GAIT & ITS CLINICAL IMPORTANCES

It is a simple act of falling forward and catching backward.

OR
It is a style of walking.

Human locomotion, or gait, may be described as a translatory progression of the body as

a whole, produced by coordinated, rotatory movements of body segments.
The normal gait is rhythmic and characterized by alternating propulsive and
retropulsive movements of the lower extremities.
Gait may be described as a translatory progression of the body as a whole, produced by
coordinated, rotatory movements of body segments.
The alternating propulsive and retropulsive movements of the lower extremities
essentially support and carry along the head, arms, and trunk (HAT).
1. HAT constitutes about 75% of total body weight,
2. Head and arms contributing about 25% of total body weight and
3. Trunk contributing the remaining 50%.
To understand gait, let us first identify the fundamental purposes. Winter proposed
the following five main tasks for walking gait:
1. Maintenance of support of the HAT: that is, preventing collapse of the lower limb.
2. Maintenance of upright posture and balance of the body.
3. Control of the foot trajectory to achieve safe ground clearance and a gentle heel or
toe landing.
4. Generation of mechanical energy to maintain the present forward velocity or to
increase the forward velocity
5. Absorption of mechanical energy for shock absorption and stability or to decrease the
forward velocity of the body
Three main task involved in walking-
1. Weight acceptance
2. Single Limb supported
3. Swing Limb Advancement
GAIT CYCLE:
Gait cycle is the description of what happens in one leg.
The gait cycle includes the activities that occur from the point of initial contact of one
lower extremity to the points at which the same extremities contact the ground again.

During one gait cycle each extremities passes through two phases,
1. A single STANCE PHASE= 60-65%
2. A single SWING PHASE= 40-35%
 The Gait cycle is the time interval or sequence of motion occurring between two
consecutive initial contacts of the same foot (Ipsilateral foot).
1. STANCE PHASE:
 Period in which some portion of the foot of the reference extremities is in
contact with the supporting surfaces.
 The period extant from the point of initial foot contact of the lower extremities
to the point at which only the toes of the same extremities are in contact with
the supporting surfaces.
Or
 Stance phase begins at the instant that one extremity contact s the ground
(heel strike) and continue only as long as some portion of the foot is in contact
with the ground (toe off). During stance phase of gait some portion of the foot
is in contact with the supporting surfaces at all times.

2. SWING PHASE:
 Period in which the foot of the reference extremities is in contact with the
supporting surfaces.
 Swing phase extend from the instant that the toes of the reference extremities
(right lower extremities) leaves the ground to just before initial contact of the
reference extremities.
 S. Traditional Classification % of Gait S. RLA Classification % of Gait Cycle
No. Cycle No.
STANCE PHASE 60%-65% STANCE PHASE 60%-65%
1. Heel Strike 0%-10% 1. 0%-10%

2. Foot Flate 10%-12% 2. 10%-12%

3. Mid Stance 12%-31% 3. 12%-31%

4. Heel Off 31%-50% 4. 31%-50%

5. Toe Off 50%-62% 5. 50%-62%

SWING PHASE 35%-40% SWING PHASE 35%-40%

1. Acceleration 62%-75% 1. 62%-75%

2. Mid Swing 75%-82% 2. 75%-82%

3. Deceleration 82%-100% 3. 82%-100%

STAGES OF GAIT
TRADITIONAL CLASSIFICATION RLA CLASSIFICATION
STANCE PHASE
The stance phase begins at the instant that one extremity contacts the ground and continuous only as long as some portion
of the foot is in contact with the ground.

1. HEEL STRIKE: 1. INITIAL CONTACT:

The beginning of the stance phase when the heel contacts the When the heel or any part of the foot part is contact the
ground. ground.
2. FOOT FLAT: 2. LOADING RESPONSES: (First Double limb
It occurs immediately following heel strike, when sole of the Support)
foot contacts the floor. The portion of the first double support period, initial
contact until the contralateral extremity leave the ground.
1. MID STANCE: 3. MID STANCE: (First Single limb Support)
the point at which the body passes directly over the reference The portion of single limb support, stance phases the
extremity.
1. HEEL OFF:
The point following midstance at which time the heel of the
reference extremity leaves the ground.
1. TOE OFF:
The point following heel off when only the toe of the reference
extremity is in contact with the ground.
begging when the contralateral extremity leaves the
ground and end where the body is directly over the
supporting limbs.
4. TERMINAL STANCE:
The last portion of the single limbs supporting (SLS)
stance phase then begin the heel raise and continuous
until contralateral extremity contact the ground.
5. PRE SWING: (Second Double limb Support)
The portion of stance that begin the 2 nd double supports
period from the initial contact of the contralateral extremity
to lift off the reference extremity.

