Gait Flashcards
Average step length and stride length
Step: 14-16 inches
Stride: 28-32 inches
General factors that may change gait
Age
Pain
Disease
Fatigue
Avg cadence?
How is this different in women vs. men?
Avg cadence = 90-120 steps/min
Women higher by 6-9 steps/min
Avg gait speed
3 mph
Gait cycle
From heel strike to next heel strike of SAME foot
What are the 2 main phases of gait
Stance - period when foot is in contact with ground
Swing - period when foot is not in contact with ground
4 sub-phases of gait
[stance] = contact –> midstance –> propulsion
[swing] = swing
Define contact
Lateral calcaneus strikes ground and at point of impact, tibia internally rotates, causing calcaneus to evert and talus to drop and adduct to unlock midtarsal joints and provide max shock absorption
Foot is lowered eccentrically to ground by extensor digitorum longus and tibialis anterior
Define mid-stance
Cycle progresses from flat foot to heel off, as rearfoot fully pronates, metatarsals hit ground to bring foot flat on ground, body’s center of gravity passes from behind to over foot
During this phase, subtalar joint resupinates (calcaneus everts and talus abducts) and locks midtarsal joints, transforming foot from shock absorber to rigid lever
Posterior tibialis is an important restraint to overpronation and is an active foot supinator. As body passes over midfoot, it places ankle in max dorsiflexion, putting maximal preload on the gastroc/soleus complex
Define propulsion
Heel lift progresses to toe off
Define swing
Last phase of gait - foot dorsiflexes to keep toes from hitting ground and supinates to position foot for lateral calcaneus to make contact aat heel strike
Cycle then repeats
How much of the gait cycle is spent in stance phase?
60%
During which phase of gait do most problems occur?
Stance phase
Stance phase consists of initial contact, loading response, midstance, terminal stance, and pre-swing. Which of these comprises the majority of stance phase?
Pre-swing 50-60% of stance phase
Which part of stance phase is heel strike?
Initial contact
Which part of stance phase is foot flat?
Loading response
Which part of stance phase is heel off?
Terminal stance
Which part of stance phase is toe off?
Pre-swing
Swing phase makes up 40% of total gait cycle. What are the components of swing phase?
Initial swing
Midswing
Terminal swing
When the right leg is in initial contact(heel strike), the left side is ___________
Terminal stance (heel off)
When the right leg is in loading response (foot flat), the left side is ___________
Pre-swing (toe off)
When the right leg is in midstance, the left side is ___________
Midswing
When the right leg is in terminal stance (heel off), the left side is ___________
Initial contact (heel strike)
When the right leg is in pre swing (toe off), the left side is ___________
Loading response (foot flat)
Function of initial contact phase of gait
Establish contact with leading foot, begin stance
Function of loading response (phase 2 of gait)
Shock absorption
Begin weight bearing
Continue progression
Function of phase 3 of gait: midstance
Limb and trunk stability
Progression over stationary foot
Function of phase 4 of gait: terminal stance
Progression past stationary foot
Prepare for swing
Function of phase 5 of gait cycle: preswing
Weight release from stationary foot
Position limb for swing
Function of phase 8 of gait cycle: initial swing
Prepare foot for clearance
Advance foot from trailing position
Function of phase 7 of gait cycle: midswing
Foot clearance
Limb advancement
Function of phase 8of gait cycle: terminal swing
Prepare for stance
Complete limb advancement
8 phases of gait
- Initial contact
- Loading response
- Midstance
- Terminal stance
- Pre-swing
- Initial swing
- Midswing
- Terminal swing
5 requirements of gait
Stability in swing
Foot clearance in swing
Preposition for initial contact
Adequate step length
Energy conservation
Foot clearance in swing requires what motions of the LE?
Ankle dorsiflexion
Knee flexion
Hip flexion
Adequate step length is a requirement for gait. What happens if steps are too short vs. too long?
Too short: expends energy, minimal progress
Too long: lose balance, strain ligaments and muscles
How is energy conserved through pelvic List?
In early stance, as weight is being transferred to foot, hip on nonweight bearing side DROPS about 2” (to make up for center of gravity moving about 2” up and down during gait cycle)
How is energy conserved in the gait cycle as the foot moves forward for heel strike?
Innominate (pelvic) rotation - innominate will rotate forward in a sagittal plane
Effect is to lengthen femur (some compensation for pelvic list)
Rotation is about 4 degrees, and reverses in stance phase
How does your center of mass compensate to facilitate abduction of the hip during stance phase?
Pelvis shifts laterally about 2”
Pathologic gait described as painful
Antalgic
Pathologic gait described as stiff
Arthrogenic
Pathologic gait described as unsteady
Ataxic
Pathologic gait described as semicircle
Hemiplegic
Pathologic gait described as shuffling
Parkinsonian
Pathologic gait described as foot drop
Steppage
_____gait = swing enhanced on affected side, stance phase shortened on affected side, adopted limp to avoid pain on weight bearing structures
Antalgic
Causes of antalgic gait
Trauma Osteoarthritis Pelvic girdle pain Coxalgia Tarsal tunnel syndrome
______ gait = due to stiffness in joints; plantar flexion of contralateral foot during stance phase to increase clearance (circumduction)
Arthrogenic
Causes of arthrogenic gait
Osteoarthritis of hip/knee joints
Post orthopedic surgeries of hip/knee
____ gait may lurch or stagger, patient watches feet while walking, needs broad base of support
Ataxic
Causes of ataxic gait
Vestibular Cerebellar abscess/hemorrhage Friedrichs ataxia Pontine-cerebellar atrophy Chronic mercury poisoning Posterior fossa tumor Wernicke's syndrome (alcohol abuse) Drugs
_____ gait may be caused by cerebrovascular event. leg is stiff without flexion at knee or hip. Leg rotates away then back towards - semicircle
Hemiplegic
Causes of hemiplegic gait
Stroke
Spinal cord injury
T/F: parkinsonian gait is found in all patients with parkinsons
False, only some
[may also be caused by first generation antipsychotics]
Hypokinesia vs. akinesia
What pathologic gait are these associated with?
Hypokinesia = generally slow movement
Akinesia = total loss of movement
Parkinsonian (festinating) gait
