Assessment of Gait

Question 1

Components of the stance and swing phases of gait including gait width and length

Answer 1

Stance: 
Heel strike 
Foot Flat
Midstance
Push off
Swing: (40 % of normal gait)
Acceleration
Midswing
Deceleration
Gait width: width of the base should not be more than 2-4 inches from heel to heel. Patients usually widen their gait if they feel dizzy or unsteady.
Gait length: Average step is approximately 15 inches. With pain or pathology of the lower extremity, the length of the step may decrease.

Question 2

Evaluation of normal and abnormal gait patterns

Answer 2

Note limps or deformities that may be affecting gait. Determine which phase and component of gait is affected

Question 3

Spastic hemiparesis

Answer 3

· The affected leg is stiff and extended with plantar flexion of the foot
· Movement of the foot results from pelvic tilting upward on the involved side
· The foot is dragged, often scraping the toe, or is circled stiffly outward and forward (circumduction)
· The affected arm remain fixed and abducted and does not swing
· Examples – cerebral palsy

Question 4

Spastic diplegia

Answer 4

· Patient uses short steps, dragging the ball of the foot across the floor
· Legs are extended and the thighs tend to cross forward on each other at each step due to injury to the pyramidal system

Question 5

Steppage/ drop foot

Answer 5

· Hip and knee are elevated excessively high to lift the plantar flexed foot off the ground
· The foot is brought down to the floor with a slap
· Patient is unable to walk on heels
· Muscle weakness of tibialis anterior

Question 6

Ataxia - cerebellar/sensory

Answer 6

Cerebellar:
· Patient’s feet are wide based
· Staggering and lurching from side to side is often accompanied by swaying of the trunk
Sensory:
· Patient’s gait is wide-based
· Feet are thrown forward and outward, bringing them down first on heels, then on toes
· Patient watches the ground to guide his/her steps
· Positive Romberg sign is present

Question 7

Dystonia

Answer 7

· Jerky, dancing movements appear nondirectional

Question 8

Abductor/ Adductor lurch

Answer 8

Weakened gluteus medius muscle forces the patient to lurch toward the involved side to place the center of gravity over the hips

Question 9

Extensor lurch

Answer 9

· Gluteus maximus muscle is weakened and patient must thrust his thorax posteriorly to maintain hip extension (an extensor or gluteus maximus lurch)

Question 10

Flat foot

Answer 10

· Patients with muscle weakness of the gastrocnemius-soleus group (S1-S2) may have a flat foot gait with no forceful toe off

Question 11

Back knee

Answer 11

· Patients with quadriceps weakness may walk with a back knee gait to lock their knees into extension

Question 12

Antalgic

Answer 12

· Patient limits the time of weight bearing on the affected leg to limit pain

Question 13

Normal gait

Answer 13

The width of the base should not be more than 2-4 inches from heel to heel. The body’s center of gravity should oscillate no more than 2 inches in a vertical direction. The knees should remain flexed during all of the stance phase. The pelvis and trunk should shift approximately 1 inch to the weight bearing side during gait. The approximate length of the step should be 15 inches. The average adult walks 90-120 steps per minute. During the swing phase, the pelvis should rotate 40 degrees forward with the opposite hip joint acting as the fulcrum.

Question 14

Abnormal gait

Answer 14

Observe for a greater width of base, shorter number of steps, uncoordinated footing and accentuated lateral shift of trunk and pelvis.

Question 15

Heel strike

Answer 15

Pain is elicited when the heel lands on the floor. Pain is caused by a spike of a bone in the heel that protrudes on the plantar surface of the oscalcis.

Question 16

Foot flat

Answer 16

Weak dorsiflexors of the foot cause the foot to slap down after heel strike instead of landing smoothly.

Question 17

Midstance

Answer 17

Pain is elicited when walking on uneven ground due to uneven weight distribution on all aspects of the foot. Corns and calluses commonly develop on areas that bear greater weight.

Question 18

Push off

Answer 18

Limited hyperextension of the great toe causes the patient to push off from the lateral side of the forefoot instead of the medial aspect of the forefoot.

Question 19

Acceleration

Answer 19

Dorsiflexors of the ankle help hold the ankle neutral so the foot can clear the ground. Knees flex to shorten the leg to clear the ground.

Question 20

Midswing

Answer 20

Weak dorsiflexors of the ankle causes the toes to scrape the ground. To compensate, the patient flexes his/her hip excessively to bend the knee to clear the ground.

Question 21

Deceleration

Answer 21

Weak hamstrings do not contract fully to allow the heel to strike the ground in a controlled motion so the heel strike may be excessive.