GAIT ANALYSIS

PRESENTER –
DR.NISHCHAIY
NASA
GAIT
 It is defined as continuous rhythmic
alternative movements of lower limbs, in
order to achieve forward propulsion of
the body, by moving center of gravity in
forward direction with minimal
expenditure of energy
GAIT NEEDS 3 COMPONENTS

1) Progression: This is basically the forward

fall of the body weight. The primary force for
this is generated by the lower limb.

Secondary momentum may also be generated

by swinging motion of the upper limb
2) Stability: The forward fall is a controlled fall
that, at all times, maintains the upright stability
of the body.
The body is most stable during the stance phase
when the ankle, knee and hip are vertically
aligned and least stable during the swing phase.
3) Energy conservation: Gait Efficiency is
improved by reducing the amount of muscular effort
required to walk.

Can be done in two ways -

I. Substituting momentum for muscle action
Achieved by smooth swinging movements without
jerks and abrupt starts and stops.

2. Minimizing displacement of body from the line of

progression  Done by coordinating pelvic ,knee and
ankle motion, Ensuring that the center of gravity of
body displaces only by 5cm up and down and 5cm
sideways
SAUNDER’S DETERMINANTS OF GAIT
 The optimizations used to minimize excursion of COG
in vertical & horizontal planes are known as
SAUNDER'S DETERMINANTS OF GAIT.

The six determinants are

 1. Pelvic rotation
 2. Pelvic tilt
 3. Knee flexion
 4. Ankle mechanism
 5. Foot mechanism
 6. Physiological valgus of knee
 BENEFITS OF GAIT ANALYSIS
 To diagnose mechanisms responsible for
gait disorders.
 To assess the degree of disability.
 To evaluate the improvement resulting
from treatment.
 To evaluate the rate of deterioration in
progressive disorders that affects gait.
 For quantification for clinical & research
purpose.
GAIT TERMINOLOGIES

 Base of support
 Step length
 Stride length
 Gait cycle
 Cadence
 Walking velocity
 Double limb support
 BASE OF SUPPORT

 It is defined as the supporting

area beneath the body.
 It includes the points of contact
with the supporting surface and
the area between them. These
points may be body parts (such as
feet), or extensions of body parts
(such as crutches or other walking
aids)
 In a normal healthy person it
refers to the distance between a
person’s feet while standing or
during ambulation.
 Normally it is 2-4 inches from heel
to heel.
 STEP LENGTH

 It is the linear
distance along the
line of progression
of one foot
travelled during
one gait cycle.

 It is approximately
15 inches.
 STRIDE LENGTH

 It is the linear
distance in the
plane of
progression
between
successive point of
foot to floor contact
of the same foot.

 Normally 27 — 32
inches.
CADENCE
It is defined as the number of steps taken per
minute
The average no. of cadence in adults is
90-120/minute

Walking velocity
It is the speed of ambulation on a smooth surface
Average walking velocity in a normal individual is
around 262Ft/min.

Average velocity (m/min)= step length(m) X

cadence(steps/min)
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 and the center of
gravity is at it’s lowest
point.
 It happens between push
off & toe off on same side
and heel strike & foot flat
on the contra lateral side.
 GAIT CYCLE
 It is the period of time from
one heel strike to next heel
strike of the same limb.
 Each gait cycle has 2 phases:
 •Stance Phase : Defined as
the time during which the
limb is in contact with the
ground and supporting the
weight of the body.
 •Swing Phase : Defined as the
time period during which the
limb is off the ground and
advancing forward and the
body weight supported by
contralateral limb.
 SUBDIVISION OF PHASES
 Stance phase -
 1) Heel strike
 2) Foot flat
 3) Mid-stance
 4) Heel Off
 5) Toe off

 Swing phase -
 1 )Acceleration
 2) Mid-swing
 3) Deceleration
COMPARISON OF GAIT TERMINOLOGY
 HEEL STRIKE

