ions

occili

is

I lie

in noimtl

Iiii(l(lle

The

of t lie
les and

vatiat

ions

over

(hisplacemelit

t lie

51)011(15 eXactly
Inc would
hiave

ical

t Iu.

t lie

heel-st

pitce

of the

is standing.

summits

vent

it

(luring

subsequent

phase

lie is standing,

Rela

t lie

in a double

stance

gravity

of

foot

(lesciihes

(hiVe,

ion

(hile(t

I I0

Ui(

body

I his

iioii

of the

wit

subject

one

(yUle

( )I

y of I he

iCill

)a I ii way

ni (1 )n( )Xi ninat c

flhi(l(lle

displacement,

tine

)Iiiot

vent

IL

; ifl(hivi(hlal

oscillrtt

t ia

the

ari(l

center

of

ill

sti((essivel\
of this

inches

these

loc

progression.

\\ice

rike

1)iL55C5

1
it

en of giavit

(elit

of
t

aniount

eighit-beuing
S t15c(Iit

i)lt11e

t lie

( )t

iise

t he

lied-st

body

S of

I his

iI

t lie

(lisl)hitce(l

-1 elit his

s)onding

alking,

is

total

Fhie sunnit

l)l

l)iecise

iii

ion

is, as

t he

I Ii e
level

Ci1i\(

(cut
t lint

to

flOilUal

ii

FI(.
wino i( (W n(pn(sen

glass

three-quarter

to describe

of the body
an almost

since

vertical

the

and

.546

.1.

( lig.

U.

2 ).

I in

ol

gia

; hu

t ti

smoothly

of

iiiL

lie

to

and

tue

It

center

loconot

I i inc

ion
as

the

left

at

73

procee(ls

to

fall,

to

per

motion

Newtons
itiot

sI at e.

first
iOI)

iii

iranslat

ion

law

of inotion

It

st n-night

of

a i)o(1\

line,

to
as

iight

lily

right

cycle.

When

once

more

summit

the

right

and

in its

state

body

states

that

unless

it h)e compelled

every
with

the

- ----

--

continues
h)y impressed
least

force

expenditure

--

of the
impossible

gait.

oi(ial

foice

times

accelera-

mass

(F
is

direction
a

of

as

shall

ment

of

ment

stable
the

we

gain

may

influence
t

t ciii

order

of
to

of progression

the

until

analyze

In

pat

In childreii

come

this

factors

vhiichi

50,

it

the

pathway

is necessary

introduce

center

locomotor

especially
to

see

in

Developmentally,
come
about
by

have

of the

of the

ahnoi-mahity,

to

is variable
and irregular,
year
of life. Therefore,

seventh

understanding

pathological
(10

the

determine

considerable

appeal-

of locomotion

pattern

human

energy;

and,

considering

no locomotion.

would

ap)i-0ximitte1y

the

gait,
the
body
every
attempt
to
to conserve
energy.

make

continue

displarenients

vertical

the
through
pathway

amplitude,
conserves

will
unIt
thU
gravity

gravity

1)ody
we

of

translating

undulating

pathological

of

expen(hiture

In

of low

in(I(nse(ti((ni
of (lie inonizonital
I lie pat iiwav
of I he oniten

ai)i-upt
changes
in
of motion
com-

high

center
smooth

is

ttcceleraof
time

a. function

v, t)

an(l

ma)

energy.

TIn

ampli-

deflections

Since

pd

J)nO(IU((S

the

to

tion
tion

a sinus-

gra(iual.

equal

(a

most

of low

whichi

it is
of

would
be
body,
as in

through

in

the

but
means

next

method
of the

pathway

ttide

by

The

locomotion,

are

that
maybe

wheel,
by

economical
translation

or of

mechanically

means
quite

of rest

to change
of energy

bipedal

lo;.

to

is reached
has reached

GAIT

achieved

, it

begins

is completed.
OF

line

it

the

second

to

I lie

t oe-oft,

25 per ccii I of
en i)egins
to desceIl(l

as

gradually

velocity

at

cent

the

left

of

line

eveii

t o tine

tine

As

in the

almost

a suniiit

deviation

cycle

of gravity
with

heel-strike

this

DETERMINANTS

in a straight

center

to

return

the

EBEHIIART

D.

moves

tine

of the

11.

the

sinoot

continue

cent

THE

uniforni

center

I 0 t lie

it begins

of tine forward

of

the
froni

es

AND

I)athwaY

rises

ii

(leiItt

it.

INMAN,

T.

which

O\V((l

)ll

summit

axis

the

alolig

( )t

towar(1

a secon(1

tine central

sn ie

deviates

1.ise

V.

of

a spiral

cycle

single

ily

sAtNI)ERS,

l)icture

is that

(i

cycle

n)1C.

thlcc-(IiflieflsiOflltl

.:

progression

((iit

ii.

at

regards

first

certain

of gravity,
the

achieveexperi-

and it does
not
it is of importance

mechanism

as

the
natural

energy

purely

since from
and
appreciate
cost

to

theoretical

the

be-

to
them
the

i)ody.

considcra-

i4)Ii5.

(viii

pa.s.

For
bipedal

Gait

analytical
system

purposes,
in which

the

let
lowci-

us

consider

the

behavior

extremities

are

represented
THE

of

the

center

by rigid
JOURNAL

OF

BONE

of

levers
AND

gravity

in

without

foot.

