Gait Flashcards
What is a full gait cycle?
- from initial contact of one foot to initial contact of that same foot
What is the stance phase and what percentage of gait does it take up?
- initial contact to pre-swing
- 60%
- entire period in which the foot is on the ground
What is the swing phase and what percentage of gait does it take up?
- from toe off to just before heel strike
- 40%
- time foot is in the air
What is stride length?
- distance b/w IC to IC on same limb
Men = 1.51m
Women = 1.32m
How do you calculate stride length?
velocity divided by .5 x cadence
What is step length?
- distance b/w 2 successive events on opposite limbs
What is toe clearance?
- minimal distance from hallux to floor during swing phase
- normal is 1.28-1.9cm
What is step width?
- horizontal distance b/w 2 points on opposite limbs
- 7-10cm is normal
What is foot progression angle?
- angle b/w longitudinal axis of foot & line of gait progression
- 5-7 degrees is normal
toe angle or toe out
What is gait speed/velocity?
- 6th vital sign
- distance traveled over a specific time period
Men = 1.37m/sec
Women = 1.30m/sec
What is cadence?
- number of steps/minute
Men = 108 steps/min
Women = 118 steps/min
At what speed does walking usually turn into running?
- 4.8 to 5.0 mph
- running has NO double limb support
Describe CoM displacement in the sagittal and frontal planes during the gait cycle
Sagittal:
- 1-2 inches
- highest in mid-stance
- lowest LR & PreSw
Frontal:
- about 3cm
- most during mid-stance
How could you decrease CoM excursion?
- pelvic rotation
- pelvic list/obliquity
- stance phase knee flexion, foot & knee mechanics
- hip adduction in stance phase
How does the LoG differ from GRF during gait?
LoG:
- is always a plumb-line into the ground
GRF:
- equal and opposite to the foot force
- direction changes
How are vertical, A-P, and M-L GRF different in gait?
Vertical:
- most & perpendicular to the ground
A-P:
- parallel to ground, shear force
- Prevent slipping via: decrease distance b/w foot location & CoM and decrease speed
M-L:
- small shear force
- prevent slipping via: decreasing step width
Where is the CoP on the foot through the stance phase?
IC = just lateral to mid-heel
MS= lateral midfoot
TS & PreSw = medial forefoot
If toe drag occurs in Initial swing what does this normally mean?
- lack of knee flexion
If toe drag occurs in mid-swing what does this normally mean?
- lack of ankle DF
Explain how the medial longitudinal arch of the foot behaves during the gait cycle
- raised initially & as it moves through LR & stance phase it lowers to absorb shock & create elasticity for push off
When are the Post tib and fibularis muscles active during the gait cycle?
Post Tib:
- IC (ECC)
- LR (ECC)
- MStan (early=ECC; late = Conc)
- TS (Conc)
FIbularis:
- TS (Conc)
What is the difference between Primary, Secondary, and Compensatory gait deviations?
Primary:
- directly caused by an impairment (weakness, deformity, impaired motor control, pain)
Secondary:
- From abnormal posture at adjacent joint
Compensatory:
- accommodation for an impairment, rather than being a direct result of an impairment
How is the gait of a young child?
Age 3:
- uneven step length
- IC w/ flat foot
- Knee hyperextended throughout stance
- LR & MS pronation
- Wide BoS
- UE’s high-low guard positions
- lack of pelvic rotation
- decreased stride length with increased cadence
How is the gait of an older adult?
> Age 60:
- decreased velocity
- decreased stride/step length
- decreased anticipatory abilities
- decreases SLS & increased DLS
- wide BoS
- may need AD
- loss of independence
Why would you see flat foot at the foot and ankle in IC?
- weak DF’s
- impaired motor control
Why would you see foot slap at the foot and ankle in LR?
- weak DF’s
Why would you see early heel off or vaulting at the foot and ankle in Mid stance?
