Gait

Question 1

Describe phases of gait

Answer 1

Stance phase (60%) Time foot is in contact with ground and bearing weight

Swing phase (40%) Time foot is not in contact with ground

Question 2

Describe normal gait cycle

Answer 2

Stability in stance – we have to be able to transfer weight from one foot to the other and therefore need to be able to stand on one leg. This ability requires adequate neuromuscular and proprioceptive (joint position sense) function.

Foot clearance during the swing phase – we need to be able to raise the foot off the ground as we bring it forward

Pre-positioning for initial contact – we need to be able to prepare the position of the foot for the next stance phase

Adequate step length – the lower limb needs to be brought forward by a suitable distance during the swing phase before making contact with the ground during the next stance phase

Energy conservation – we need to make our movements as energy-efficient as possible (see notes below).

Question 3

Describe stance phase

Answer 3

Initial contact – in normal gait the first part of the foot to strike the ground is the heel. ‘heel strike’

Loading response - this is the period of deceleration where the shock of then impact is absorbed by the knee and ankle joints. The person rocks forwards on their heel, ready to bring the rest of their foot into contact with the ground.

Mid-stance – the foot is flat on the ground and the centre of gravity of the body is shifted from behind the foot to in front of the foot, ready for forward propulsion.

Terminal stance – The ankle is plantarflexed and the heel of the supporting leg raises from the ground.

Pre-swing – The metatarsophalangeal joints flex to give a ‘push off’ by the toes

Question 4

Describe swing phase

Answer 4

Initial swing – the knee flexes to enable the foot to clear the ground

Mid-swing – the hip flexes and the pelvis ‘swings’ forwards to enable forward progression (moving forwards). There is dorsiflexion of the ankle to the neutral (anatomical) position.

Terminal swing – the knee extends, and the foot is brought close to the ground in preparation for the initial contact (heel strike)

Question 5

Define stride

Answer 5

The distance from initial contact with one leg to the next initial contact with the same leg

Question 6

Define step

Answer 6

The distance from initial contact with the one leg to initial contact with the opposite leg

(there are 2 steps for every stride)

Question 7

Define cadence

Answer 7

The number of steps per minute

Question 8

Concentric contraction (shortening)

Answer 8

acceleration and power generation

Question 9

Eccentric contraction (lengthening

Answer 9

deceleration and shock absorption

Question 10

Isometric contraction (same length)

Answer 10

stability

Question 11

why do you get pathological gait

Answer 11

Nerve lesions
Joint instability
Immobility of joints and pain

Question 12

Observation and diagnosis of gait abnormalities

Answer 12

phases of walking
lower limb joint movement
stride length
arm swing 
lateral movements of the shoulders and head.

Question 13

Antalgic gait

Answer 13

Patients walk in a manner that reduces pain e.g in OA of hip

Walk with limp

Shortening stance phase of painful limb i.e. more time walking on less painful limb

Shorten swing phase in unaffected limb

Uneven gait

Walking stick to reduce laod throguh painful limb
Walking stick used in hand opposte the painful limb
Patient can lean towards the walking stick, shift their cenre of gravity away from painful limb and therefore reduce load through it during the stance phase

Question 14

Trendelenburg gait

Answer 14

Lesion of superior gluteal nerve (and conseuqent muscle paralysis) e.g. as a complication of hip surgery or injections to buttock

Muscle pain and inhibiton of function e.g. in hip OA

Trauma e.g. fractures of greater trochanter (site of insertion of gluteaus mmedisu) or dislocation of hip)
Biomechanical hip instability e.g. developmental dysplasia of hip

Stance phase of trendelburg gait
Pelvis drps on unaffected side
Patient often tries to compensate for this by swining their toros over towards affected side

Question 15

Hemiplegic gait

Answer 15

Due to paraslysis of one side of body

- Stroke 
- Consequence of cerebral palsy

Trauma to CNS e..g head injury, spinal cord injury

Patient has splasticity (continuous contraction) of affected side of body
Most severe in flexor mscles of upper limb
And extensor msucles of lower limb

Flexed upper limb and an extended lower limb
Cannot flex hip, knee or ankle
In order to take a step they need to lean towards the unaffected side of body then circumduct the paralysed leg

The patient cannot bear much weight on the paralysed
leg so the stance phase on this limb is very short.
Their gait therefore comprises a short step with the unaffected leg followed by circumduction of the affected leg

Question 16

Diplegic gait

Answer 16

Spasticitct affects both lower limbs
Develops in cerebral palsy

Walks with v.narrow based gait (feet closed together)
Dragging both legs Scarping toes on ground

Spasticity in the hip adductors can cause the legs to cross the midline – this is referred to as scissoring

Spasticity in the hamstrings means that the knees are slightly flexed and spasticity in the gastrocnemius and soleus results in plantar-flexion of the ankles.

In a diplegic gait it is commonly the forefoot that makes the initial contact with the ground

Question 17

High steppage gait

Answer 17

Weakness of ankle dorsiflexion = foot drop

When the foot is raised from the ground in the swing phase, the absence of active dorsiflexion means that the foot, under gravity, assumes a position of plantarflexion.

The patient therefore has to flex the hip much more than usual in order to lift their foot high off the ground and stop their toes from dragging along the floor.

During ‘initial contact’, the normal eccentric contraction of the tibialis anterior muscle is absent so the foot also tends to slap down onto the ground.

If the deep peroneal nerve is damaged but the superficial peroneal nerve is intact, instead of a classical high-steppage gait, the patient may compensate for the lack of dorsiflexion during the swing phase by everting their foot in a sudden motion, called an eversion flick.

Question 18

Causes of high steppage gait

Answer 18

Causes

- Common peroneal nerve palsy e.g. trauma to the nerve following a fracture of the neck of the fibula; compression of the nerve against the fibular neck  by a tightly applied plaster cast;
- peripheral neuropathy (e.g. in poorly controlled diabetes)
- Sciatica (Remember: the L4 myotome dorsiflexes the ankle
- Neuromuscular disease e.g. Charcot-Marie-Tooth disease (a hereditary motor and sensory neuropathy).

Question 19

Parkinsonian gait

Answer 19

Nerve cells in a part of the brain called the subtantia nigra degenerate, leading to reduction in a chemical called dopamine.
Dopamine plays a vital role in regulating body movement.

difficult to initiate movement. To counteract this they flex their neck and trunk forwards to move their centre of gravity in front of their lower limbs.

very short steps, known as a shuffling gait and may also exhibit a ‘festinant’ gait, which is the tendency to take accelerating steps.

typically have loss of arm swing whilst walking.

Question 20

Ataxic gait - causes

Answer 20

Proprioceptive (loss of awareness of the position of your joints)

Cerebellar disease (normally coordinates elements of movement e.g. posture, balance, speech)

Vestibular (damage to the organs of balance in the inner ear)

Question 21

3 types of cerebella dysfunction

Answer 21

Cerebellar dysfunction can be either:

Inherited – some degenerative conditions specifically affect the cerebellum

Acquired e.g. a stroke affecting the cerebellum

Due to acute alcohol intoxication (being ‘drunk’)

Question 22

titubation

Answer 22

Patients often hold their arms outwards to help them to balance. Whilst standing still, the patient’s body may sway back and forth and from side to side

Patients will not be able to walk heel-to toes or in a straight line