Things which help for better gait analysis

Gait pattern is a series of rhythmical, alternating movement of trunk and limbs which results in forward progression of COG (center of gravity).
It is defined as human locomotion achieved by coordinated muscle work.
It is bi-phasic forward propulsion of COG of human body.
In simple words, gait pattern is the style of walking.

PHASES

A gait cycle is the cyclic pattern of the movements that occur during walking. It is completed with two successive events of the same extremity.
During one cycle each extremity passes through two major phases :

Each of the phases again go through some sub phases to complete the gait cycle.

STANCE PHASE

• HEEL STRIKE
• FOOT FLAT
• MID STANCE
• HEEL OFF (PUSH OFF)
• TOE OFF (PUSH OFF)

SWING PHASE

• EARLY SWING
• MID SWING
• LATE SWING

JOINT RANGE OF MOTION DURING GAIT PATTERN

For a normal walking, we need to maintain range of motion around hip joint, knee joint and ankle joint.

HIP JOINT – ROM approximately 20 degree extension to 20 degree flexion.

KNEE JOINT – ROM approximately 0 degree to 60 degree flexion.

ANKLE JOINT – ROM approximately 25 degree planter flexion to 7 degree dorsiflexion.

But it changes from phase to phase as follows

STANCE PHASE

HEEL STRIKE (INITIAL CONTACT)
Hip : 20 degree flexion
Knee : 0 degree flexion
Ankle : 0 degree planter flexion

FOOT FLAT
Hip : 15 degree flexion
Knee : 15 degree flexion
Ankle : 5 degree planter flexion

MID STANCE
Hip : 0 degree flexion
Knee : 5 degree flexion
Ankle : 5 degree planter flexion

HEEL OFF
Hip : 10-20 degree hyperextension
Knee : 0 degree flexion
Ankle : 0 degree planter flexion

TOE OFF
Hip : 10-20 degree hyperextension
Knee : 30 degree flexion
Ankle : 20 degree planter flexion

SWING PHASE

EARLY SWING
Hip : 20 degree flexion
Knee : 60 degree flexion
Ankle : 10 degree planter flexion

MID SWING
Hip : 30 degree flexion
Knee : 30 degree flexion
Ankle : 0 degree planter flexion

LATE SWING
Hip : 30 degree flexion
Knee : 0 degree flexion
Ankle : 0 degree planter flexion

REASONS FOR ABNORMAL GAIT PATTERN

Some pathology affects the normal pattern. It may be due to any joint deformity, lack of muscular strength, weakness, loss of motor function, pain, musculoskeletal or neuro-muscular cause.
Age is also a factor. As the age increases, walking speed declines. Step length getting shorter and slower cadence.

TYPE OF ABNORMAL GAIT PATTERNS

ANTALGIC GAIT

It is one of the most common forms of altered gait in patients presenting to the emergency department and primary care offices. patient complains –

• Pain in any lower extremity
• Result in shorter step length and lower stance time.
• Result in limping

HEMIPLEGIC GAIT (circumductory or spastic gait)

PARKINSONIAN GAIT (propulsive/ fascinating)

• Typically this is found in Parkinson’s patient
• Brady kinetic, short, shuffling.
• Difficulty in initiation and stoppage
• Typically rigid akinetic gait impairement, which includes slow, narrow base and forward stoop posture
• Posture involving neck, shoulder and trunk bend.
• Feet are lifted less than normal, which may lead to shuffling.

HAND TO KNEE GAIT (knee extensor weakness)

Any assessment of lower limb must include gait pattern assessment. Musculoskeletal pathology tends to modify walking pattern because of muscle weakness, pain or altered ROM.