JOINT

SURGERY

DETERMINANTS

IN

NORMAL

AND

PATHOLOGICAL

547

GAIT

Fin.
In the hypothetical
pathway
of the center

compass
of

gravity

gait,
is

the

a series

of ar(s.

Fin.
The
i nfluenn-e
t he arcs
of t he
gravity.

VOL.

35-A,

NO.

3,

JUn.Y

i953

of pelvic
pat hw:u

1
rot :ution
of

line

flat (emns
centen
of

548

B.

j.

ankle,

or knee

flexion

and

M.

DEC.

mechanisms

but

extension

v.

SAUNDERS,

only

are

T.

INMAN,

articulated

(Fig.

3).

AND

at the

In

such

H.

levers

and,

the

would
by

The

energy

proportional

cost

terms

gravity

of the

inches,

extremities

with

each

step,

equal
that
in extension.
Locomotion
walking
on the heels with the knee
to

a person

of the

body

would

is double

which

using

average
have

the

the

human
to

normal

vertical

model

First

The

In

Deteriii

in a at: Pelvic

normal

level

relative
to the
the magnitude

determinants

would

the

be

the

can

walking,

significance

model

(Fig.

the

In

of

three-quarter

of intersection

of
the apof such

be followed.

pelvis

rotates

alternately

to

the

right

and

to

the

left,

At the customary
cadence
and stride
of average
persons,
is approximately
4 degrees
on either
side of the central
axis,

of pelvic

4)

of the

center

consequence,

and,

of translation
(tuced,
an(l the

angles

at the

hip

joint

phase

and

relative

producing

pelvic
tilt, the
the swing-through
The
vertical

of its
energy

at

are

Pelvic

Tilt

the

pelvis

knee

effects

joint
of that

of pelvic

the

by

rotation
rotation

occurs
alterduring
the

loss
of the

is tilted

at

the

the

relative
extremity

to the

limb

of the

swing

phase

of the

must

center

of the

of that

arcs

are

In

this

way,

to the

Trendelenburg).

extremity
the

flex

the

horizontal

displacement

of

arc.

rendered

extension
is reis conserved.

(positive
The

arc

is more
gradual,
in the succeeding

relative

5 degrees.

limb

pathway

extremities
summit.

downward

theoreti-

the

in flexion
and
of the member

adduction
in the

of our

of potential
energy
center
of gravity

the hip
oscillation

or lists

a study

somewhat

of successive

in relation
The

of the non-weight-bearing
member.
on

by

flatten

elevating

of the weight-bearing
is on the average

of the

tilt

to

intersections

elevated

an equivalent

abduction

appreciated

are

angular
rotation
for the internal

side opposite
to that
angular
displacement

at. the

experimental

time,

be

gait

is greatly
reduced.
to (-hiange
the direction

locomotion

plane
on the
The alternate

best

rotation

in compass

of inflection

same

Determinant:

In normal

can

of pelvic

is less. The
energy
required

arc

Jlie Second

rotation

effects

of gravity

the

abrupt

The

energy
cost in locomotion
and the force
required

cycle.

to allow

of gravity

occurs

in the

are

stance

To

permit

clearance
evident

for
in the

(Fig.
5). As the lateral
list occurs
while
the body
is passing
over the
supporting
member,
the center
of gravity
is lowered.
Thus
the summit
of the at-c
translation
falls and still further
flattening
of the pathway
results.
The saving
of
by the cutting
of the vertical
displacement
of the center
of gravity
in half is obvi-

ous. Furthetof the knee

The

high.

center

phase.

less

the

in

im-

Rotation

line of progression.
of this rotation

The

passage
In

hip

but

would
require
a consideration

a total
of some 8 degrees.
Since
the pelvis
is a rigid structure,
this
nately
at each hij) joint
wiiich
passes
from
relative
internal
to external

cal

the

and

point

01

stance

the

exceedingly

three
At

at

of stride,

acceleration
it is from

of locomotion

permits
produce

be imitated,

length

displacement.

a simple

the

rotation

approximately

the ai)rupt
change
in direction
of the forward
of force of considerable
magnitude.
Nonetheless
that

angular

gait

and

the arcs,
plication

This

with a pair of compasses

or
in forward
translation
would
be equal
to the length
of the

the

compass

elevated

joint.

would

of this type
might
fixed in extension.

stature

be

of a hip

quasilocomotion

of stepping-off
distances
of gravity
of the system
radius
of these
arcs would

representing

EBERHART

equivalent

system

something
analogous
to the process
dividers.
The pathway
of the center
be a series
of intersecting
arcs. The
flexion
perfectly,

D.

model

energy
is saved
i)y greater
reduction
of the limb
in the
swing
phase
likewise

at the inflection
of the arcs. The flexion
conserves
energy
by the shortening
of

pendulum.
Third

Determinant:

A characteristic

Race
of locomotion

Flexion

in

is the

the

Stance

passage

Phase

of the
THE

body
JOURNAL

weight
OF

over
BONE

the
AND

supporting
JOINT

SURGERY

DI-:rF:HMIN.NT5

IN

NORMAI

A ND

PATIIOL0GIC.L

1-in.
The

effects

of

Inn.

Note
(onni)ined

hat

tilt achieve
of the center

VOn.

35-A,

No.

