ASSESSMENT OF GAIT
KARL LUIGI L LORILLA, PTRP
THE GAIT CYCLE
Normal Parameters of Gait
1. Base Width
• Distance between two feet
• 5-10cm (2-4 in)
• Wider base width = cerebellar or inner ear problem which results in poor balance
• CROSSOVER
2. Step Length
• Distance between successive contact on OPPOSITE FEET
• 72cm (28 in)
• Children > Adults ; Females > Males
Normal Parameters of Gait
3. Stride Length
• Linear distance in the plane progression between successive points of contact of
the same foot
• 144cm (56 in)
• Decreases with age, pain, disease and fatigue
4. Lateral Pelvic Shift (Pelvic List)
• Side to side movement of the pelvis during walking
• Functions to center the weight of the body over the stance leg for balance
• 2.5-5cm (1-2in)
• Increases if the feet are farther apart
• TRENDELENBURG GAIT
Normal Parameters of Gait
• Maintains the COG from excessively moving up and down more than
5cm during gait
• High point = Midstance
• Low point = Initial Contact
• On swing : The hip is lower on the swing side and limits the rising of
the COG
Normal Parameters of Gait
5. Pelvic Rotation
• Necessary to lessen the angle of the femur with the floor to lengthen the femur
• Total of 8 Degrees = 4 Degrees forward on swing leg and 4 Degrees backward on
stance leg
• The THORAX rotates in the OPPOSITE direction to help regulate the speed of
walking
Normal Parameters of Gait
6. Center of Gravity
• 5cm (2 in) anterior to the second sacral vertebra
• Vertical and Horizontal Displacements describe a figure of eight within the
pelvis on ambulation
• Head descends during weight loading and unloading; rises during Single leg
sance
7. Cadence
• 90-120 steps per minute
• Varies with patient’s height
• Women > Men (6-9 Steps)
• Gait Speed: 3mph
• Pace increases = Stride width increases and toe out angle decreases
STANCE PHASE
• INTIAL CONTACT
• Occurs when the limb first strikes the ground and the limb is being prepared to
take in weight
HIP KNEE TIBIA ANKLE
• 20-40 Degrees Flex • In Full Extension • Slight ER • Supination moving into
• Flexion moment before contact Plantar flexion
moving towards Flexes as heel strikes • Dorsiflexion muscle
Extension the floor groups contract
• Forward Pelvic Rot • Quadriceps contract eccentrically to slow
• Gmax and Hamstrings concentrically down PF
work ECCENTRICALLY Eccentrically to control
• Erector Spinae work rapid flexion and
ECCENTRICALLY buckling
STANCE PHASE
• INTIAL CONTACT
• POSSIBLE DEVIATIONS
• Heel Spur, bone/ fat pad bruise or bursitis = Increase knee flexion and PF to relieve
stress Possible Heel First IC
• Foot Flat = Weak Dorsiflexors, Knee flexion Contracture or spasticity
• Excess Plantarflexion = PF contracture or spasticity
• Knee Extensor Thrust = Quadriceps Spasticity
• Quadriceps Avoidance = Supports Knee or thigh with hand upon contact / Leans forward
STANCE PHASE
• LOADING RESPONSE
• The person subconsciously decides whether the limb is able to bear weight of the
body
• The trunk is aligned with the stance leg
HIP KNEE TIBIA ANKLE
• Hip moving into • In 20 Degrees flexion • IR • Dorsiflexors activity
extension, adduction moving towards decreases/relaxes
and IR extension • TP, FHL, FDL contract
• Gmax and Hamstrings • Quadriceps become ECCENTRICALLY to
contract concentrically concentric to bring the control pronation
• Erector Spinae resists femur over tibia
trunk flexion
STANCE PHASE
• LOADING RESPONSE
• POSSIBLE DEVIATIONS
• Foot Slap = Weak Dorsiflexors
• Quadriceps Avoidance = Supports Knee or thigh with hand upon contact / Leans forward
• Excess Plantarflexion = PF contracture or spasticity
• Knee Hyperextension = PF Contracture / Spasticity
• Knee Wobbling = Weak Quadriceps
• Backward Trunk Lean = Weak Hip Extensors
• Trendelenburg Sign = Gluteus Medius Weakness
STANCE PHASE
• MIDSTANCE
• Period of Stationary foot support (Single-Leg Support)
• Trunk is aligned over the stance leg and pelvis shows a slight drop to the swing leg.
HIP KNEE TIBIA ANKLE
• Moving through • In 15 Degrees flexion • Neutral • PF muscles activated to
neutral position; Pelvis moving towards control DF of the foot
rotates posteriorly extension
• Illipsoas working • Quadriceps femoris
eccentrically to resist activity decreasing
extension • Gastrocnemius
• Gmed contract in working eccentrically
reverse action to control knee
extension
STANCE PHASE
• MIDSTANCE
• POSSIBLE DEVIATIONS
• Quadriceps Avoidance = Supports Knee or thigh with hand upon contact / Leans forward
• Knee Buckling= PF Contracture / Spasticity
• Excess Plantarflexion = PF contracture or spasticity
• Genu Recurvatum = Spasticity
• Knee Wobbling = Weak Quadriceps
• Trendelenburg Sign = Gluteus Medius Weakness
• Varus Thrust = Weak Posterior and Lateral Ligaments of the knee joint
• Waddling Gait???
