Post on 05-Feb-2018
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Observational Gait Analysis
Identifying Key Events in the Gait Cycle
Normal Gait Four objectives must be accomplished for normal gait to occur.1. Leg supports body weight without collapsing2. Balanced maintained (statically &
dynamically) during single support phase3. Swing leg advance to take over supporting
role4. Sufficient power for necessary limb
movements and trunk advancement
Effectiveness Of Normal GaitDepends on free joint mobility & muscle action
Pathological conditions of:musclebonejointssensory nervous systemcentral motor control cardiopulmonary system
Alters mode and efficiency of gait
During Normal Gait Cycle
Joints are:• free to move• possess optimal alignment• depends on…
– fibrous tissue mobility– articular cartilage smoothness
*Evaluated during static biomechanical examination-also examine: plantar lesions, soft tissue abnormalities
Keep In Mind...
• Step• Stride• Cadence• Gait CycleAbnormal or subtle change in gait
– movement is forced due to weakness spasticity or deformity
or– movement is a compensation to correct for some other
problem which needs to be identified
Requirements for Observational Gait Analysis
• Suitable site– straight, level walkway
(length & width)– line of progression– lighting
• Patient attire• Treadmill and video• Observe
– posterior, anterior, lateral– barefoot vs. wearing shoes– with & without orthotics
Observational Gait AnalysisEvent: Head tilt at heel strikeNormal: Vertical PositionSignificance of Deviation• Tilts to short or long limb• Tilts towards the raised shoulder• Muscle tightness • Habit
Observational Gait Analysis
Event: Shoulder position during stanceNormal: EqualSignificance of DeviationShoulder drop due to
– Scolosis– Short or long limb– Trauma– Occupational
Observational Gait AnalysisEvent: Arm swing during stanceNormal: Equal active arm swingSignificance of DeviationNo arm swing
– Need to stabilize the trunk– Tight erect posture
Unilateral arm swing– Greater arm swing on the side of
the short leg– Limitation of motion in the opposite hip– Occupational
Evaluation of Short LegPalpate pelvic crest ASIS and PSIS • Level the pelvic crest with know
thickness of material under short side
Observational Gait Analysis
Event: Pelvic hike in swingNormal: NoneSignificance of DeviationUsed to assist ground clearance if foot drop is present
Observational Gait AnalysisEvent: Pelvic drop of opposite side during
stanceNormal: NoneSignificance of DeviationIf present:• Weak hip abductors• Tight hip adductors
Observational Gait Analysis
Event: Pelvic drop of same side in swing
Normal: NoneSignificance of DeviationIf present suspect:• Opposite side hip abductor
weakness• Loading a short limb• Scolosis
Observational Gait Analysis
Event: External hip rotationNormal: Terminal stance and into swingSignificance of DeviationIncreased by:• Muscle problem – gluteus maximus• Foot fault contact – retroversion• Compensation• Excessive supination at contact
Observational Gait Analysis
Event: Internal hip rotationNormal: Contact into midstanceSignificance of DeviationIncreased by:• Tight medial musculature• Foot contact fault – Anteversion• Compensation• Excessive pronation into propulsion
Observational Gait AnalysisEvent: Knee extension in stanceNormal: Fully extends in midstanceSignificance of DeviationIf excessive consider:Compensation for equinus Weak quadricepsPain
Observational Gait AnalysisEvent: Knee flexion in stanceNormal: After contact and
midswingSignificance of DeviationIf excessive in stance or swing:Hamstring contractureSoleus weakness (stance only)Quadriceps weakness (swing
only)
Observational Gait AnalysisEvent: Transverse plane position
of knee at end of contactNormal: 3-5 internally rotatedSignificance of DeviationInternal:• Internal femoral torsion or position• Spastic or tight medial musculature
Observational Gait Analysis
Event: Transverse plane position of knee at end of contact