3,

JUlY

1953

.)

pelvic

tilt

side
furl her
of t he ceniten

weight-hearinng
of translation

it

tine

Ii

549

(;AIT

effects

pelvic

on

tin

flatten
of gravit

10)11-

he arc

(
of knee
rot at ion and

minimal
v(-rt
of gravity.

i(Il

flexion

(hisplacem(-n

pelvic
I

J.

550

The

net

effect

Ii.

of

DEC.

Fin.
the

M.

SAUNDERS,

V.

T.

INMAN,

AND

H.

D.

EBERHART

7
determinants,

pelvic

rotation,
pelvic
tilt, and
knee
flexion,
produces
flattening
of the
arc
of the
center
of gravity.
This
is the
equivalent
of progressive
lengthening
of
I he extremity
with
tine same
length
of stride
and
reduction
inn the range
of flexion
and
extension
of

the

as exempliho-oi

iIiJ)

inn the

series

of figures.

extremity

while

dergoing

flexion.

member
heel

enters
strike

with

extension.

to flex

until
ion

The

effects
of the arcs of foot
and
knee
rotation
abrupt
inflexions
at the intersection
of
of translation
of the
center
of gravity.
out

lock

is

since

extension
If

apparent.
further
act

the

knee

prior
The
low-ct-ed

These
in the

to its

examine

we

is first
final

the

summit

with

in extension,

full

weight-bearing,

tue

(Fig.
arc

conservation

6),

the

described

extremities

the

at

in full

knee

joint

to (to so

on

the ground.
of this flex-

Immediately

middle

of

ante-

the

period

the

of

knee

into

joint

extension
followed

tue

knee.
heel

terminal

flexion

This

begins

simultaneously

rise,
into

as the limb
is at length
carried
the swing
phase.
This
erioi
of
stance

40

per

to

as

phase,

the

with

occupying

of the

cent.

of

by

the

ai)out

cycle,

period

of

by flexion,

effects

of

by

passage

of energy

three
determinants
of gait-pelvic
same
direction
by flattening
the

of the

the

phase
joint

continues

more
passes
is immediately

unlocked

the

reduces

materially

walking

rotation,
arc

the

over
of the

by reduction

is referred

double

and

again

which
the

a flexed
center

knee

locked

tilt,
the

and

in

extremities

of flexion
THE

JOURNAL

and
OF

l)ecome

flexion-all

of gravity
of the

arc,

net effect
of which
relative

extension
BONE

is still

displacement.
knee

center

its summit.
The
of a circle,
the radius
extremity
(Fig. 7). The

range

knee

of gravity

of its vertical

pelvic

through

i)O(ly is translated.
The
first-pelvic
rotation-elevates
second
and third-pelvic
tilt and knee flexion-depress
passage
of tine center
of gravity
through
a segment
and two-tenths
longer
than
the length
of the low-er
ening

stance
knee

is tin-

flexion.

model
of

the

locked

the

15 degrees.
to

the

smooth
the
arcs

the

---

supporting

the

and

nor
once
which

---

joint

the foot is flat

average
magnitude

The

knee
The

Thereafter

begins

Fin,

its

AND

the
the

is the
is two
length-

at
JOINT

of
and

the
SURGERY

hip

DETERMINANTS

IN

NORMAL

AND

influence

exploded

joint

of the several

view

of locomotion

required

to

tremities
plays
slight
increases
lengthening

The

In

with
the

at

and

the

the

angular
phase
ankle
heel

of the

a radius

contact

by

of the center

is equally

of stride.

increases

Foot

fourth

of the

and

and

of gravity

relative

elongation

of its arcs.

ex-

Mechanisms
of locomotion,

center

Accurate

of the

velocities
of gait at
are achieved
by the

cadence.

determinants

of the

is seen in this

spaced.

The

in

Knee

fifth

pathway

foot

level

and

establishing
a sinusoidal
The translation
of the

Determinant:

As has
been
weighit-hearing

duced

by

the

extremities

sarily
inches

(Fig.

view

exploded

the
for

of gravity

recordings

we

in the

of the

be half
(Fig.

are

plane

phase

concerned

of progression

relationships

of the

angle

mentione(I,
extremity

the
at

the

of this

approxi-

curvature

arc

with

point

initiation

is similarly
heel

rise.

The

pattein
of the knee and the (-enter
of the abrupt
inflexions
at. the point
center
of gravity
smooths
the gait
by

obliteration

the

with
plane

a great
reduction
of energy
of progression
is illustrated

cost.
in an

of the

Pelvis

necesthiree

11)

which,

vertical

i953

displacement

reversing

associated

the

of

in

JULY

on the
8. The

progression

slightly

knee

rise.

so that
its lowest

with

forward

termination

second

reached

heel

one

the

3,

of the

has

extended,

associated

of the

with

the pelvis
or by relative
adduction
at the hip.
another,
the amount
of this displacement
would
between
the axes of the hip joints,
that
is, approximately
lateral
displacement
is corrected
by the existence

to

an(1

NO.

its

and
The

flexion

foot

rotation

over
is pro-

one

35.A.

with

flattening

of

is fully

of gravity
of the

the

is displaced
laterally
This displacement

shift

parallel

and

joint

by

in association

the center
of gravity
of the body
twice
during
the cycle
of motion.

