Gait & Gait Aids

Normal Gait & Abnormal Gait

 Why we should know
Normal Gait

If we have sound knowledge of

the characteristics of normal gait

We can accurately detect & interprete

deviations from the normal gait pattern
60% 40%
40% 60%

20-25%
Stride width
5-10cm

Cadence 70-130 step/min

 Abnormal gait
Stance phase
Antalgic
Lateral trunk bending
Anterior trunk bending
Posterior trunk bending
Lordosis
Hyperextended knee
Excessive knee flexion
Excessive Genu Valgum or Varum
 Inadequate Dorsi-flexion control
Insufficient Push-off
Abnormal walking base
Internal or external limb rotation
Excessive medial or lateral foot contact
Vaulting
 Swing phase
Circumduction
Hip hiking
Internal or external limb rotation
Inadequate Dorsiflexion control
Abnormal walking base
 Antalgic gait

Pain in stance phase :

knee, hip, foot pain
 Lateral trunk bending

Hip abductor weakness

Hip dislocation, coxa vara, slipped
capital femoral epiphysis
Hip pain
Perineal pressure
Involved limb relatively shorter
Compensation for abducted gait
 Trendelenberg gait

Gluteus Medius Gait

 Anterior Trunk Bending

Quadriceps
weakness
combined with
weakness of
gluteus maximus,
gastrocnemius, or
both

Pushing backward with the hand /

lateral rotation
 Posterior Trunk Bending

Gluteus Maximus (Lurch) Gait

Hip-extensor weakness
Knee ankylosis, spasticity or
orthotic knee lock
Hip-extensor spasticity
 Hyperextended knee

Quadriceps weakness
Capsular ligament laxity
Quadriceps spasticity
Plantar-flexion contracture or spasticity
Compensation for contralateral limb
shortening (hip-flexion or knee-flexion
contracture)
 Excessive knee flexion

Knee-flexion or hip-flexion contracture

Knee-flexor spasticity
Uncompensated quadriceps weakness
Ankle ankylosis, pes calcaneus
Plantar-flexor weakness
Involved limb relatively longer
 Steppage gait

Ankle dorsiflexor weakness : compensate by

exaggerated hip and knee flexion

Foot drop / dragging

 Slap foot

Ankle dorsiflexor weakness : early stance

phase
 Insufficient Push-Off

Flat foot gait

Plantar-flexor weakness
Rupture of the Archilles tendon
or the triceps surae
Metatarsal pain, hallux rigidus
Internal or External Limb Rotation

Internal rotation
Biceps femoris weakness
spasticity
External rotation
Quadriceps weakness
Inner hamstring weakness
Spasticity
 Abnormal walking base

Wide Base (> 4 inch)

Hip-abduction contracture
Instability due to fear, proprioceptive
deficit, cerebellar problem
Perineal pain
Genu valgum
 Narrow base (< 2 inch)
Spasticity
Genu varum
 Vaulting

Swing-phase limb is
relatively longer
 Hip hiking

Increased ipsilateral length:

hip -flexor or dorsiflexor
weakness
hip, knee, ankle ankylosis or
spasticity
insufficient hip or knee flexion
Contralateral shortness
 Circumduction

Spasticity
Hip flexor weakness
Hamstring paralysis
Knee or ankle ankylosis /
orthotic knee lock
Dorsiflexor weakness
Plantar-flexion contracture
Scissoring gait

In spastic
CP with
spasticity of
adductor m.
Crouched Gait

Excessive flexion of
hip and knee due to
spasticity, muscle
tightness or
contracture
Spastic CP
 Parkinsonian gait

Trunk ,head ,neck forward

and knee flexed
wide base ,small shuffling
step
trend to fall forward and to
increase speed
(festination)
 Hemiplegic gait

Abnormal arm swing : adduction

with flexion at shoulder ,elbow ,wrist
and fingers
extensor synergy of lower limb: leg
extension ,adduction and hip IR
,knee extension ,ankle and foot
plantarflexion and inversion.
Gait aids
Purpose of gait aids

Increase area of support, maintain

center of gravity over support area
Redistribute weight-bearing area
Requirements

ROM, muscle strength and endurance,

coordination, trunk balance, sensory
perception, mental status
Amount of weight-bearing permitted on
lower limb
 Requirements
Shoulder depressor latissimus dorsi,
lower trapezius, pectoralis minor
Shoulder adductor pectoralis major
Shoulder flexor, extensor and abductor
deltoid
Elbow extensor triceps
Wrist extensor ECR, ECU
Finger flexor FDS, FDP, FPL, FPB
 Crutches
Body weight
transmission with
bilateral axillary
crutches = 80% of BW,
nonaxillary crutches =
40-50% of BW
Good strength of
upper limbs usually
required more weight
bearing and propulsion
 Unilateral non/partial weight bearing
eg fracture, amputee -> 3-point gait
Bilateral partial weight bearing or
incoordination/ataxia -> 2 or 4-point
gait
Bilateral weakness of lower extremities
eg paraplegia -> swing-to or through
gait
 Non-axillary crutches
Lofstrand/forearm crutches
Platform crutch
Wooden forearm orthosis (Kenny stick)
Triceps weakness orthoses (arm
orthoses) eg Warm Spring, Everett,
Canadian crutch
 Axillary crutches
Crutch length : measure anterior
axillary fold to point 6 inches
anterolaterally from foot or to heel
plus 1-2 inches
Hand piece : elbow flexed 30
degree, wrist max extension,
finger fist
2-3 FB from apex of axilla
Compressive radial neuropathies
 Lofstrand/forearm crutches
Single aluminum tubular
adjustable shaft,
handpiece, forearm
piece 2 inches below
elbow, forearm cuff
anterior opening (hinge)
Elbow flexion 20 degree
Can release hand
without loosing crutch
Requires great skill,
good strength of UEs,
trunk balance
Platform crutch
Painful wrist and
hand condition or
elbow contractures,
or weak hand grip
Platform, velcro strap
Elbow flexed 90
degrees
Crutch Gaits

Point gait stability, slow

Swing gait more energy, fast
Four-point gait

Good stability - at
least 3 point
contact ground
Ataxia or
incoordination
Slowest, difficulty
 Three-point gait/alternating
two-point gait
Non-weight-bearing
gait for lower limb
fracture or amputation
3-point PWB gait ->
required 18-36% more
energy per unit
distance than normal
NWB required 41-
61%more energy per
unit distance than
normal
Two-point gait

Faster than 4-point

gait but less
stability
Decrease both
lower limbs weight-
bearing
Swing-through gait

Fastest gait,
requires functional
abdominal muscles
Required increase
of 41-61% in net
energy cost (= 3-
point NWB)
Swing-to gait

Both crutches ->

both lower limbs
almost to crutch
level
Canes

Body weight
transmission for
unilateral cane
opposite affected
side is 20-25%
Gluteus medius
weakness, or
pathological at
knee or ankle
 Cane eliminate necessary gluteus
medius force and reduces
compressional force on hip
Measure tip of cane to level of greater trochanter,
elbow flexed 20-30 degree
 Walker/Walkerette

Wider and more

stable base of
support, but slow
gait (interfere
smooth reciprocal
gait)
For patients
requiring maximum
assistance with
balance,
uncoordinated
 Add wheels to front
legs for who lack
coordination or power
in upper limbs
 Front of walker 12 inches in front of
patient
Shoulder relaxed and elbow flexed 20
degree
Three-point gait