Gait

Dr.K.S.K
 Gait
• Definition: It is Series of rhythmical , alternating
movements of the lower extremities, essentially
support and carry along the Head, Arm and Trunk
(HAT), which result in the forward progression of the
center of gravity series of ‘controlled falls’
 Gait Cycle
• The point of initial contact of one lower
extremities to the point at which the same
extremity contact the ground again.
• It may be described as a translatory
progression of the body, which are produced
by coordinated, rotatory movement of the
body segments.
 Gait
• Everyone starts out on the outer right heel
• Rolls forward through the step
• And ends up on the big toe
 Task for walking
Rancho Los Amigos (RLA) Winter’s
• Weight acceptance • Maintenance of support
• Single limb support of HAT against gravity
• Swing limb • Maintenance of upright
advancement posture and balance
• Gentle heel contact and
foot clearance
 Phases of gait cycle
• Normal Walking
– Stance - 60 % of the Complete
Gait Cycle
• Single Stance – 30% - 40%
• Double Stance - 20% - 30%
– Swing - 40 %
• Slow/Fast Walking
– Slow – Stance Phase percentage
Increases
– Fast – Stance Phase percentage
decrease
– Pathological Gait – generally,
stance phase percentage
increases
 Phases-Subdivisions
• RLA (phases) Traditional (events)
• Initial Contact → Heel Strike
• Loading response → HS → foot flat
• Midstance → FF → midstance
• Terminal stance → Midstance → heel off
• Pre-swing → Heel off → toe off
• Initial swing → Toe off → early acceleration
• Midswing → Acceleration → midswing
• Terminal swing → Midswing → deceleration
Phases
 Foot (heel) Strike

Initial Contact
Beginning of Loading
Foot Position may vary, but is
generally supinated
Represents end of single
support on the opposite side
 Foot Flat

Maximum Impact Loading occurs

Controlled by the Ant Tib
Foot rapidly moves into pronation
Weight has been shifted to the support
leg
Coincides with end of the Initial period of
Double Support on the Opposite side
 Mid-Stance

Single Support
Balance Critical
All weight supported by single leg
Foot remains pronated initially
then re-supinates
Late mid-stance is the period of
max propulsion
Swing occurring on opposite
 Heel-Off

Un-loading of limb and preparation

for swing
Foot Strike on Opposite Side
Weight Shift to opposite side begins
 Toe-Off

Weight transition to opposite

side completed
Hip flexion has been initiated to
facilitate swing
Coincides with beginning of
single support on the opposite
side
 Muscle Function - Pre-swing
(Heel to Toe off)
• Femur flexes forward due to gravity and
momentum, may be facilitated by adductor
longus and rectus femoris
• Adductors stabilize weight shift across midline to
other foot
• Rectus femoris may restrain rapid passive knee
flexion, otherwise quads silent
• Passive tension in ankle plantar flexors facilitates
knee flexion and then decreases to zero in
preparation
 Acceleration
• Toe of the reference extremity leaves the
ground and continues until midswing.
• Maximum knee flexion
 Mid-swing

Leg shortened (ankle dorsiflexion)

and hip elevated (abducted) to
facilitate swing
Mid-stance on the opposite side
C. Of G. directly over opposite
supporting foot
 Terminal Swing