STANCE PHASE
• TERMINAL STANCE
• The Forefoot is initially in contact with the floor
• Weight on the foot moves forward with plantar flexion so only the big toe is in
contact with the floor
HIP KNEE TIBIA ANKLE
• 10-15 Degrees • 4-5 Degrees flexion • ER • PF muscles begin to
Extension + abduction moving towards contract
and ER extension CONCENTRICALLY to
prepare for push off
STANCE PHASE
• TERMINAL STANCE
• POSSIBLE DEVIATIONS
• Quadriceps Avoidance = Supports Knee or thigh with hand upon contact / Leans forward
• Excessive Lumbar Lordosis = Hip Flexion contracture
• Premature Heel elevation = Lack of DF (Bouncing Gait)
STANCE PHASE
• PRE SWING
HIP KNEE TIBIA ANKLE
• Moving towards 10 • From near full • ER • Supination c 20
Degrees Extension + extension to 40 Degrees Plantarflexion
Abduction and ER Degrees flexion • PF muscles at peak
• Adductor Magnus • Quadriceps contracting activity but becomes
works ECCENTRICALLY inactive as foot leaves
ECCENTRICALLY to ground
control pelvis
• Iliopsoas continually
contracts
ECCENTRICALLY
SWING PHASE
• ACCELERATION TO MIDSWING
HIP KNEE ANKLE
• 15 Degrees flexion 30 • 30 -60 Degrees Flexion • 2o Degrees DF and
Degrees flexion ; ER + ER moving towards slight pronation
Neutral neutral • Dorsiflexors contract
• Hip Flexors contract • Hamstrings CONCENTRICALLY
CONCENTRICALLY CONCENTRICALLY
• Contralateral Gmed contracting
contracts
CONCENTRICALLY
STANCE PHASE
• INITIAL SWING MIDSWING
• POSSIBLE DEVIATIONS
• Foot Drop/Drag / Excessive Plantarflexion = Weak Dorsiflexors
• Quadriceps Weakness= S1-S2 Nerve root Pathology Foot Pronation
• Posterior Pelvic Tilting = Hip Flexor weakness (Abdominal Compensation)
• Cirumducting Gait = Hip Flexor weakness
• Reduced or absent knee flexion = Knee extensor spasticity, knee extension contracture
SWING PHASE
• MIDSWING DECELERATION
• POSSIBLE DEVIATIONS
HIP KNEE ANKLE
• Inadequate
• Continued flexionpush-off
at • = Hallux
MovingRigidus, Turfext
to near full Toe, Pain on the
• Ankle in MTP
neutral; foot
30-40 degreesPlantarflexion =and
• Absent slight
S1-S2 ER root Pathology in
Nerve slight supination
Foot Pronation
• Gmax CONCENTRIC
to control hip flexion
STANCE PHASE
• MIDSWING DECELERATION
• POSSIBLE DEVIATIONS
• Sustained Knee flexion = Knee Flexion Contracture, Hamsting Spasticity, Knee pain and
effusion
• Foot Drop/Drag / Excessive Plantarflexion = Weak Dorsiflexors
OTHER ABNORMAL GAIT PATTERNS
• ANTALGIC GAIT
• Self-protective and is the result of injury to the pelvis, hip, knee, ankle, or foot.
• The swing phase of the uninvolved leg is decreased. The result is a shorter step length on the uninvolved
side, decreased walking velocity, and decreased cadence.
• ATAXIC GAIT
• If the patient has poor sensation or lacks muscle coordination, there is a tendency toward poor balance
and a broad base
• The gait of a person with cerebellar ataxia includes a lurch or stagger, and all movements are exaggerated
• EQUINUS GAIT
• Weight-bearing is primarily on the dorsolateral or lateral edge of the foot, depending on the degree of
deformity.
• The weight-bearing phase on the affected limb is decreased, and a limp is present. The
• pelvis and femur are laterally rotated to partially compensate for tibial and foot medial rotation.2
OTHER ABNORMAL GAIT PATTERNS
• PARKINSONIAN GAIT
• The neck, trunk, and knees of a patient with parkinsonian gait are flexed. The gait
is characterized by shuffling or short rapid steps (marche à petits pas) at times.
• The arms are held stiffly and do not have their normal associative movement.
• During the gait, the patient may lean forward and walk progressively faster as
though unable to stop (festination).
• SCISSOR GAIT
• This gait is the result of spastic paralysis of the hip adductor muscles, which causes
the knees to be drawn together so that the legs can be swung forward only with
great effort.
• AKA Spastic Gait
OTHER ABNORMAL GAIT PATTERNS
• PSOATIC LIMP
• The psoatic limp is seen in patients with conditions affecting the hip, such as Legg-Calvé-Perthes
disease.
• The patient demonstrates a difficulty in swing-through, and the limp may be accompanied by
exaggerated trunk and pelvic movement.
• The limp may be caused by weaknessor reflex inhibition of the psoas major muscle. Classic
manifestations of this limp are lateral rotation, flexion, and adduction of the hip
• SHORT LEG GAIT
• The patient may demonstrate a lateral shift to the affected side, and the pelvis tilts down on the
affected side, creating a limp.
• The patient may also supinate the foot on the affected side to try to “lengthen” the limb.
• The joints of the unaffected limb may demonstrate exaggerated flexion, or hip hiking may occur
during the swing phase to allow the foot to clear the ground.