Thus

horizontal

thus

Displacement

(hiSplacement
to about
vertical
displacement.
both

centei-

flexion

translation

Lateral

(Fig.

knee

is made

foot

9).

the interval
10). Excessive

tibiofemoral

the

pathway
for its progression
center
of gravity
in the

horizontal

were

the

of translation.

at the foot
in Figure
of

and

arc

of the

of gravity

time,
arc

second

part

and

center

by

arcs

The

fore

plantar

some

reversed

effects
of the rotations
of gravity
are illustrated
of intersection
of the

Sixth

length
Rapid

of its

slightly

heel.

the

is dorsiflexed

maintains

same

the

at

maximum

commencement

flattened

by

displacement.

tue

the

formed

the

flexion,

mately

VOL.

of motion

length

than

established

is at its

of knee

the

stage

same

Determinants:

out

a center

of downward

The

each

important
role in permitting
increased
since greater
velocities
of locomotion

rather

of intersection

Itl)OUt

extremity

at

Fifth

discussion

about

At

which

the

stride

of gait on the passage

displacements
at the ankle,
foot, and knee show that their
motions
are intimately
Two
intersecting
arcs of rotation
are established
at the foot during
the stance
(Fig.
8). The
first arc occurs
at heel contact
and is described
by rotation
of the

related.

foot

maintain

smoothing

point

in

an exceedingly
in energy
cost,

of the

Fourth

determinants

551

GAIT

FIG.

The

PATHOLOGICAL

together
three-quarter
(leviation

planes.

with

relative

adduction

at the

hip,

inches
so that
it approximates
of the center
of gravity
is almost

Togethei,

these

deviations

of the

center

If

of

reduces

the

the
the

that
of tine
symmetrical
of gravity

552

J.

fl.

oN.

Fit;.
Fig.
in

of

l():

exo-o-s.sivo

If I lie linnins
laten-al

.\I.

SAUNDERS,

\.

T.

INMAN,

AND

H.

D.

EIIEHLIA

RI

10

were

pan:nllel,

olisplao-ennennt

thene
of

tine

woulol
Fin.

centen-

11

gravity.
Fig.

I:nt enal

11: Thurougin

tine

displ:n-ennenni

is

influence
(onrecte(

of a tii)iofennoral

angle

Fin.
The sum of tine (fleets
is viewed
inn I nw phase

and

of

adduction

at

tine

hip

joint,

exo-essive

of tine several
relationship.

determinants

12

on

the

1HE

pathway

JOURNAL

of tine

OF

(enter

BONE

AND

of gravity

JOINT

SlRGlRY

DETERMINANTS

to the

contribute

IN

establishment

in the

equal
axes and add smoothness
replaced
by a sinusoidal
curve.
tiOflshii1)

in

Figure

these

gerations

range

in the

h)V

of gait,

the

described,

an(l
minor

the

Gait:

(lone

phase

for

by

in one
various

or another
of
factors,
exag-

reductions

in another,

essentially
the same
in that
it is
disturbances
of the limbs
have
of one function
is frequently
well
in the

clinical

examination

In

of

already
this way

Levels
should
be said coneeining
mathematical
formulation,

energy
level of a body
is tile
the energy
level is constant,

where
the loss of potential
When
the energy
level

sum
as

the energy
qualitative

of its potential
in the classical

and
cx-

energy
is exactly
compensated
is not. constant,
then
work
must

for
ie

to produce
the change
in energy
level.
In the computing
of the energy
levels
diffeient
segments
of the low-er extremity,
it is found
that
the levels
are not conThe difference
is a measure
of the work
done by the muscles
at the joints.
The net

in ordei

result

is the

pated

in the

put

of energy

and

hip

level

forw-ard
i-otations

stu(hies

of the

is considerably

walking
the

ergy.
though

However,

out}Jtit

is so much

the
by

later

body

at

the

(Inc

to

the

swinging

the

levels,

the

leg
knee

the
less

Part

of

time

-hen

push

the

most

of the

the

a large

portion
of the
referred
to as the

are

energy

is dissi-

output

an(1

input

process,

a rigid

phase

by

of its

potential

member

the

Outj)ut

of the

; therefore,

establishied
most

of the

energy

required

on

joints.

In

this

overall

energy

Additional

imparting

energy

also

hut

flexion;

is

of the
the

to

knee

energy
system

acceleration
locomotion

to
is not

of the

(leceleration

at

a constant

cadence
of the

energy

eited

into

in one

or more

expended

Potential

(luring

recoverable.

of the
There

storage
35-A.

NO.

energy

straight

JULY

conti-act

is evidence,
occur
1953

would
of the

dut-ing

does
3,

and

segments

1)0th

energy

energy

the
only

knee.

and

level

walking

at

divided

expend

althan

by tile

all

returned

pull

en-

and,
is less

not

Thus

to the

absorbs

by

forward

for

knee

approximately
equally
between
the production
of rhythmic
oscillations
and
the elevation
and depression
of the center
of gravity
of the body.
mechanism
were a truly
efficient
machine,
the kinetic
energy
in the system

The

in-

ankle

of the

is ahsOrbe(l

and

is lost.

case

requirement

continued
energy

body

Nonetheless,
stored

the

predominantly

of the

swing
phase.
portion
is

in support

joint

motion
the

knee.

that

these

that

vertical

(luring
the
A considerable

sw-ing

been

input

acting

the

over

is lost.

the

than

in

foot

the

muscles

(leereases

and

it has

than

in walking

he necessary

to decelerate
the

by

the knee
is dissipated

energy

absorbed

energy
greater

is provided

joint,

w-ould

displacement
of the body,
but
of the segments.
These
effects

respectively.