Hip flexion stopped and knee

extended via Mo
Foot supinated and positioned
for foot strike
Coincides with the end of the
second DS phase on the
opposite side
The Sequence Begins Again
 Muscle Function - Terminal Stance
(Midstance to Heel off)
• Brief burst from hip flexors resisting
hyperextension of the hip
• Tensor fascia latae active throughout stance to
resist pelvic drop
• Minimal to no quad or hamstring activity
• Ankle plantar flexors prevent forward tibial
collapse and contribute to heel rise through
passive tension
 Distance & time variable
Temporal – Measures of Spatial – measure of
Time distance
• Stance duration • Stride length
• Step & Stride duration • Step length
• Single & double limb • Width of walking space
support duration • Degree of toe out.
• Swing duration
• Cadence & speed
 Distance & time variable
• Its provides quantitative –gait
• It may affect by-
• Age
• Sex
• Height
• Size and shape of bony components
• Body mass
• Joint mobility
• Muscle strength
• Type of cloth & footwear
• Habit
• Psychological status.
Distance & time variable
 Steps and Strides
• Step length :distance between the point of initial contact of one
foot and the point of initial contact of the opposite foot. (right =
left).
• Stride length : distance between successive points of initial
contact of the same foot. ( Right = left ).
• Velocity: cadence and step length= distance per time. "Free
speed" refers to the individual's comfortable walking speed.
• Walking base : sum of the perpendicular distances from the points
of initial contact of the right and left feet to the line of forward
progression.
• Foot angle or toe out : angle between the line of progression and
a line drawn between the midpoints of the calcaneus and the
second metatarsal head.
 Temporal Measures
• Stance Phase Duration: Single limb support +
Double limb support
• Single limb support : Duration that only one foot
is in contact with the ground
• Double limb support : Duration that both feet are
in contact with the ground, Period of increased
stability
• Swing Phase Duration : Duration that a foot is not
in contact with the ground
• Cadence : Steps per minute
Walking speed
= Distance / Time or
= Step length X Cadence

• Meters per second

• Meters per minute

• Seconds per 100m

Speed Cadence Step Walking Foot

(m/s) length Base angle
(steps/mi (m) (cm)
n)
Women 1.2- 1.5 115- 120 0.65 – 7.1 6*
0.75
men 1.3 – 1.6 110 - 115 0.7- 0.8 8.1 7*

Normative Values (Kirtley, 2006, p.23)

 Joint motion
Stance phase

Joints Hip Knee Ankle Toes (MTP)

Initial contact 30* flexion 0* Neutral 0*
End of loading 25* flexion 15* flexion 15* PF 0*
response
End of mid 0* 5* 5-10* DF 0*
stance
End of terminal 10-20*H.Ext 0* 0*DF 30* Hyp.Ext
stance
End of 0* 35-40* flexion 20* PF 50-60* Hyp.Ext
preswing
 Swing phase
End of initial swing End of midswing End of terminal swing
Hip 20* flexion 30* flexion 30* flexion
Knee 60* flexion 30* flexion 0*
Ankle 10* PF 0* 0*

Total range of motion

Total ROM Stance phase Swing phase
Hip 0-30* flexion, 20-30* flexion
0-20* Hyp.Ext
Knee 0-40* flexion 0-60* flexion
Ankle 0-10* DF, 0-10* PF
0-20*PF
 Determinants of gait
• The determinants represent adjustments
made by body that help to keep movement of
the body’s COG to minimum.
• There are
• Lateral pelvic tilt in frontal plane
• Knee flexion
• Knee interaction
• Ankle interaction
• Pelvic rotation in transverse plane
• Physiological valgus of the knee
CENTER OF GRAVITY DISPLACEMENTS
• Center of Gravity (COG):
– midway between the hips
– Few cm in front of S2
• Least energy consumption if COG travels in straight line
During ambulation, the body's center of gravity moves
vertically and laterally.
Overall displacement:
• Sum of vertical & horizontal (lateral) displacement
• Figure ‘8’ movement of COG as seen from AP view
 A. Vertical displacement
• Rhythmic up & down
movement
• Highest point: midstance
• Lowest point: double support
• Average displacement: 5cm
• Path: extremely smooth
sinusoidal curve
 B. Lateral displacement
• Rhythmic side-to-side
movement
• Lateral limit: midstance
• Average displacement: 5cm
• Path: extremely smooth
sinusoidal curve
 Lateral pelvic tilt(pelvic drop)

• Lateral pelvic tilting (dropping on the

unsupported side) during mid-stance prevents
an excessive rise in the body's center of
gravity.
• During this period the COG reaches its highest
point in the sinusoidal curve.
• Pelvic tilting controlled by (isometric &
eccentric)the abductor of the stance
extremity.
Knee flexion

• Mid-stance knee flexion prevents an excessive

rise in the body's COG during that period of
the gait cycle.
• If not for mid-stance knee flexion, the COG's
rise during mid-stance would be larger, as
would its total vertical amplitude.
Knee, ankle, & foot interaction

