Traditional Gait Cycle: Heel strike
Point when heel contacts ground
Quads absorb shock, DFs decelerate foot
Traditional Gait Cycle: Foot flat
Point when sole of the foot is makes contact with the ground. Occurs immediately after heel strike
Gastroc/soleus eccentrically control tibial advancement.
Traditional Gait Cycle: Midstance
Point at which full body weight is taken by limb.
Hip/knee/ankle extensorsoppose antigravity forces and stabilize limb. Hip extensors control fwd motion of trunk. Hip abductors stabilize pelvis during unilateral stance.
Traditional Gait Cycle: Heel off
After midstance as heel leaves the ground.
PF peak activity just after heel-off for push-off
Traditional Gait Cycle: Toe off
Last portion of stance phase, only toe is in contact with the ground.
Hip and knee extensors contribute forward propulsion with brief burst of activity.
Traditional Gait Cycle: Acceleration
From toe-off to midswing
Brief quads and iliopsoas action to initiate swing. By midswing quads are silent.
Traditional Gait Cycle: Midswing
Mid portion of swing phase - limb is directly below the body.
Hip/knee flexiors and DFs clear foot from ground. Forward motion is pendular.
Traditional Gait Cycle: Deceleration
End portion of swing. Limb slowing down in preparation for heel strike.
Hamstrings decelerate limb. Quads and DFs activate in late swing to prepare for heel strike.
Rancho Los Amigos Gait Cycle: Initial contact
Instant that the foot strikes the ground.
Pelvis: 4-5deg ant rot
Hip: 30 flxn, neutral rot, add/abd
Knee: Full extn
Ankle: Neutral, heel first
Toes: Neutral
Rancho Los Amigos Gait Cycle: Loading response
First period of double stance after initial contact until other foot leaves the ground.
Pelvis: Less fwd rotation
Hip: 30 flxn, neutral rot, abd/add
Knee: 15 flxn
Ankle: 15 PF
Toes: Neutral
Rancho Los Amigos Gait Cycle: Midstance
Contralateral limb leaves the ground, body weight taken and advanced over and ahead of stance limb. Perior of single-limb support.
Pelvis: Neutral rot
Hip: Extending to neutral
Knee: Extending to neutral
Ankle: From PF to 10 DF
Toes: Neutral
Rancho Los Amigos Gait Cycle: Terminal stance
Last period of double stance - begins with heel rise and continues until contralateral leg contacts ground.
Pelvis: Post rot 4-5
Hip: Apparent hyperextension 10
Knee: Full extn
Ankle: Neutral, tibia stable, heel off
Toes: Neutral IP, extended MP
Rancho Los Amigos Gait Cycle: Preswing
Second portion of double stance from initial contact of contralateral limb to lift off of support limb.
Pelvis: Post rot 4-5
Hip: Neutral
Knee: 35 flxn
Ankle: 20 PF
Toes: Neutral IP, extended MP
Rancho Los Amigos Gait Cycle: Initial swing
First portion of swing phase from toe-off until maximum knee flexion.
Pelvis: Post rot 4-5
Hip: Flxn 20
Knee: Flxn 60
Ankle: PF 10
Toes: Neutral
Rancho Los Amigos Gait Cycle: Midswing
Portion of swing phase from maximumknee flexion to vertical tibia.
Pelvis: Neutral
Hip: 20-30 flxn
Knee: From 60-30 flxn
Ankle: Neutral
Toes: Neutral
Rancho Los Amigos Gait Cycle: Terminal swing
Portion of swing phase from vertical tibia to just prior to initial contact.