SWING PHASE
The swing phase begins as soon as the toe of one extremity leaves the ground and ceases just before heel strike or contact
of the same extremity.
1. Acceleration: 1. INITIAL SWING:
The portion of beginning swing from the moment the toe of the The period where the reference extremity leaves the
reference extremity leaves the ground to the point when the ground to maximum knee flexion of same extremity
reference extremity is directly under the body.
2. Midswing: 2. MID SWING:
Portion of the swing phase when the reference extremity From maximum knee flexion of reference extremity to a
passes directly below the body. Midswing extends from the end vertical tibial position.
of acceleration to the beginning of deceleration.
3. Deceleration: 3. TERMINAL SWING:
The swing portion of the swing phase when the reference From vertical position of tibial of reference extremity to just
extremity is decelerating in preparation for heel strike. prior to heel strike.

Acceleration Mid-swing Deceleration

GAIT PARAMETERS:
Gait cycle parameter can be measured by two variables:
1. Distance or spetio variables or parameter.
2. Time or Temporal Variables or parameter.
S. No. Distance Parameters Time Parameters
1. Step Length Step duration
2. Stride Length Stance duration
3. Base Width Single limb Support time
4. Single limb support or Stance Double limb support time
 5. Double limb support or Stance Cadence
6. Walking velocity

1. DISTANCE OR SPETIO VARIABLES OR PARAMETER:

a) STEP LENGTH: It is the linear distance from the point of heel strike of one lower
extremity to the next heel strike of the opposite extremity. Or Step length or gait
length is the distance between successive contact points on the opposite feet.
Normally this distance is 35 cm to 41 cm or 14 inches to 16 inches. A comparison
of right and left step lengths will provide an indication of gait symmetry. The more
equal the step lengths, the more symmetrical is the gait. Variability in step length
is at a minimum when the ratio of step length to step rate is about 0.006 m/step or
at a person’s preferred walking speed.

It should be equal for both legs. It may vary with age and sex.
Children < Female < Male
NOTES: Step Length tends to decrease with age, fatigue, pain and diseases. If step
length is normal for both legs, the rhythm of walking will be smooth.

b) Stride length: It is the linear distance from the point of heel strike of one lower
extremity to the next heel strike of the same extremity. Or It is the linear distance
in the plane of progression between successive point of foot to foot of the same
extremity.
Stride length is normally about 70cm to 82cm or 27.5 inches to 32.5 inches
and reality is one gait cycle.
NOTES: Stride Length tends to decrease with age, fatigue, pain and diseases.
c) Single Limb Stance: The single limb stance phase of gait cycle occurs when only
one leg is on the ground. This occurs twice during the normal gait cycle.
Single limb support or stance takes up approximately 30% of the total gait
cycle.
 d) Double Limb Stance: The double limb stance is the phase of gait cycle occurs
when both leg are on the ground. This occurs twice during the normal gait cycle.
Double limb support or stance takes up approximately 25% of the total gait
cycle.
a) Base Width: Step width, or width of the walking base, may be found by
measuring the linear distance between the midpoint of the heel of one foot and
the same point on the other foot. Step width has been found to increase when
there is an increased demand for side-to-side stability, such as occurs in elderly
persons and in small children. In toddlers and young children, the center of gravity
is higher than in adults, and a wide base of support is necessary for stability. In
the normal population, the mean width of the base of support is about 3.5 inches
and varies within a range of 1 to 5 inches.

