1. Chapter 7
Evaluation of Gait

2. Introduction
“Walking has been described as a series of narrowly averted catastrophes where the body falls forward, then the legs move under the body to establish a new base of support.”
Gait analysis
Functional evaluation of walking or running style
Classic LE functional test
Gait evaluation identifies
Functional limitations
Chronic pain related to physical activity

3. Gait Terminology
Step—sequence of events from a specific point in the gait on one extremity to the same point in the opposite extremity
Step length—distance traveled between the initial contacts of the right and left foot
Step width—distance between the points of contact of both feet
Stride—two sequential steps

4. Gait Terminology
Cadence—number of steps taken per unit time (i.e., steps per minute)
Adults average = 107 +/– 2.7 steps per minute
Velocity—distance covered per unit time (i.e., m/sec)
Gait velocity—meters per second
Gait cadence—steps per minute

5. Gait Terminology Stride time—time required to complete a single stride
Stride length—linear distance covered in one stride

6. Gait Terminology Ground reaction force (GRF) Center of pressure (CoP)
Contact of the foot with the ground creates force yielding vertical, anteroposterior (A/P), and mediolateral (M/L) components
Center of pressure (CoP)
Shows the path of the pressure point under the foot during gait

7. Phases of the Gait Cycle
With the right (facing) limb as an example, two distinct phases occur
Weight-bearing (WB) stance phase
Non–weight-bearing (NWB) swing phase
Legs alternate between supportive (stance) and nonsupportive (swing)
Two points the body is supported by a single leg
Midstance
Terminal stance

8. Phases of Gait

9. Walking Gait Phases Efficient gait Center of gravity
Minimal side-to-side motion
Maximal forward motion
Body rises and falls approx. 5 cm
Center of gravity
Path is a sinusoidal curve.

10. More Terminology…
Kinematic—the characteristics of movement related to time and space (e.g., range of motion, velocity, and acceleration); the effects of joint action
Kinetic—the forces being analyzed; the causes of joint action

11. Stance Phase Five periods
Initial contact
Loading response
Midstance
Terminal stance
Preswing
The weight-bearing phase of gait; begins on initial contact with the surface and ends when contact is broken.
High-energy phase
Kinetic energy is absorbed from the ground and transferred up the kinetic chain.

12. Swing Phase
The non–weight-bearing phase of gait; begins at the instant the foot leaves the surface and ends just before initial contact.
38% of gait cycle
Low-energy phase
Three periods
Initial swing
Midswing
Terminal swing

13. Muscle Activity During Gait
Understanding muscle activity and ROM aids in identifying impairments and compensations associated with pathology.

14. Running Gait Cycle Differences from walking gait
Flight phase—neither foot is in contact with a supportive surface
No period of double limb support
Vertical GRF
2.0–6.0 x the body weight
Stance phase time
As speed increases there are changes in
Arm swing
Stride length
Cadence
Knee flexion ROM
Muscular force
Speed of contraction
Less up and down motion

15. Ground Reaction Forces
(A) During walking; (B) during running.

16. Stance Phase of Running Gait
Hip: Flexed to 50° and moves to extension
Knee: Flexed to 30°, moves to 50° of flexion, and then moves into extension
Ankle: DF to 25° then moves to PF
Subtalar: Supinates, pronates, then supinates again
Loading response and midstance period occur more rapidly.

17. Swing Phase of Running Gait
Clears the NWB limb over the ground and positions the foot to accept WB.
Probability of injury is < stance phase
Hamstrings eccentrically contract to slow knee extension.
Swing phase
Hip: 10° of extension to 50° to 55° of flexion
Knee: Full extension to 125° of flexion (sprinters) and to 40° of flexion (preparing for contact)
Ankle: 25° of PF to 20° of DF

18. Gait Evaluation Two basic methods Qualitative assessment
Observational gait analysis (OGA)
Quantitative assessment

19. Quantitative Gait Analysis

20. Observational Gait Analysis
Poor to moderate reliability
Improves with experience, video equipment, and use of OGA tools
Good observation
Auditory clues
Observe left and right sides separately
Self-selected pace

21. Observational Gait Analysis Guidelines
Prepare the area and materials ahead of time.
Avoid clutter in the viewing background.
Have the patient wear clothing that does not restrict viewing of joints.
Ensure that the patient is at a self-selected walking pace; otherwise, gait will be altered.