 It is the beginning of
the 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.
 HEEL OFF

 It is the point
following
midstance at
which the heel of
the reference
extremity leaves
the ground.
 TOE OFF

 It is the point
following heel
off when only
the toe of the
reference
extremity is in
contact with
the ground.
 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.
 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
 DECELERATION

 It occurs after
mid-swing
when the
reference
extremity is
decelerating in
preparation
for heel strike.
ANKLE POSITION DURING VARIOUS
PHASES OF GAIT CYCLE
 Heel strike: Dorsiflexors of the ankle (tibialis anterior, extensor
digitorum longus and extensor hallucis longus) prevent foot from
slapping the ground.

 Mid-stance: Plantar flexors of the ankle(gastrocnemius, soleus

tibialis posterior and flexor digitorum longus) control the
movement of tibia over the foot.

 Heel off and toe off: Plantar flexors are most active at heel off
and become inactive at toe off.

 Swing phase: The ankle dorsiflexors act to maintain neutral

position of ankle, their contraction assures foot clearance. It
further ensures that ankle remains neutral or slightly dorsiflexed
throughout the swing phase.
THREE ROCKERS IN NORMAL GAIT

 First (Heel) rocker is heel strike at initial contact and

subsequent ankle plantar flexion.

 Second (ankle) is the tibial advancement over the foot

i.e. ankle dorsiflexion

 Third (forefoot) is the heel rise before toe off with

forefoot dorsiflexion and ankle plantar flexion.
KNEE POSITION DURING VARIOUS PHASES
OF GAIT CYCLE
 Heel strike: There is eccentric contraction of
quadriceps.
 Foot flat: There is concentric contraction of quadriceps.
 Mid-stance: During this both the quadriceps and
hamstrings are inactive and knee is extended passively.
 Heel off: During this the active gastrocnemius prevents
hyperextension.
 Push off: During this the vastus intermedius and rectus
femoris become active towards end to prevent
hyperflexion.
 Toe off to late swing: The quadriceps is active during
this phase and just before heel strike the hamstrings act
to prevent forward swing of the leg and to decelerate it.
HIP POSITION DURING VARIOUS
PHASES OF GAIT CYCLE
 Heel strike: During this the flexion beyond 30 degrees
is prevented by gluteus maximus and hamstrings. At the
same time, erector spinae prevents flexion of spine.

 Swing phase: It starts by shift of hip from extension to

flexion. This is accomplished by contractions of the
iliopsoas, rectus femoris, and sartorius muscles. The hip
adductors bring the feet toward the line of progression
thus decreasing the energy demands of walking.

 Late swing: During this the action of gluteus maximus

reverses hip flexion to extension.
 RLA PHASES OF GAIT
 Initial contact
 It refer to the initial contact of the foot of leading lower limb.
 Normally the heel is the first to contact.
 In abnormal gait it is possible that either whole foot or toes are the
first to contact.

 Load response
 It begins at initial contact & ends when the contralateral extremity
lifts off the ground at the end of the double-support phase.

 Mid-stance phase
 It begins when the contralateral extremity lifts off the ground at
about 11% of the gait cycle
 It ends when the body is directly over the supporting limb at about
30% of the gait cycle.
 Terminal stance
 It begins when the body is directly over the supporting limb at about
30% of the gait cycle
 It ends just before initial contact of the contralateral extremity at about
50% of the gait cycle.
 Pre-Swing
 It is the last 10% of stance phase and begins with initial contact of the
contra-lateral foot (at 50% of the gait cycle) and ends with toe-off (at
60%).
 Initial swing
 It begins when the toe leaves the ground & continues until max knee
flexion occurs.
 Mid-Swing
 It encompasses the period from maximum knee flexion until the tibia is
in a vertical position.
 Terminal swing
 It includes the period from the point at which the tibia is in the vertical
VISUAL REPRESENTATION OF RLA
PHASES OF GAIT
GAIT IN YOUNG

 The walking base is wider.