From

VOL.

are
rela

ltssesSe(l.

gait is considered,
something
In or(ler to aVOi(l lengthy

of a simple
pendulum
gain in kinetic
energy.

of the
stant.

in

and

in true

GAIT

Therefore

be readily

Energy

will 1)e laigely

employed.
rflie
enet-gies.
If no work
is done,

the

obliterated

be focused
serially
on the six determinants
losses
in their
range
should
I)e noted.

may

teims

by

are

exaggerations
between
the

compensated

of another.

should
and

(luring

ample

are

to

of gravity
remains
Even
gross
pathological
pattern,
since the loss

of gait

pathological
locomotion.

OF

are due
the interaction

center

levels
kinetic

of approximately

is illustrated

EXAMINATION

exaggeration

of Patholoqical

Before

spiral

inflexions

factors

.)33

GAIT

of the

all sharp

these

determinant

attention
exaggerations

disturi)ances

Evaluation

since
of

CLINICAL

of one

the

for

(hisOr(ters

even

sum

in locomotion
Owing
to

so that
the final pathway
of the
the most
economical
to maintain.
little
influence
on the fundamental
compensated

of progression

gait,

The

PATHOLOGICAL

12.

variations
determinants.

seven-al

AND

plane

to the

THE

Individual

NORMAL

in the

be stored
body.

ion and

however,

muscular

until

However,

since

elongation,
that

system

it is required
energy

under

certain

and

perhaps

tile

muscles,

specific

If the

human

\o1il(l

he

to initiate
when

storage

is never
and

as much

40

con-

movement
stimulated,
complete

rigid
as

is
legs

or

situations,
per

cent.

of

554

J.

200

I).

M.

DEC.

SAUNDERS,

T.

VERTICAL

/00

V.

INMAN,

AND

H.

D.

EBERHART

LOAD

FUSED

ANKLE

NORMAL

ao

ANKLE
TIME,

SECONDS

FORE

Q_40

AND

AFT

SHEAR

2\j/)/:t,v//\
FIG.

13

of

Fig.
13:
a person

shown.

The

There

Fig.

14:

motion

acceleration

of the
figure).
and aft
The

joint

center

inflexion
in the
arcs
of
ankle
is transmitted
to the
by excessive
flexion
maintains
the path of translation
of the

of

of gravity.

volve

the

contraction
moving

As

the

center

of the

is expended

recovered
on its descent.
tinde
of this- expenditure
walking
up a slight
grade

body

during

The

net

result

is qualitatively
is much
more

is displaced

its

is a continual

With

the

loss

of

one

of the

major

determinants

the

grade
pull
as

this

expenditure

the

minimal

of pathological

of energy.

to

very
action

the

muscle

sinusoidal

of the
of the

brief
periods
of two joint
pathway

a portion

of this

of energy.

of low

energy
The

That

of approximately
of gravity.

a result

compensate
w-ithin
their
ai)ility
of the body through
a sinusoidal

requires

recovery
they
in-

that
walk-

4 per

of injury

or

is

magni-

i)y the common

experience
w-alking
on the level,
whereas

i-emaining
mechanisms
will
ment
of the center
of gravity
analysis

of

mechwhich

displacements
the
limiting

the

expenditure

appreciated
fatiguing
than

ing down
a gentle
slope
is still easier.
A descending
requires
little
or no elevation
of the body
against

its

only

and
but

timing

to the
segments,

and

locomotor
The factors

storage
here,

precise

through

elevation,

the

energy
discussed

muscle
contraction
of activity,
and
muscles.

of gravity

energy

is
be-

and
the normal
figure
illustrates
not altered.

abrupt

which

permit
this
will not be

amplitude,

foot

difference

fused
ankle
The
lower
shears
are

the energy
put into
anism
is recoverable.

14

body

of one

at the fused

the smoothness

Fin,

of the

panarthrodesis

is no appreciable

tween
records
ankle
(upper
that
the fore

knee

vertical

with

cent.

disease,

the

to produce
an over-all
displacepath
of low amplitude,
since
this

is true

is confirmed

1)y

gait.
THE

JOURNAL

OF

BONE

AND

JOINT

SURGERY

Hfl

DETERMINANTS

The

Force

IN

NORMAL

AND

PATHOLOQICAL

VERTICAL

Plate

rea(Iy

means

determining

GAIT

of

is

tue

availai)le

vertical

for

FLOOR

REACTIONS

tine

displacement

of

O.D.

B.w.

tine center
of gravity
of the body
thi-ough
the
use of a force
plate.
A force
plate
is a device
for measuring
the ground
i-eactions,
including
torque,
(luring
locomotion.
Essentially
the
al)Paratus

of a
supported

consists

is

which

rigidly

columns
opposing
all).
The

to which
are
pairs
of strain
deformations

coordinates,
by balanced

as well
1)ridge

OIl

by

In

operation,

plates
in

the

are employed;
the
course
of walking,

then

on

the

other

with

the

acts

as an

inertialess

The

force

plate

scale

center

two

Bare

of great

of gravity

of the

body

Furthermore,
accelerations,

plate,

therefore,

becomes

useful
instrument
for the
the degree
of compensation
major
are

constituents
amplified

study
which

of the
when

they

a pci-son

When

the

in

angular

changes

ankle.