22. Observational Gait Analysis Guidelines
Position yourself so you can view the individual segments.
Observe the subject from multiple views but not from an oblique angle.
Look at the individual body parts first, then the whole body, then the individual parts again.

23. Observational Gait Analysis Guidelines
Conduct multiple observations or trials.
Conduct the analysis with the patient barefoot and wearing shoes.
Label all video files.

24. Observational Gait Analysis Findings

25. Interventions
Cue words or phrases during gait or exercise to improve gait
Footprints on the floor for visual feedback on technique
Hand on a body segment for kinesthetic feedback
Orthotics
Different shoes
Strength training exercises
Flexibility or ROM exercises

26. Excessive Pronation Pronation is necessary for shock absorption.
Pronation through a range > 15.5° has been linked with LE injury.
Related to
Genu valgum
Leg-length discrepancy
Pes planus
Hip musculature imbalance
Soft midsoles in shoes
Exhibits
Calcaneal eversion
Lowering and elongation of medial longitudinal arch
Increased pressure on the first MTP
Wear pattern on shoe
Medial knee pain

27. Toe In or Toe Out
Found in midstance or just after push-off
Causes
Tibial rotation
Hip rotation
Excessive pronation during stance (places limb medial, lower leg compensates = toe out)
Toe in
Stress on lateral soft tissues (peroneus longus)
Toe out
Stress on medial and plantar structures

28. Shortened Step Length Causes Pain (hip, knee, or ankle)
Shorten stride so as to not make symptoms worse with larger impacts on contact
Inadequate push-off (triceps surae)
Inadequate pull-off (hip flexors)

29. Shortened Stance Time Antalgic gait pattern (i.e., “limp“) Causes
Pain
Acute or chronic
Avoid load absorption
Recommendations
Crutches
Protective brace

30. Unequal Hip Height Causes Leg-length discrepancy Weak gluteus medius
Trendelenburg gait

31. Asymmetrical Arm Swing
Arm swing counterbalances hips and pelvis
Larger arm swing in running
Causes
Upper extremity injury
Leg-length discrepancies
Spine dysfunction
Scoliosis
Limited or exaggerated motion on one side of hip or pelvis

32. Plantarflexed Ankle at Initial Contact
Causes
Gastrocnemius spasticity
Can only keep ankle in PF
Drop foot
Nerve pathology that prevents DF
Hamstring pathology
Keeping muscle short eases pain
Knee joint pathology

33. Flat Foot Stance Exhibits Causes Absence of initial heel contact
PF at the ankle is avoided in terminal stance and preswing
Causes
Ankle sprain
Gastocnemius sprain
Soleus sprain

34. Inadequate Ankle Plantarflexion Angle at Push-Off
Insufficient ankle PF at push-off
Causes
Inadequate strength (triceps surae)
Acute ankle sprain (pain and swelling)
Forefoot pathology

35. Excessive Knee Flexion Ankle at Contact
Normally knee is near full extension at contact during walking (running 21° to 30°)
Causes
Pain
Hamstring strain
Hip adductor strain
Tight hamstring or spasm
Sciatic nerve pathology
Herniated disk
Piriformis syndrome

36. Inadequate Knee Flexion Angle During Stance
Knee normally flexes to 20° during stance.
Controlled by eccentric contraction of quadriceps muscle
Causes
Quadriceps pathology
Knee joint pain

37. Inadequate Knee Flexion During Swing
During the swing phase, knee normally is flexed to 30° to 60° during walking and over 90° during running
Causes
Hamstring pathology
Strains
Spasms
Sciatica

38. Inadequate Hip Extension at Terminal Stance
Normally, hip extends as the body is propelled forward.
Causes
Contracture of the hip flexors

39. Forward Trunk Angle Indicates Low back pathology
For example, herniated disk
Weak and painful hip flexors
Weak ankle plantarflexors