 The stride length & step length are lower &
the cycle time shorter.
 Small children have no heel strike, initial
contact being made by flat foot.
 There is an absence of reciprocal arm
swinging.
GAIT IN ELDERLY
 The age related changes in gait takes place in decade
from 60 to 70yrs.
 There is a decreased stride length, increased cycle
time(decreased cadence).
 There is relative increase in duration of stance phase
of gait cycle.
 There is an increase in walking base.
 The speed is almost always reduced in elderly people.
 There is reduction in total range of hip flexion &
extension, a reduction in swing phase knee flexion &
reduced ankle plantar flexion during the push off.
NEUROLOGICAL CONTROL OF GAIT
CAUSES OF ABNORMAL GAIT

 Pain
 Joint muscle range-of-motion (ROM) limitation
 Muscular weakness/ paralysis
 Neurological involvement (UMNL/ LMNL)
 Leg length discrepancy
TYPES OF ABNORMAL GAIT
ANTALGIC GAIT (PAINFUL GAIT)
 In this type of gait due to
pain anywhere from foot to
hip, the patient avoids
bearing weight on the
affected limb.
 There is reduced stance
phase, shortened step
length, shortened stride
length, shortened
reciprocal arm swing and
increased velocity of steps.
 TRENDELENBURG GAIT
The stability of hip during
walking is provided by bony
components of joint, muscles
around joint & normal
alignment of center of
gravity.

Any disruption in the Osseo

muscular mechanism
between pelvis & femur leads
to lost of stability of hip joint.

In Trendelenburg gait the

action of abductor in pulling
downwards in stance phase
become
 Abductor mechanism
comprising of head and
acetabular socket as
FULCRUM.
 Neck and trochanteric
region as LEVER.
 Abductor (primarily
gluteus medius aided
by TFL ) as POWER.
 Load is the lower limb
distal to trochanteric
region
 Trendelenburg test
can be positive in

 Failure of lever –
Trochanteric avulsion,
fracture neck of
femur, coxa vara

 Disruption of fulcrum-
Dislocated hip, DDH
or hips, Perthe's
disease

 Gluteal inhibition-
there can be pain
around hip due to
 QUADRICEPS GAIT
 Quadriceps action is needed during heel strike & foot
flat when there is a flexion movement acting at the
knee.
 Quadriceps weakness/ paralysis will lead to buckling
of the knee during gait & thus loss of balance.
 Patient can compensate this if he has normal hip
extensor & plantar flexors.

Compensation:
 With quadriceps weakness, the individual may lean
forward over the quadriceps at the early part of
stance phase, as weight is being shifted on to the
stance leg.
 Normally, the line of force
falls behind the knee,
requiring quadriceps action
to keep the knee from
buckling.
 By leaning forward at the
hip, the COG is shifted
forward & the line of force
now falls in front of the knee.
 This will force the knee
backward into extension.
 In addition, the person may
physically push on the
anterior thigh during stance
phase, holding the knee in
extension.
 STEPPAGE OR EQUINE
GAIT
 Weakness of pretibial
muscles causing slapping
of the foot during the
stance phase at the time
of loading response

 There is ipsilateral
circumduction of the limb,
ipsilateral high stepping
gait and contralateral hip
hiking