• Combined knee, ankle, & foot movement

prevent vertical displacement of the COG from
a downward to an upward direction.
• Downward at heel strike & upward motion at
foot flat is accomplished by knee flexion,
ankle-PF, & foot pronation.
• A combination of ankle-PF, foot supination, &
knee extension at heel off.
Knee, ankle, & foot interaction
Pelvic rotation in transverse plane
• Forward rotation of the
pelvis on the swing side
prevents an excessive drop
in the body's COG during
periods of double limb
support.
• If the pelvis does not rotate,
the COG's position is
somewhat lower during
periods of double limb
support, and the COG's total
vertical amplitude is greater.
• Pelvic rotation during swing
phase- 4*, during stance- 8*
Physiological valgus of the knee

• Physiological genu valgus

limits lateral movement in
the body's center of
gravity during the gait
cycle.
• Its reduce the width of
the base of support,
Because of this knee
alignment, the COG
moves laterally a distance
equal to that between the
two ankle joints
Physiological valgus of the knee

• Without physiological
genu valgus, the COG
would move laterally a
distance equal to that
between the two hip
joints
 Energy requirement
• Force must be used to produce acceleration &
deceleration of the body & its segments.
• Converting metabolic energy into mechanical
energy for muscle activity.
• The energy will be measure by using body’s O2
consumption / unit of distance traveled.
• Average O2 consumption for walking- 4-5
km/h = 100 ml/kg(body weight).
 Mechanical energy
• Kinetic energy : • Potential energy: is the
translational & rotational quantity of mass raised,
components multiplied by the height
• Translational energy: to which it is raised.
energy related to the
linear velocity of a
segment in space.
• Rotational energy : is due
to the rotational velocity
of a segments in space.
 Mechanical energy
• In human gait, kinetic energy must expended
in order to raise the body’s mass.
• The higher the COG raised, kinetic energy
expenditure raised.
• At mid-stance, COG reaches its highest point,
the body has greatest potential energy.
• The energy expenditure is often equated with
movement of the COG.
 (+) and (-) work
• The kinetic energy supplied by muscles.
• If muscle work (+) concentrically, total energy
transfer to bony component, it increase a
cadence, and (-) work of muscle by acting
eccentrically to control movement.
• e.g: during heel strike & foot flat: the hip
extensors (+ work) contract concentrically,
while knee extensors work (-) eccentrically to
control flexion movement.
 Kinetic
• External force : Inertia, • Internal force : muscle,
gravity, ground reaction
force.
• Inertial force is
proportional & opposite
direction to the
acceleration of
segments.
• The force of gravity acts
ligaments, tendons,
joint capsule, bony
components assist the
muscle by resisting,
transmitting, &
absorbing forces.
 KINEMATICS
(DIRECTION,EXTENT, SPEED OF
MOTION)

TRANSLATORY ROTATORY Movement

Movement (typical units)
(typical units)
DISPLACEMENT / ANGULAR
DISTANCE (in.; cm) DISPLACEMENT (degrees)
VELOCITY (in/sec ; ANGULAR VELOCITY
cm/sec) (deg/sec)
ANGULAR VELOCITY ANGULAR
(deg/sec) ACCELERATION
(deg/sec/sec)
 Giilllletttte Gaiitt IIndex
Kinematic parameters Temporal parameters
 The sailor gait
• It consists of a physiological ↑ of the lateral
and horizontal oscillations of the pelvis and
the shoulder, associated with ↑ pelvic
inclination.
 The processional gait
• Time of the swing ↑.
• The restraint is decreased due to the higher
position of the hip.
 Goose gait
• The swing is prolonged
• Slamming of the foot into ground.
 Exaggeration of restraint
• It is the mincing gait, has short step length but
not the increased cadence natural to it.
 Inco-ordinate gait
• Enlarge the supporting area in the frontal
plane in order to secure lateral balance.
 The slouch or mal-posture gait
• Swing is decreased
• Short steps
• Decreased cadence
• Pelvic & trunk oscillation are diminished.
 Fatigue gait
• The body bent forward, the hip & knee are
flexed → lowers the COG → stability
increased.
• Short steps & cadence are diminished.
 Short leg gait
• 1 ½ inches : equalized by dropping the pelvis
→ trunk hangs on affected side
• 1 ½ - 3 inches : equinus position of the ankle
• > 3 inches : shorten the other leg by knee
flexion.