2. TIME OR TEMPORAL VARIABLES OR PARAMETER:

a) Stance time: It is the amount of time that elapses during stance phase of one
extremity in a gait cycle.
b) Single-support time: It is the amount of time that elapses during the period when
only one extremity is on supporting surface in the gait cycle.
c) Double-support time: It is the amount of time that a person spends with both the
feet on the ground during one gait cycle.
OR
Double-support time is the amount of time spent with both feet on the ground
during one gait cycle. The percentage of time spent in double support may be
increased in elderly persons and in those with balance disorders. The percentage
of time spent in double support decreases as the speed of walking increases.
d) Stride duration: It refers to amount of time it takes to accomplish one stride.
OR
Stride duration refers to the amount of time it takes to accomplish one stride.
Stride duration and gait cycle duration are synonymous. One stride, for a normal
adult, lasts approximately 1 second. Complex fluctuations in stride duration during
slow, normal, and fast walking have been identified as being statistically
correlated with variations in stride duration thousands of strides earlier. These
fluctuations appear to be a characteristic of normal gait.
e) Step duration: It refers to the amount of time spent during a single step.
OR
Step duration refers to the amount of time spent during a single step.
Measurement usually is expressed as seconds per step. When there is weakness
 or pain in an extremity, step duration may be decreased on the affected side and
increased on the unaffected (stronger) or less painful side.
f) Cadence: It is the number of steps taken by a person per unit of time.
OR
Cadence is the number of steps taken by a person per unit of time. Cadence may
be measured as the number of steps per second or per minute, but the latter is
more common:
Cadence =number of steps/time
A shorter step length will result in an increased cadence at any given velocity.20
Lamoreaux found that when a person walks with a cadence between 80 and 120
steps per minute, cadence and stride length had a linear relationship.11 As a
person walks with increased cadence, the duration of the double-support period
decreases. When the cadence of walking approaches 180 steps per minute, the
period of double support disappears, and running commences. A step frequency
or cadence of about 110 steps per minute can be considered as “typical” for adult
men; a typical cadence for women is about 116 steps per minute.3 Sometimes
authors report values that refer to stride cadence, which is exactly half the step
cadence.
g) Walking velocity is the rate of linear forward motion of the body, which can be
measured in meters or centimeters per second, meters per minute, or miles per
hour. Scientific literature favors meters per second. The term velocity implies that
direction is specified, although this is frequently not included, and the more correct
term walking speed should be used if direction is not reported. In instrumented
gait analyses, walking velocity is used, inasmuch as the velocities of the
segments involve specification of direction: Walking velocity (meters/second) _
distance walked (meters)/time (seconds) Women tend to walk with shorter and
faster steps than do men at the same velocity.20 Increases in velocity up to 120
steps per minute are brought about by increases in both cadence and stride
length, but above 120 steps per minute, step length levels off, and speed
increases are achieved with only cadence increases. Speed of gait may be
referred to as slow, free, and fast. Free speed of gait refers to a person’s normal
walking speed; slow and fast speeds of gait refer to speeds slower or faster than
the person’s normal comfortable elapses during the period when only one
extremity is on the supporting surface in a gait cycle.
h) Degree of toe-out represents the angle of foot placement (FP) and may be found
by measuring the angle formed by each foot’s line of progression and a line
intersecting the center of the heel and the second toe. The angle for men normally
 is about 70 from the line of progression of each foot at free speed walking. The
degree of toe-out decreases as the speed of walking increases in normal men.12
i) Power generation is accomplished when muscles shorten (concentric
contraction). They do positive work and add to the total energy of the body. Power
is the work or energy value divided by the time over which it is generated. The
power of muscle groups performing gait is calculated through an inverse dynamic
approach. The power generated or absorbed across a joint is the product of the
net internal moment and the net angular velocity across the joint.24 If both are in
the same direction (flexors flexing, extensors extending, for example), positive
work is being accomplished by energy generation. The most important phases of
power generation and absorption have been designated by joint (H= hip, K =
knee, A =ankle) and plane (S= sagittal, F =frontal, T= transverse)
j) Power absorption is accomplished when muscles perform a lengthening
(eccentric) contraction. They do negative work and reduce the energy of the body.
If joint motion and moment are in opposite directions, negative work is being
performed through energy absorption.
Case study on Effects on Time and Distance Gait Variables
Ms. Brown walks with a speed of 0.20 m/sec and a cadence of 25 steps per minute. It
is evident even on visual inspection that double-support time is considerably longer
than normal on both steps. Stance phase is more than 60% of the gait cycle on her
affected side, but she spends an even greater proportion of time in stance on the
unaffected side. Her left step length (unaffected side) is shorter than her right
(affected side), but her stride lengths are equal. Why? If you understand that a
person walking in a straight line must have equal stride lengths but may have
unequal step lengths, you understand the concepts of steps and strides.

PATHOLOGICAL GAITS

1. ANTALGIC OR PAINFUL HIP GAIT:

This is the gait of a person with a painful condition in the hip joint. To minimize the
pain the person shortens the time duration of the stance phase on the painful side
and quickly transfers the weight to the painless leg.
2. STIFF HIP GAIT:
 When one hip is ankylosed, it is not possible to flex at the hip joint during walking to
clear the ground in the swing phase.
3. UNSTABLE HIP GAIT:
The stability of the hip in walking is provided by the bony components of the joint
being kept in stable position by the muscles and ligaments around the joint. Any
problem in these structures causes instability of hip.
4. TRENDELENBERG GAIT:
Anatomical disruption on the right side Ex: non union fracture neck of femur. The
action of gluteus medius in pulling the pelvis downwards in the stance phase is
ineffective or weak due to lack of a stable fulcrum. The pelvis drops on the opposite
(i.e. left) side causing instability.
5. Gluteus medius gait:
When the right gluteus medius is paralyzed, it is unable to pull down the pelvis on the
right due to a functional deficiency of the abductor mechanism in the stance phase.
6. Gluteus maximus gait:
When the gluteus maximus muscle is paralyzed, the stabilizing factor is lost and the
patient leans backward at the hip to passively extend it and keep the centre of gravity
over the stance leg. This causes the backward lurch in the gluteus maximus gait.
7. Quadriceps gait:
When quadriceps power is weak or paralyzed; the locking is done by passively
pushing the knee backward by the patient putting his hand over the front of the lower
thigh. This results in a limp and may even cause genu recurvatum.
8. High stepping gait: when there is a foot drop, the foot slaps on the ground on heel
strike and then drops in the swing phase. To get the foot clear the ground, the hip is
flexed more and this causes the high stepping gait.
9. Short leg gait:
Inequality of the legs is obvious when the shortening of one leg is more than 1”. It
leads to gait with a marked pelvic tilt downwards and an equines deformity at the foot.
10. Scissoring gait:
This is characteristic gait of a spastic child with marked bilateral spasm at the hips
and equines spasm in the ankle.