Post on 26-Dec-2015
description
GAIT
Dr. Madhukar
Assistant Professor
Department of Orthopaedics
SBMCH
CHENNAI
GAIT
Gait is pattern of movement of limbs Observation of gait is important part of
examination of orthopaedic patient Normal gait requires
Normal biomechanical functioning of musculoskeletal system of limbs and spine
Good sensory feedback from proprioceptive sensations from the feet and joints
Visual and labrynthine sensory inputs and coordination for the smoothness, rhythm, grace and elegance of the human gait
BIOMECHANICAL CONSIDERATIONS
Mechanics of propulsion
Antigravity support and stoppage
Centre of gravity should fall within the base of support in all phases of walk for stability
Line of gravity should also pass through the joints of the supporting leg
Normal swinging of arms contribute to elegance of the walk paralysis of arm affects cadence of gait
GAIT STUDY TECHNIQUES
Observational gait analysis
Electromyography recording of muscles controlling the joints
Energy consumption
Foot print studies
Knowledge of the mechanism of normal gait essential to interpret abnormality in locomotor system
GAIT OR WALK CYCLE
One complete walk cycle extends from the heel strike of one leg to its next heel strike
Each leg alternately goes through a stance and swing phase
Long stance phase – 60% Foot is on the ground Supporting the body Lasts from heel strike to toe off of one leg
Shorter swing phase – 40% Leg swings froward along with the forward movement
of the body
TERMINOLOGY
RLA (phases) Traditional (events)
Initial Contact → Heel StrikeLoading response → HS → foot flatMidstance → FF → midstanceTerminal stance → Midstance → heel offPre-swing → Heel off → toe offInitial swing → Toe off → early accel.Midswing → Acceleration → midswingTerminal swing → Midswing →
deceleration
GAIT CYCLE
STANCE PHASE
1. Heel strike – first event heel strikes ground2. Foot flat - whole foot is flat on ground3. Mid-stance – with the foot flat body swings
forward. Active extension of hip4. Heel off – heel lifted off the ground with
active extension of the hip and knee5. Push off - the whole foot except the toes is
raised up as the calf muscles start pushing body up and forward
6. Toe off – in this last part, the toes also go off and whole foot leaves the ground
STANCE PHASE
The heel strike and foot flat of one foot corresponds to push off and toe off of other foot that is 1&2 stages of one leg with 5 &6 stages of the other leg
This span of time when both foot are on the ground simultaneously period of double suppor.
Tor the moothness of walk the stance leg must support the centre of gravity and provide active extension of the hip and knee to help the swing leg to clear the ground
SWING PHASE
1. Acceleration – theis is the phase of acceleratrion of the swinging leg by the hip flexors taking it ot the front of the body
2. Mid swing – leg continues to swing forward
3. Deceleration – slowing down of the swing to get the foot ready for the heel strike
CADENCE PARAMETERS
Step length: Distance between two feet during double-limb support
Stride length: Distance one limb travels during stance and swing phases
Step time: Time needed to complete one step length
Cadence: Number of steps per minute Walking velocity: Distance traveled per
time (m/sec)
RUNNING
Sequences are faster
Moment in the cycle when both feet are off the ground
ABNORMAL GAIT
Painful hip gait Stiff hip gait Unstable hip gait
Trendlenberg gait Gluteus medius gait
Gluteus maximus gait Quadriceps gait High stepping gait Short leg gait Scissoring gait
ANTALGIC GAIT
Painful condition in hip joint commonly Can be in painful conditions of knee, ankle
and foot also To minimise pain shortens the time duration
of stance phase on affected side And quickly transfer weight to the opposite
normal side Longer stance phase of normal side Shorter stance phase on painful side
STIFF HIP GAIT
Ankylosed hip
Not able to flex at hip joint to clear ground in swing phase
Lifts pelvis othe side and swings the pelvis with the leg in circumduction and moves it forward
UNSTABLE HIP GAIT
Stability of hip in walking is provided by Muscles and ligaments
Normal alignment of the line of gravity through the joint
The abductor muscles – the power
Fulcrum – at hip joint
Lever arm – neck of femur
NORMAL BIOMECHANICS
Trendlenberg test
Anatomical disruption
Physiological disruption
Trendlenberg gait – anatomical disruption
Glutes medius gait – physiological disruption
GLUTEUS MAXIMUS GAIT
Anterior poliomyelitis
Gluteus maximus paralysed
Hip cannot extend
Patent lurches backwards to extend the hip passively
QUADRICEPS GAIT Quadriceps muscle paralysis
Anterior poliomyelitis
In late stance phase, the knee actively extended and locked by power of quadriceps
With loss of quadriceps power, patient pushes his knee backward by putting his hand over the front of the lower thigh
Results in genu recurvatum later with associated external rotation of foot for broad base support to improve stability
HIGH STEPPING GAIT
Foot drop
Foot drops on the ground on heel strike and the drops in the swing phase with a thud
For ground clearence hip is flexed more and this causes high stepping gait
SHORT LEG GAIT
Obvious when shortening more than 2.5cm or 1 inch
Upto ½ inch shortening masked by pelvic tilt
1 ½ inch shortening masked by equinus of foot
>2 inch marked pelvic tilt and equinus deformity
SCISSORING GAIT
Spastic child
Bilateral adductor spasm at hip and equinus spasm at ankle
Child needs support to walk
During swing phase the leg crosses opposite side