Anormal Yürüyüş
Paternleri
Assoc. Prof.
Demet Tekin
What is a gait?
• A gait is your pattern of walking. When you
walk, your muscles balance and coordinate
your movement.
What is an abnormal gait?
• An abnormal gait is a change to your walking
pattern. Everyone’s natural walking style is
unique. However, injuries and medical
conditions can affect your walking pattern.
Anything that affects your brain, spinal cord,
legs or feet can change your gait. Some
common examples of an abnormal gait
include:
• Limping.
• Dragging your toes.
• Shuffling your feet.
• Short steps.
• Difficulty supporting the weight of your body.
• Trouble with coordination.
• Another term for an abnormal gait is
ambulatory dysfunction.
Paralytic gait
1. Gluteus Maximus walk
2. Gluteus medius walk
3. Quadriceps Femoris paralysis (hamstring muscles intact)
4. Paralysis of Quadriceps Femoris and Hamstrings
(Gluteus Maximus and Gastro-soleus intact)
5. Dorsiflexors paralysis (Drop Foot)
6. Paralysis of the plantar flexors (Calcaneal gait)
7. Paralysis of all lower extremity muscles
Abnormal Gait
1- SAILOR’S GAIT:
While walking normally, the opposite side is elevated for a sufficient
time by the contraction of the gluteus medius and TFL of the weight-
bearing hip. Elevation time is insufficient in the sailor's gait, sudden
decreases occur in the contralateral pelvis. This causes an increase
in pelvic rotation and lateral oscillations of the center of gravity. This
is why oscillations occur when walking in the sailor's gait.
2- PROCESSIONAL GAIT:
The swing phase, which normally accounts for 40% of the gait, is
prolonged.
3- GOOSE STEP:
Similar to Processional gait. However, both the extension in the
swing phase and an increase in the lateral oscillations of the pelvis
occur.
4- MINCING GAIT:
In individuals with short legs, there is a shortening of the pacing
phase of the gait. As a result of sudden contraction and
relaxation of the gluteus medius, there is an increase in both
vertical and lateral oscillations of the pelvis.
4- Gait due to coordination disorder:
• It is the way of walking when people who stay in bed for a long
time due to illness or elderly people stand up.
• When there is insufficiency in the muscles due to inactivity as a
result of lying for a long time, the support surface is expanded to
provide balance while walking, and the legs are abducted.
• The wider the support surface, the easier it is to achieve and
maintain balance.The expansion of the support surface is done
to provide lateral balance in the frontal plane.
5- Malposture gait:
The person tries to walk with the effect of gravity by minimizing
the energy expenditure. Generally, there is flexion in all joints,
shoulders are low, and there is lengthening in the stance phase
of gait. The swing phase is shortened.
6- Fatigue walk:
Exhaustion walk. Occurs after excessive exertion, the shoulders
are low and the joints are in a flexed position.
Pathological Walk
Limb Shortnesses
1- LIGHT SHORTS
• They are short between 0-4 cm.
• The short side pelvis is lowered to facilitate walking.
• There is no strain in the swing phase.
• Gait is normal in the sagittal and horizontal planes.
• Pelvic drop occurs in the frontal plane and in the swing phase.
2- SHORTS BETWEEN 4-10 CM
• The person lowers the short-side pelvis and brings the foot to
plantar flexion.
• In the swing phase, the toes touch the ground instead of the heel
strike.
• There are most problems in the stance phase: Heel strike, sole
contact and mid stance phases cannot be done.
• There is also a decrease in ground reaction from a mechanical
point of view.
3- 10 CM ÜZERİNDEKİ KISALIKLAR
• Person lowers short side pelvis, puts foot in crop position, intact side
flexes the knee.
• Shortness effects above 10 cm are seen in all planes.
• Pelvis is pushed backwards, lumbar lordosis increases
• The patient gets tired quickly.
• If the shortness is 10 cm or more, an assistive device or prosthesis should
be used.
Contractures
1- Hip joint Extensor Contracture
• When the limb enters the swing phase, excessive pelvic elevation
and circumduction occur because the hip joint cannot flex.
• While the ankylosis side rotates internally, the contralateral side
rotates externally.
• In unilateral hip joint ankylosis, movement is managed from two
separate centers:
• solid hip,
• lumbosacral region
2- Knee joint extensor contracture
• Difficulty is seen in the swing phase.
• The swing phase can be compensated by pelvic elevation.
3- Joint contracture of hip and knee joint
• Pelvic elevation and circumduction movement are greatly increased.
• If the contracture is present in both extremities, the pivot point of the
gait is fully vertebral column.
• Excessive movement of the trunk and upper extremities shifts the
center of motion from the hip joint to the knee joint. If there is
ankylosis, the center of movement is shifted to the ankle joint.
• Persons with fully limited limbs cannot move forward in the sagittal
plane.
4- Flexion contracture of hip and knee joint
• Flexion type contractures of the hip and knee joints between 15°-30°
are the best grades for gait.
• When it is exceeded 30°, a relative shortness occurs in the extremity
and the pathology is observed mostly in the stance phase of the gait.
The difference in brevity is appropriate to the degree of brevity
pathologies.
• In ankle contracture, heel strike cannot be performed and the foot is
always in the equine position. To compensate for this, the person
overextends the knee joint, which leads to genu recurvatum of the
knee.
Static Deformities
Coxa vara, coxa valga
• With the displacement of the troconter major, the Gluteus medius
shortens and its contraction is insufficient.
• The problem arises in the stance phase.
• The opposite side cannot be held above the hip.
• The person lateral flexes the trunk towards the weighted side.
• External force is carried outside the hip joint center.
• There is an increase in the lateral oscillations of the pelvis and in
the horizontal plane.
Pain-related walking
1- Pain in the vertebral column
• Vertebral tuberculosis, traumatic or pathological compression
fractures of the vertebrae, lumbosacral joint sprains and disc
ruptures are among the most important events that create
antalgic posture.
• The person develops a rigid gait with superficial breathing by
completely limiting trunk movements.
2- Pain in hip joint
• There are flexion and external rotation positions to reduce
pain in the hip. The reason is that this is the most relaxed
position of the hip joint capsule.
• In walking, the stance phase is very shortened and the swing
phase is prolonged.
• In addition to the flexor contracture in the hip, the knee and
ankle joint are also brought into flexion.
3- Pain in knee joint
• The knee joint tends to flex. Its best position is 15°-30° flexion.
In this case, the capsule and ligaments around the knee joint
become loose.
• Swing phase is prolonged, stance phase is shortened
4- Pain in ankle joint and foot
• Dropped foot arches, calluses, ligament injuries and bone
• There are many reasons for the lesions.If there is pain in the
anterior joints, the person makes a calcaneal gait. Foot flat
and push off do not occur.
• If there is pain in the ankle or calcaneal bone, in the toesgait
is observed, heel strike cannot be observed.
• In all painful conditions of the lower extremity, the stance
phase is shortened,the swing phase is prolonged.