Early heel off:
- skeletal deformity
- PF contracture
- limited DF
Vaulting:
- length of stance limb too short
- can’t DF swing limb
- knee flexion restriction
Why would you see inadequate MTP extension at the foot and ankle in PreSw?
- pain at MTP joint
- effusion of joint
Why would you see toe drag at the foot and ankle in initial swing?
- knee flexion limited
Why would you see excessive pronation at the foot and ankle in Terminal stance?
- skeletal deformity
- weak INV’s
Why would you see drop foot at the foot and ankle in mid swing?
- weak DF’s
- deep fibular nerve lesion
Why would you see extensor thrust at the knee in IC?
- weakness/spasticity of quads
- upper motor nerve lesion
Why would you see genu recurvatum or crouch gait at the knee in mid stance?
Genu Rec:
- knee extension weakness
- contracture of PF’s
- loose posterior structures of knee
Crouch gait:
- knee flex contracture
Why would you see inadequate knee flexion at the knee in initial swing?
- knee extension contracture
Why would you see excessive knee flexion at the knee in mid swing?
- impaired motor control
- inadequate DF
Why would you see varus/valgus thrust at the knee in LR?
Thrust into either position via:
- skeletal deformity
- ligament instability
Why would you see inadequate knee extension at the knee in terminal swing?
- knee flexion contracture
- joint effusion
Why would you see glute max gait at the hip in LR?
- glute max is weak which leads to leaning backwards to lock hips into extension
Why would you see antalgic gait at the hip in mid stance?
avoids pain
- decreased stance on limb
- painful to apply pressure to limb
Why would you see scissoring gait at the hip in mid stance?
- thighs touch (usually cerebral palsy)
Why would you see a trendelenburg sign at the hip in mid stance?
- weak abductors on contralateral side (glute med)
Why would you see excessive backward rotation at the hip in terminal swing?
- hip flexion contracture
Why would you see steppage gait at the hip in mid swing?
hip flexes excessively
- inadequate knee flexion
- inadequate ankle DF
Why would you see circumduction at the hip in mid swing?
leg swings laterally
- poor knee flexion/ankle DF
- lengthened swing limb or shortened stance limb
What are some dysfunctions seen in IC?
weak DF’s -> abbreviated heel contact, flat foot contact & forefoot contact
shortened limb (compensatory) -> forefoot contact
PF contracture -> inadequate DF
Knee pain -> inadequate knee ext
What are some dysfunctions seen in LR?
Inadequate knee flexion due to:
- weak quads (P)
- skeletal deformity (P)
- abnormal PF activity (S)
Foot slap:
- weak DF’s (P)
Inadequate PF:
- abbreviated/absent heel rocker (S)
What are some dysfunctions seen in stance?
Inadequate DF:
- ankle pain/effusion (P)
- PF contracture (P)
Excessive eversion:
- weak invertors (P)
- genu valgus (S)
- hindfoot valgus w/ uncompensated forefoot valgus (P)
Inadequate knee ext:
- knee pain/effusion (P)
- excessive DF posture (S)
What are some dysfunctions seen in terminal stance/push-off?
Inadequate DF:
- weak DFs (P)
- ankle pain/effusion (P)
No heel off:
- weak PF’s (P)
- forefoot pain (P)
- inadequate toe ext (S)
- excessive ankle DF (S)
Inadequate MTP Ext:
- skeletal deformity (P)
- avoid forefoot pain (S)
What are some dysfunctions seen in Swing phase?
Inadequate DF (mid swing):
- weak DF’s (P)
- PF contracture (P)
Excessive Inversion (mid swing):
- flaccid paralysis of pretibials (P)
Toe drag (initial & mid swing):
- initial = inadequate knee flexion (S)
- mid = inadequate DF strength (P) or inadequate hip flex (S)
Inadequate knee flexion (initial):
- tibiofemoral pain (P)
- inadequate hip flex (S)
- inadequate knee flexion in pre swing (S)
