Table of Contents
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% of gait cycle)
It occurs when foot is on the ground and bearing weight.
Mnemonic: I Like My Tea Pre-sweetened
a. Initial contact (heel strike)
b. Load response (foot flat)
c. Mid-stance (single leg stance)
d. Push off:
- Terminal stance (heel off)
- Preswing (toe off)
Swing phase (40% of gait cycle)
It occurs when the foot is not bearing weight and moves forward.
Mnemonic: In My Teapot
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 5Āŗ below horizontal at mid-stance of opposite leg
2. Pelvic rotation: Normally, during swing phase, pelvis on ipsilateral side rotates 4Āŗ anteriorly and the pelvis rotates 4Āŗ 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
7. Angle of toe out: During normal walking, there is slight out-toeing (8-15 degrees)
FootĀ progressionĀ angleĀ (FPA):Ā angleĀ betweenĀ theĀ lineĀ fromĀ theĀ calcaneusĀ toĀ theĀ secondĀ metatarsalĀ andĀ theĀ lineĀ ofĀ progressionĀ averagedĀ fromĀ heelĀ strikeĀ toĀ toeĀ offĀ duringĀ theĀ stanceĀ phaseĀ ofĀ walkingĀ forĀ eachĀ stepĀ (toe inĀ angleĀ isĀ positiveĀ andĀ toe-outĀ angleĀ isĀ negative).Ā
Types or Patterns or Abnormalities of Gait
2nd row (from left to right): Gluteus maximus gait, Steppage gait, Trendelenburg gait
| Type of gait | Description | Probable diagnoses |
| Antalgic or painful gait | Patient does not bear weight on affected side and the body lurches to opposite side. There is decreased stance phase, stride length and step length. | Any painful lesion of the lower extremity i.e. foot, knee, hip |
| Toe-walking or Equinus gait | Heel strike is avoided | Heel pain Clubfoot Congenital short Achilles tendon Muscle spasticity (Cerebral palsy) |
| Quadriceps weakness gait | Inability to maintain knee extension at heel-strike and patient may push on thigh to extend the knee and lock | Quadriceps paralysis |
| Gluteus medius gait or Abductor lurch or Trendelenburg gait | Sound side 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; in contrast to the unaffected side in antalgic gait) | Polio Developmental Dysplasia of Hip Legg-Calveās Perthe disease Slipped Capital Femoral Epiphysis Dislocated hip Fracture neck of femur Congenital coxa vara Gluteus medius paralysis |
| Gluteus maximus gait or Extensor lurch or Rocking horse gait | Trunk lurches backward at heel-strike on weakened side to interrupt forward motion of the trunk | Hip extensor weakness (e.g. poliomyelitis) |
| Flat foot or Calcaneal or Triceps gait | Absent push-off phase | Forefoot pain or rigidity Weakness of calf muscles |
| High stepping or Steppage or foot drop or Dorsiflexor gait | The 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 gait | Hikes up the ipsilateral pelvis, in order to clear the floor | Stiff knee Foot drop |
| Circumduction gait | Lifts the entire leg higher than normal and swings the leg out along the side, in order to clear the floor (knee is extended and ankle is plantarflexed due to rigidity in UMN lesion) | Stiff hip gait Stiff knee gait Cerebral palsy Limb length discrepancy |
| Waddling gait | Bilateral drooping of hip (trendelenburg gait); Lurches on opposite side with wide base of support | Myopathies |
| Winking gait | Excess pelvic rotation in axial plane toward affected hip will demonstrate a pelvic wink. The pelvic wink produces extension and rotation through the lumbar spine to attain terminal hip extension. | Laxity Hip flexion contracture Anterior capsular injury or laxity |
| Ataxic gait | Wide-based gait (>2-4 inches); patient sways in different direction during ambulation | Cerebellar ataxia |
| Hemiplegic gait | Circumduction gait with affected arm, elbow and wrist flexed on the affected side | Hemiplegia |
| Paraplegic gait or Scissoring gait | Hypertonia 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 use | Spastic cerebral palsy (adductor contracture) |
| Stamping gait | Hard thump resulting from inability to perceive the distance between the foot and the floor | Posterior spinal column lesions |
| Short limb gait | <1.5 cm – compensated by pelvic tilt while walking Upto 5 cm – compensated by equinus >5 cm – patient’s body dips down on that side | |
| Shuffling or festinating gait | Short steps, stooped posture and patient is propelled forwards quickly as if trying to catch up with the center of the gravity which is placed anteriorly | Parkinson’s disease |
| Duck footed (slew-footed) gait | In-toeing | Increased femoral anteversion |
| Genu recurvatum gait | Hyperextension at knee | Paralysis of hamstrings (polio) ACL injury |
| Varus thrust gait | Varus (bow-leg) alignment as the limb accepts weight (stance phase), with a return to less varus and more neutral alignment during lift-off and the non-weightbearing (swing) phase of gait. | Posterolateral knee instability Pseudolaxity due to medial knee compartment osteoarthritis |
| Valgus thrust gait | Valgus (knock-knee) alignment visualized during the stance phase, with a return to less valgus (more neutral) alignment during lift-off and the swing phase of gai | Lateral comparment osteoarthritis |