Pelvic motion
Rotates 4deg anteriorly during swing and 4deg posteriorly during stance (8 total)
Tilts laterally 5 degrees, controlled by hip abductors
High point at midstance, low point during double stance
Moves side-to-side 4cm
Cadence
Steps per minute
Average = 113
Increased cadence = shorter step length, decreased double stance duration
Running = 180
Step
From heel strike to heel strike of opposite foot
Normal width = 1-5"
Normal length: 13-16"
Increases as stability demands increase
Stride
Distance between two consecutive contact point of same limb
Normal = 26-32
Walking speed
Average = 3mph
Gait deviations: Stance phase - Lateral trunk bend
Trendelenberg gait
Weak glut med
Will see bending to same side as weakness
Gait deviations: Stance phase - Backwards trunk lean
Weak glut max
Will have difficulty with stairs and ramps
Gait deviations: Stance phase - Fwd trunk lean
Weak quads
Hip/knee flexion contractures
Gait deviations: Stance phase - Excessive hip flexion
Weak hip extensors
Tight hip/knee flexors
Gait deviations: Stance phase - Limited hip extension
Tight/spastic hip flexors
Gait deviations: Stance phase - Limited hip flexion
Weak hip flexors
Tight extensors
Gait deviations: Stance phase - Antalagic
Decreased stance time on painful limb
Uneven gait pattern
Uninvolved limb has shortened step lengtrh
Gait deviations: Stance phase - Excessive knee flxn
Weak quads (knee wobbles/buckles)
Knee flexor contracture
Difficulty going down stairs/ramps
Hip flexion contracture (at terminal stance)
Fwd trunk bend can also compensate for weak quads
Gait deviations: Stance phase - Knee hyperextension
Weak quads
PF contracture
Extensor spasticity
Gait deviations: Stance phase - Toe first
Toes contact at heel strike
Weak DFs
Spastic/tight PFs
Shortened leg
Painful heel
Positive support reflex
Gait deviations: Stance phase - Foot slap
Foot makes floor contact with an audible slap
Weak DFs or hypotonia
Compensated for with steppage gait
Gait deviations: Stance phase - Foot flat
Entire foot contacts grounds
Weak DFs
Limited ROM
Immature gait pattern
Gait deviations: Stance phase - Excessive DF with uncontrolled fwd motion of tibia
Calcaneus gait"
Weak PFs
Gait deviations: Stance phase - Excessive PF
Equinus gait"
Heel doesn't touch ground
Spasticity/contracture of PFs
Poor eccentric contraction and advancement of tibia
Insufficient DF ROM
Gait deviations: Stance phase - Supination
Exessive lateral contact of foot
Calcaneus varus
Spastic invertors
Weak evertors
Pes varus
Genu varum
Gait deviations: Stance phase - Pronation
Excessive medial foot contact
Calcaneus valgus
Spastic everters
Weak inverters
Pes valgus
Genu valgum
Gait deviations: Stance phase - Toes claw
Spastic toes flexors
Hyperactive plantar grasp reflex
Positive support reflex
Gait deviations: Stance phase - Inadequate push-off
Weak PFs/toe flexors
Decrease ROM
Pain in forefoot
Insufficient PF ROM
Gait deviations: Swing phase - Insufficient fwd pelvic rotation
Stiff pelvis, pelvic retraction
Weak abdominals
Weak flexor muscles
Gait deviations: Swing phase - Insufficient hip/knee flxn
Result of weak hip/knee flexors
Inability to lift leg and move it fwd
Joint effusion
Quads spasticity
PF spasticity
Insufficient flxn ROM
Gait deviations: Swing phase - Circumduction
Weak hip/knee flexors
Gait deviations: Swing phase - Hip hiking
QL action
Compensation for weak hip/knee flexors or extensor spasticity
Gait deviations: Swing phase - Excessive hip/knee flxn
Steppage gait"
Compensation to shorten leg
Result of weak DFs
Flexor withdrawal reflex
Gait deviations: Swing phase - Insufficient knee flxn
Extensor spasticity
Pain
Decreased ROM
Weak hamstrings
Gait deviations: Swing phase - Excessive knee flxn
Flexor spasticity
Flexor withdrawal reflex
Gait deviations: Swing phase - Foot drop
Equinus"
Weak or delayed contraction of DFs or spastic PFs
Gait deviations: Swing phase - Varus/inverted foot
Spastic invertors
Weak peroneals
Gait deviations: Swing phase - Equinovarus
Spasticity of tib post and/or gastroc/soleus
Developmental abnormality
Two-point gait
One crutch and opposite extremity move together followed by opposite crutch and extremity
Three-point gait
Both crutches and involved leg advance together
Uninvolved leg follows
Uses two canes/crutches or a walker
Four-point gait
Slow pattern
One crutch, opposite leg, other crutch, other leg
Stairs for injured limb
Uninvolved leg goes up 1st
Then crutches/cane and involved leg together
Crutches/cane and involved leg go down first
Then uninvolved leg
Peak Muscle activity: Tibialis ant
Just after heel strike
Eccentric lowering of fot
Peak Muscle activity: Gastroc/soleus
Late stance
Concentric raising of heel during toe off
Peak Muscle activity: Quads
Single support
Just before toe-off to initiate swing
Peak Muscle activity: Hamstrings
Late swing
Decelerates swing limb
ROM required for normal gait
Hip flxn: 0-30
Hip extn: 0-15
Knee flxn: 0-60
Knee extn: 0
DF: 0-10
PF: 0-20
Gait deviations: Ataxic
Staggaring, unsteadiness
Wide BOS
Exaggerated movements
Gait deviations: Cerebellar
Staggering pattern seen in cerebellar disease
Gait deviations: Hemiplegic
Pt abducts paralyzed limb, swings it around and brings it fwd so foot comes to the ground in front of them
Gait deviations: Parkinsonian
Increased fwd flxn of trunk and knees
Shuffling, quick, small steps
May festinate
Gait deviations: Spastic
Stiff movement
Toes seem to catch and drag
Legs held together, hip and knee joints slightly flexed
Commonly seen in spastic paraplegia
Gait deviations: Tabetic
High stepping ataxic gait pattern in which feet slap the ground
Gait deviations: Vaulting
Pelvic elevation and PF of stance leg