Physical Examination: Gait

Definition: Gait is the manner or style of walking. It is dependent upon muscles, joints, nervous system and labyrinthine functions.

Normal Gait Cycle:

The gait cycle is the time interval or sequence of motions occurring between two consecutive initial contacts of the same foot, i.e. cycle of stance and swing by one foot.

Stance phase (60%): occurs when foot is on the ground and bearing weight

a. Initial contact (heel strike)
b. Load response (foot flat)
c. Mid-stance (single leg stance)
d. Push off:

  1. Terminal stance (heel off)
  2. Preswing (toe off)

gait cycle normal phases

Swing phase (40%): occurs when the foot is not bearing weight and moves forward

a. Initial swing (acceleration)
b. Mid-swing
c. Terminal swing (decceleration)

Note: During the heel-strike of one foot (initial contact), the other foot is in the phase of toe-off (pre-swing phase) and vice-versa. This is called “double support” as both the feet remains in the ground and occupies 20% of the gait cycle. Hence, the gait cycle is symmetrical in both the feet.

In running, there is no period of double support; consequently, the time and percentage of the gait cycle represented by the stance phase are reduced. Instead, both the feet may be off the ground at some moment and this is known as “double float”.

Gait Analysis:

Apart from the gait cycle, following components of gait must be noted:

1. Pelvic tilt: Normally, iliac crest on the side of swing leg drops approximately 5º below horizontal at mid-stance of opposite leg

2. Pelvic rotation: Normally, during swing phase, pelvis on ipsilateral side rotates 4º anteriorly and the pelvis rotates 4º posteriorly on opposite side

3. Lateral tilt: Normally, during stance phase, pelvis and trunk shifts 1 inch towards the stance phase leg

4. Width of base (horizontal distance between 2 feet during double support): Normally, 2-4 inches wide

5. Stride length (distance between 2 consecutive heel strikes of the same foot): Equal for both legs

6. Step length (distance between heel strike of one foot to the heel strike of another foot: Equal for both legs

Types or Patterns or Abnormalities of Gait:

gait abnormalities patterns
1st row (from left to right): Scissoring gait, Ataxic gait, Circumduction gait
2nd row (from left to right): Gluteus maximus gait, Steppage gait, Trendelenburg gait
Type of gaitDescriptionProbable diagnoses
Antalgic or painful gaitDecreased duration of stance phase as the painful limb is unable to bear full weightAny painful lesion of the lower extremity i.e. foot, knee, hip
Toe-walking or Equinus gaitHeel strike is avoidedHeel pain

Clubfoot

Congenital short Achilles tendon

Muscle spasticity (Cerebral palsy)

Quadriceps weakness gaitInability to maintain knee extension at heel-strike and patient may push on thigh to extend the knee and lockQuadriceps paralysis
Gluteus medius gait or Abductor lurch or Trendelenburg gaitContralateral hemipelvis drops downward during single-limb stance phase on weakened side (Trendelenburg gait)
Lurch of body towards affected side in every stance phase (Abductor lurch)
Polio

Developmental Dysplasia of Hip

Legg-Calve’s Perthe disease

Slipped Capital Femoral Epiphysis

Dislocated hip

Fracture neck of femur

Congenital coxa vara

Gluteus medius paralysis

Gluteus maximus gait  or Extensor lurchTrunk lurches backward at heel-strike on weakened side to interrupt forward motion of the trunkHip extensor weakness
Flat foot or Calcaneal or Triceps gaitAbsent push-off phaseForefoot pain or rigidity

Weakness of calf muscles

High stepping or Steppage or foot drop or Dorsiflexor gaitThe affected foot is lifted high by flexing at hip and knee joint, in order to clear the toes from ground

The foot may audibly slap the ground and 1st strike is not with the heel

Weak dorsiflexors

Paralyzed dorsiflexors

Common peroneal/fibular nerve palsy

 

Hip-hike gaitHikes up the ipsilateral pelvis, in order to clear the floorStiff knee

Foot drop

Circumduction gaitLifts the entire leg higher than normal and swings the leg out along the side, in order to clear the floorStiff hip

Stiff knee

Cerebral palsy

Limb length discrepancy

Waddling gaitBilateral drooping of hip (trendelnburg gait)Myopathies
Ataxic gaitWide-based gait (>2-4 inches)Cerebellar ataxia
Hemiplegic gaitCircumduction gait with affected arm, elbow and wrist flexed on the affected sideHemiplegia
Paraplegic gait or Scissoring gaitHypertonia in the legs, hips and pelvis means these areas become flexed to various degrees, giving the appearance of crouching, while tight adductors produce extreme adduction, presented by knees and thighs hitting, or sometimes even crossing, in a scissors-like movement while the opposing muscles, the abductors, become comparatively weak from lack of useSpastic cerebral palsy

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