The

degree

tions

of the

force

the

only

the
the

sound

body

of the
is over

with

lower
are

abnormality
to the
is normal

In the

Minor

changes

is the

arthrodesed
joints.
Because
two
intersecting
arcs,
the

foot.
However,
an exaggeration
the curve
of knee
displacement
VOL.

35-A.

shock

NO.

3,

JULY

wave

arthrodesed
foot
and is accomplished

1953

(Fig.

of the
centers

have

little

indicating

effect

on

a smooth

verti-.

transla-

of gravity.
for the evaluation
of
of one or more
of the

in the

displacement

pattern

acceleration.

GAIT

of the

may

Reactions

15

1G.

heights

and
loss

the

in vertical

ankle

of the knee
compensate

force-plate

heel

locomotion
following

as changes

a panarthrodesis

of compensation

Varying

hes9ht5

heal

very

extremity.

pattern
and hip

cal floor reactions,

tion of the center

of pathological
has occurred

recorded

displacement
in the knee
plate.

heels

Effect of varyin9
on VertcaI
Floor

PATHOLOGICAL

changes

#{149} ,,

eg s

force

hQels

by geomet-

since
the force
it is exceedingly

The

Flat

vertical

methods
for
the
determination
of sudden
deviations
of the
center
of gravity
of the
body
caused
by
aitei-ations
in acceleration.
.

shoes

measured
accelerathe displacement

any
changes
in the normal
dispattern
of the
body
as a whole
more
accurate
than
photographic

placement
and
is

Flat

sensitivity.
the

to

sensitive

foot

such)

are set flush)

the apparatus

directly

accelerations.
From
these
tions,
it is easy
to calculate
of the

of
in
z

subject
Stepfirst
on one,

plate.
ihese
In essence,
records

nc integration.
plate
measures

plate
metal

bonded
a series
gages
(some
fifty
in the
x, y, and

force
ping,

walkway.

metal
four

as torque,
are measured
circuits
and are iecoided

oscillograph.

an

heavy

be

measured

record
noted

and

subtalar

and hip may

for the functions
by

recording

presented,
during

the

the

walks,

minor

noted.
These
small
lost in the foot and
the

vertical

compensation

transition

13). The
pathway
by exaggerating
the
fixed ankle,
of which
are

joints
be

accelerais excellent;

of body

weight

of the center
of gravity
initial
knee
bend
on the

the displacement
located
at the

of the initial
knee
flexion
prevents
from
being
transmitted
to the trunk

heel

of the
and

from
of
side

knee
joint
ball of the

the discontinuity
and maintains

of
the

.1.

H.

n)n.;(.

\I.

SAUNDERS,

V.

T.

INMAN,

AND

II.

D.

EIIERHART

ZI-.

Oz
OW

o
0

-Jil.
11.0

Id
>Q.

Id

120
PERCENT

VERTICAL

OF

FLOOR

SUBJECT

REACTION

WITH

l)(n1sate

at

less

1)0, slight

Illodificat

tern
A

iiile

angular

they

this

pelvis,

loss
hips,

is
and

(xaggeitite(i,

ever,

not

similar

vei-t

(Fig.

15).

flexion

up
Tine

ieal

an

The

the

ions

exaggel-at((l

weal-ing

(emit

ci-

of

high

of

gI-avity

\Vhen

of the

tine

knee

ai-i-angement

chai-aeten-izes
tine

patient

compensatoi-y

To

gain

since

clearance

the

are

achieved,

is

the

important

of tile
a

which

is

the

pelvis

retention

of

the

the

Thus

for

of the

normal

in gait seen
in
low heels,
the

In

familiar

to
show

person

is

the

the

in

and
This

is,

that

in

this

high

or
hip

mechanism

pathway

of

the

rotation

all.

mci-eased

foot

in both
whole

namely,
tilt

pelvic

records
and

loss
a normal

tilat

14)

compeflsate(l

howgait

low

heels

an(l

knee

cause(1

displacement

by
of the

maintained.

stiff

movements

foi-

result

the

cOni)-

constituents,
and

force-plate
the

These
to

(Fig.

in the change
of heels.

remaining

whether

offset

its

segments

gait

of

t.he

with

with

the

the

showni.

lower
extremity
are similar
of the foot to the integrated

is increased

(-haractei-istic

body

ith

heights

the

attempt

body.

various
of

is

tine

completely

(lepicted

in

gait,

the

hip

of tile

flexion

to

of
and

hip

side.

b)een

contributions

knee

is immobilized,
of

knee

of

affected

has

tue

a fused

indicative

gravity

with

movements

body

of

segments

motions

heels,

tine

modifications

aflecte(l

aceelerat

on

shloes

initial

pi-oducing

motioin

is vell

the

of

are

of gravity

vaiious

by

an-c eompensatoi-v

the

out.

made

met-ely

ceiltel
mechanism
in

presence
anud

mechanism

(lecrease

knees.

the
side

of

HIP

(enter

ankle

walking
he

of

beliavion

the

()I

loss

tile

of

the

in

normal

tine

an(1

of t
heels

high

for

t(IIl

iii

tie

neactionis

the

oIl

foot

iOilS

However,

and

of

the

displacement

sexes.