 Common causes- Peroneal

nerve palsy, L5
radiculopathy
 CALCANEAL GAIT
 It occurs due to
weakness of the
gastrocnemius-soleus
muscle group.
 As a result, reduced
foot propulsion occurs
during toe off period of
the stance phase &
patient walks on his
broadened heel with a
tendency of rotating
foot outwards.
 GENU RECURVATUM GAIT
 In this type of gait
there is excessive
extension in
tibiofemoral joint the,
knee goes in
hyperextension while
transmitting weight in
the midstance phase.
 It can occur due to
paralysis of the
hamstring muscles
(e.g. in polio), inherent
laxity of knee
ligaments and
 GLUTEUS MAXIMUS LURCH
 Gluteus maximus is the chief extensor & lateral
rotator of hip.
 Normally when body moves forward in mid stance
phase, the hip is extended by gluteus maximus
tilting pelvis backwards to retain center of gravity
over supporting leg.
 When there is weakness of gluteus maximus
muscle the stabilizing factor is lost & patient leans
backwards at hip to passively extend it & keep
center of gravity over stance leg.
 This causes backward lurch in gluteus maximus
gait.
 Patient walks with protuberant abdomen.
 Seen in poliomyelitis & above knee amputation
FESTINATING GAIT OR SHORT SHUFFLING
GAIT
 Due to rigidity of muscles the
patient adopts the stooping
posture (flexed neck, trunk,
hip & knee), in which the
center of gravity falls
anteriorly.
 Here the patient, with
stooping body, is propelled
forward quickly in
successions as if trying to
catch up with the center of
gravity.
 Examples : parkinsonism,
Wilson's disease, cerebral
STAMPING OR 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. It is seen in
peripheral neuritis, brain stem lesions, tabes dorsalis
in adults.
 DRUNKERS OR REELING
GAIT
 Here the patient tends
to walk irregularly on a
wide base, swinging
sideways without
stability and balance
with tendency of falling
with each step (it is
seen in cerebellar
incoordination, in
lesion connecting
pathway to & from the
cerebellum or in
drunken states).
HEMIPLEGIC/FLACCID GAIT
 In a hemiplegic gait the
shoulder is adducted & the
elbow & wrist are flexed.
 The patient swings the
paraplegic foot outwards &
ahead in a circumduction to
avoid foot scraping ground.
 It is seen in cerebrovascular
disease.
 WADDLING GAIT OR DUCK GAIT

 It is seen when there is disturbance

in the abduction mechanism of the
hip and there is increased lordosis.
 While walking the body sways from
side to side on a wide base.
Therefore, the patient lurches on
both sides while walking like a duck.
 Examples:
1. In b/I congenital dislocation of hip
2. Pregnancy
3. Myopathy
4.Paralysis of abductors of hips
CRUTCH WALKING PATTERNS OF GAIT

 Swinging crutch gait –seen in

paraplegics.
 Four point crutch gait –seen in unsteady
patient.
 Two point crutch gait –seen when
patient’s balance is good.
 Three point crutch gait.
 SWINGING CRUTCH GAIT

 2 Two types-
 The swing through crutch gait.
 The swing to crutch gait .
SWING THROUGH CRUTCH GAIT
 The body swings through beyond the crutches.
 It is fastest gait and requires functional abdominal
muscles.
 SWING TO CRUTCH GAIT
 The patient advances the crutches and then swing
his/her body to the crutches .
 Four point crutch gait
 It is used when all or part of the
body weight can be taken on
each foot, but the patient is
unsteady.
 It requires a wide base of
support.
 As the pt. balance improve he
may progress to two point
crutch gait.
 The four points are two crutch
tips and two limbs. The
sequences of events are right
crutch > left foot >left crutch
>right foot .
 Two point crutch gait
 When two point crutch gait
is used the amount of
body weight taken on both
feet is reduced.
 This type of gait used
when patients balance is
good.

Sequence of events:
 Right crutch & left foot
simultaneously followed by
left crutch & right foot
simultaneously.
 Three point crutch gait
 In this gait, the amount of body weight
taken by a foot can vary from none to
partial or full.
 This gait is commonly taught to
orthopaedic patients who may have one
painful or weak limb which cannot support
the whole body weight while the other
lower limb can.
 Both crutches support weaker lower limb,
while the stronger limb takes whole body
weight without any support from the
crutches.
Sequence Of events:
 Both crutches & the weaker limb together
Thank you