Normal: 3-5° internally rotatedSignificance of DeviationExternal:• External femoral torsion or position• Spastic or tight lateral musculature
Observational Gait AnalysisEvent: Frontal plane position
of the knee Normal: Vertical +/- 2°Significance of DeviationBow leg• Coxa valga- genu varum• Pediatric developmentalKnock Knee• Coxa vara- genu valgum• Pediatric developmental
Observational Gait Analysis
Event: Frontal plane position of the tibiaNormal: Vertical +/- 2°Significance of Deviation• Tibial varum• Blount’s disease• Rickets
Observational Gait AnalysisEvent: Frontal plane position of the calcaneus
at heel strikeNormal: 2 - 4° invertedSignificance of DeviationExcessive varus due to:• Tibia varum• Cavus foot type• Plantarflexed 1st ray• Narrow base of gait• Abducted gait angle
Sounds of Heel Strike
Listen…pounding?If excessive pounding this will indicate
lack of shock absorptionLook for shock waves up the leg
Observational Gait AnalysisEvent: Frontal plane position of the calcaneus at
heel strikeNormal: 2 - 4° invertedSignificance of DeviationVertical or valgus due to:• Genu valgum• Calcaneal valgum• Internal femoral torsion• Internal tibial torsion• Weak anterior group• Inability to resupinate
Navicular Position- Sagittal View
• Pronation - talar head adducts against navicular, decreasing distance from ground
• Supination - talar head abducts, increasing distance from ground
• Can be related to Medial longitudinal arch angle
Observational Gait Analysis
Event: Angle of gait during stance phaseNormal: 10-15 ° abductedSignificance of DeviationAbducted gait due to:
– External hip rotation– External tibial rotation– Fully compensated MTJ– Pronated foot at heel off
Observational Gait Analysis
Event: Angle of gait during stance phaseNormal: 10-15 ° abductedSignificance of DeviationAdducted gait due to:
– Internal hip rotation– Internal tibial torsion– Tight medial hamstring– Metatarsus adductus
Observational Gait Analysis
Event: Base of gait during the stance phase
Normal: 4” in width between subsequent heel strike
Significance of DeviationNarrow base due to:
– Tibia varum– Increase in cadence, running, and jogging
Observational Gait AnalysisEvent: Base of gait during the stance
phaseNormal: 4” in width between subsequent heel
strikeSignificance of DeviationBroad base due to:
– Genu valgum– Instability of the trunk– Pediatric– Geriatric
Observational Gait AnalysisMTJ
– Midstance & propulsion - key for foot stability
Metatarsal heads– FFL- anterior view - 5th met. head contacts first,
followed in sequence by the others– Propulsion - reverse - 5th leaves first
• 1st MPJ - lateral view - df TOE POSITION
– contact - dorsiflexion– midstance - plantargrade
Observational Gait Analysis
Event: Time of heel liftNormal: 60-70% of stance phase, when
opposite limb has passed the support limb
Significance of DeviationPremature heel lift due to:
– Short or spastic posterior group, ankle block– Associated with the limited midtarsal ROM
Observational Gait Analysis
Event: Time of heel liftNormal: 60-70% of stance phase,
when opposite limb has passed the support limb
Significance of DeviationDelayed heel lift due to:
– Moderate to severe MTJ compensation
– Short stride
Observational Gait AnalysisEvent: Frontal plane motion of the foot to the
support surface during propulsionNormal: Lateral side of the foot raises
earlier than medial sideSignificance of DeviationInverted gait due to:
– Forefoot varus– Forefoot valgus– Rigid plantarflexed 1st ray– Functional hallux limitus– Adducted gait angle
Observational Gait Analysis
Event: Frontal plane motion of the calcaneus at heel lift
Normal: Vertical moving into inversionSignificance of DeviationVertical or valgus
– Pronated STJ
Observational Gait AnalysisEvent: Direction of weight flow through
hallux at toe offNormal: moves through the long axis of the
halluxSignificance of DeviationMedial side of hallux due to:
– Pronated STJ and MTJ– Abducted gait– FHL– Hallux rigidus