Otis

I)1t

of

floor

inij)

of (lisplacenlent
siniilaiCOflll)eilsat()Iv

\VoIiTlen

RIP

nornnml

(lisplacenlent

I1OIlilal

(OnlIJIete

l)itt

the

inn I lie
refl((-te(l

FOR

FUSED

Fnn.
Tine (Iiffenennc(
al)nnorlnalities
are

CYCLE

knee
in

foot,

lower

the

contm-ibution
extremity

requires

remaining

excessive

to the

obviously
no

detailed

normal

elevation

JOURNAL

and
The

description,
segments

of the
THE

orderly
is lost.

pelvis
OF

but

should

on the
BONE

harmonilimp

AND

be

affected
JOINT

which

certain
pointed

side
SURGERY

DETERMINANTS

is necessary,
Sl)it(

or

of

increase

(leviations
body

these

gravity

of

an

IN

in

the

from
retains

of the

NORMAL

heel

AND

is required

rise

what
are considered
a remarkably
constant

(hisplacelnent
as noted
from
the force-plate
t Inc kiiee
of from
is to 20 degrees
is pieserved
The
nlechianisms
of tile low-er extremity
vell

for

gravity

of

extent,
in

(ally

tile flexion
the swing
1)y

Early

flexion

lie leg

lie swing

pilase.

swing

phlase

initiate
tion

swing

by

to start

the

knee

of

prostheses

for

All

of these
to

with

had

managed

the

expense

side

reduction

of the

moment
a (louble
this
Tile
ion

[he

remaining

VOL.

35-A.

exerted

center

of

an

the

path

to

be

intended
appearance

of
the

the

the

knee

amputees

the

heel

rise.

mechanism

they

With

played
study

by

the

to

develop

knee

beginning

the

devices

Adjoints.

of the

However,

the

a wrench

functionless

insist
placed

over

that

and

so that

a pylon

distally

that

In tile

pendulum

prosthetic

gait..

which

energy

swing

increased

provide,

requires

more
energy.
(The devices
were,
therefore,
disliked
by the ampitwould
leave
the limb shop with a well functioning
device
and an
in his gait,
only to return
at a later
time
with
a free-swinging
knee

-eight

phase.

Council

the

the
role
in the

expended

at the

the
to

Immobiliza-

of the

Research
rise

in locomo-

gained

been

into

joints,

is several

tripling

example

has

heel

that

commencement

of gravity.

experience

effort

the

hip.

to initiate

the propulsion
of
the energy
necessary
almost

A vivid

incorporated

whole

of the

requirements

to

National

to limit

the

alone

flexors

center

leads
by

of the

flexors

at the

energy

of the

limb.

the

hip

little
toward
to reduce

Much

of

the

hip,

two thirds.
it converts

knee.

the

braces

the

since

flexors

hesitancy

arthrodesed

is provided

in

of

of the
hip

phase
and
imparted

in the

of the

stump

conventional

by

the

driver

the

cost

was

lowered

at

realize
to initiate

the
the

importance
swing
phase

of
on

should

he as light

as possible

does

appreciably

itself

and
the

of a free

amputee

energy

extremity

prosthesis,

incorporation

a screw

the

thus

not

requires
of the

knee

obviates,

joint

increase

minimal

conversion

in weight.

lower

effort

to

extremity
to a certain

difficulty.
inconspicuous
be detected
normal
segments

can

easily

for
NO.

at

reasonably

of inertia

the
by

by the

involved

Limbs

extension

w-hen

relatively

posit

partially

out

amputees.

abnormal

of inertia

tine swing

degree,

be

or long

locomotion

the

to render

amputated

if flexion

of the

muscles

moment

requires

contributes
does function

of the

devices

flexor

requirement

and

with

casts,
phase

the

the

in minimizing

to smooth

Artificial

and

The

into

and

improve
flexion

the

pathway

in

tile centciof vertical

double
weight-bearing
by the upward
thrust

of the aesthetic
appearance
of his gait.
exponents
of pylons
for above-the-knee
amputees
joint
in decreasing
tile amount
of energy
required

The

stai-t

noimal

by

he observed

knee
joint

knee

were

its resultant

tine knee

the

the

in the
partly

force

a force

The

hydraulic

the amputee
to expend
tee.)
Many
an amputee
improved
appearance
joint

However,

S particularly
true
time
of its fixation.
are able to compensate

partly

the

joint

arthrodesis,

on

to

iPsistance

side.

rfili

decreases

of a person

knee

the

mechanisms

an(1

1)llase

gait

above-the-knee

and

fllecilanical

that

swing

and

mechanism

as may

in human

Committee

visoi-y

this

demands

phase

joint

normal

third
and the former,
approximately
of the swing
phase
is important,
thus

normal

but

knee

the

decreases

emphasized.

tile

by

in turn

in the

of the

tequired

and

tile

space,

foot

one
initiation

at the

of the

be

thi-ough

tile

as normal
bodily
motions,
and nearly
normal
path

of

occurs
late
is produced

of the

suppresses

impon-tance

should

body

on

records.
at the
apparently

maintenance

pendulum

This

than

The
ti()Il

knee

greater

of the

knee

This

of tile

times

the

hip, which
of walking,

flexion

a double

extremity.

Fixation

as

approximately
of the

into

lower

of the
phase

plantar

contrib)uting

far

557

CAIT

and the minimizing

of the energy
loss necessary
for external
work.
necessary
to initiate
the swing
phase
on the side of the stiff knee
three
times
that of the normal.
The flexion
of the knee and, to a lessei

1)ody

latter

as

the energy
to almost

leg

tile

knee

the

Iloweven-,
is increased

to

stiff

tile

PATHOLOGICAL

the
3.

JULY

loss
1953

of the

hip

limp

caused

by

an

arthrodesed

by

abnormalities
of the inferior

in the vertical
extremity
are

joint.

It will

that

be recalled

pelvic

hip

in good

functional

floor reactions
(Fig.
able
to compensate
rotation

and

pelvic

16).
only
tilt

558

B.

..

are important
of tile i)O(ly.
hip

joints

At

SAUNDERS,

M.

factors
in
the point

weight-bearing,

importance.

respect
the

which

T.

INMAN,

the vertical
elevation

with

in

externally
about
the weight-bearing
of the femur
with respect
to the
of considerable

V.

(lecreasing
of maximal

in mid-position

are

double

m)LC.

are

hip
pelvis.

joint.
This

the

hip

U.

D.

EBERtIAIt

displacement
of the center

to rotation.

feet

When

AND

of the
of gravity

From

videst

apart

remains
and to allow the
loss of one of the major

The

by exaggerated
reveal.
In such
body

is still

motions
cases the

translate(l

ever,
the amputee
and the vertical
minor
high

by

disease

So

system

is the

subject

which

through

in direction
from
are required

great

elderly

smoothly

cost

will

must

that,

as

our

pathway

experience

shorten

his

rotation
phase

life

requirements

at

fully

normal
manner.
compensated
amputees
of gravity

at low

shown,

the

the

is

limitation

energy

for
clearly
of the

cost.

How-

satisfactorily
Because
of the

pathway
of the center
of gravity,
and make
such
deviations
very

has

from

of

rotates

during
the swing
what little
internal

is unable
to compensate
from the normal
pattern.

the smooth
sinusoidal
which
dissipate
energy

inevitably

supply

knee

position

pelvis

resultant

below-the-knee
that
the center

a sinusoidal

foot and
markedly

the

with

to rotate
in an approximately
of the extremity
is almost

levels
as studies
in
floor reactions
indicate

who has lost both

floor reactions
deviate

changes
accelerations

costly.
the

at other
vertical

pelvis
joints

to the

stride,

be expressed
as internal
rotation
although
of small
magnitude,

of motion,
it will be found
that
the hip vill be held in external
phase
so as to be in a position
to make
available
during
the stance
rotation

point

in the

This may
movement,

is affected

this

center
of gravity
of the body,
the

the

demands

loss

upon

usurious

rate

of two
his

of 300

joints

in

cardiovascular
per

cent.

SUMMARY

Human
so

locomotion

is a phenomenon

the multitude
of space
that
analysis

great

planes

of the

of individual
is difficult

are

of the concept
that
fundamentally
through
space
along
a pathway
necessary
unifying
principle
which

most

motions
without

extraordinary

complexity

occurring
simultaneously
some
unifying
principle.

locomotion
is the
requiring
the least
permits
of qualitative

translation
expenditure
analysis

in which
in the three
The
adoption

of the center
of gravity
of energy
supplies
the
in terms
of the essential

determinants
of gait.
The
six major
determinants
are pelvic
rotation,
pelvic
tilt,
knee
and hip flexion,
knee
and ankle
interaction,
and lateral
pelvic
displacement.
The
serial
observations
of irregularities
in these
determinants
provides
insight
into individual
variation and a dynamic
assessment
of pathological
gait.
Pathological
gait may be viewed
as
an attempt
to preserve
as low a level of energy
consumption
as possible
by exaggerations
of the

motions

at

of one
makes

determinant
effective

unaffected

of which
compensation

threefold

is increased

levels.
that

with

an

Compensation

at the
impossible

is reasonably

effective

knee is the most costly.

Loss
and the cost of locomotion

inevitable

drain

upon

the

body

with

the

loss

of two determinants
in terms
of energy

economy.

REFERENCES

M. I.;

1. CROSKEY,
of the
2.

P.

DAWSON,

of Gravity

in

H.

D.;

INMAN,

T.

D.;

Fundamental

Berkeley,
MARRY,

Artificial

University
La

E. J.:

Limbs.

A Report

of California,
m#{233}thode graphique

A.

LUESSEN,

Am.

V. T.;

EBERHART,

of

M.;

Man.

MCCOWAN,

Design

3.

Center

J.

J.
on

the

1947.
dans

Human

National

les

sciences

I. E.;

HAHRON,

61:

SAUNDERS,

Studies
to

C.;

Physiol.,

171-185,
B.

and

H.

WRIGHT,

E.:

The

Height

1922.
M.;

DEC.

Research

and
Council,

exp#{233}rimentales,

THE

JOURNAL

S.;

A.

LEvENS,

Locomotion

Other
Committee

Paris,

OF

on

G.

BONE

B.;

BRESLER,

Information

Masson,

AND

and

Relating
Artificial

Limbs.

1885.

JOINT

SURGERY

to