Mitchell L. Goldflies, M.D.. Overview Introduction Stance Swing Normal and Abnormal Gait

Mitchell L. Goldflies, M.D.

Overview

Introduction Stance Swing Normal and Abnormal Gait

Introduction

Stance

60 % of gait cycle Foot is in contact with

ground Conversion of potential

energy into kinetic energy During stance phase hip

extends and pelvis rotates backward gradually

Stance

5 phases:ContactLoadingMidstanceTerminalPreswing

Stance

Stance - Contact

Length of stance phase:Begin – contact of the heel to the

groundEnd – remainder of the foot contacts

the ground

Stance - Contact

Objective of stance phase:Forward progressionShock absorptionAdaption to terrainPreparation for loading phase

Stance - Contact At initial ground contact:

Knee extendedHip flexedAnkle neutralFoot pronating at subtalar joint Leg internally rotating

Stance - Contact

At forefoot contact:Knee flexesAnkle plantarflexesSTJ pronates

Stance - Contact

Muscles:Long extensors decelerate plantarflexion

Tibialis posterior decelerates pronation

Gastrocnemius decelerates internal tibial rotation

Stance - Contact

Stance – Loading

Objective:Initial double-limb supportBody weight is transferred onto the stance limb

Stance – Loading

Body:Knee flexes 15◦ Ankle plantarflexes15◦

Muscles:Pretibials – shock absorbers

during this phase

Stance - Midstance

Objective: Limb and trunk stabilityProgression over stationary foot

Body:Knee/hip begin extensionSTJ neutral

Stance - Midstance

Muscles:Tibialis posterior/soleus start to supinate STJ

Peroneus longus stabilizes first ray

Triceps surae decelerate forward displacement of tibia and plantarflex ankle joint

Stance - Terminal

Objective:Forward progressionFoot becomes rigid lever

Stance - Terminal

Body:Knee flexesAnkle plantar flexesSTJ supinates, rapidlyFirst ray plantarflexes1st MPJ dorsiflexes – toe-off through tip of hallux

Stance - Terminal Muscles:

Soleus and tibialis posterior assist heel lift

Peroneus longus stabilizes first ray

FHL, FHB, AbH, AdH stabilize hallux

EHL dorsiflexes hallux

Stance - Preswing

Objective:Forward progressionFoot becomes “rigid lever”

30 – 60% of gait cycleSecond period of double limb support

Stance - Preswing

Stance - Preswing

Body:Knee flexesAnkle plantar flexesSubtalar joint rapidly supinatesFirst ray plantarflexes1st MPJ dorsiflexes

Stance - Preswing

Muscles:Soleus and tibialis posterior assist heel lift

Peroneus longus stabilizes first ray

FHL, FHB, AbH, AdH stabilize hallux

EHL dorsiflexes hallux

Swing

Objective:Forward progressionGround clearance

Swing Body:

Hip continues to flexKnee extends from flexed

positionAnkle dorsiflexesSTJ slightly pronated at toe-off

Swing

MusclesLong extensors dorsiflex foot for toe clearance

Tibialis anterior dorsiflexes the first ray

Swing Phases

Initial swing:○ Begins at toe off and continues until

maximum knee flexion (60◦)Mid swing:

○ Maximum knee flexion until tibia is vertical/perpendicular to the ground

Terminal swing:○ Beings when tibia is vertical and ends

at initial contact

Swing Contraction of quadriceps

before toe offHelps to initial leg forward swingPrevents heel from rising to high

in the posterior direction Hamstrings become active

before heel strikeDecelerate forward swing of legControls heel position at foot

strike

Gait Analysis

Assessment procedures required to properly asses gait:Weight acceptance – initial contact/loading

responseStance – midstance/terminal stanceForward progression – terminal

stance/preswingSwing – initial swing/midswing/terminal

swing

Gait Analysis

Normal Gait Used to describe patterns that

have been generalized across sex, age, genetic predisposition, and anthropometric variables

Duration of stance/swing phases are the same for each limb

Normal Gait

Maximizes center of gravity through:Knee motionKnee flexion after heel strikePelvic rotationPelvic tiltLateral displacement of pelvisFoot and ankle motion

Normal Gait

Abnormal Gait

Consequence of:PainWeaknessDifference in limb length

Abnormal Gait

Abnormal Gait

Antalgic gaitPain common cause of limp

Shortened stance phase on affected side

In stance phase - with pain in hip joint, trunk motion toward painful side

Abnormal Gait

Dorsiflexor gait patternSwing phase – difficulty in clearing toes

Abnormal Gait Gluteus maximus gait pattern

Contracts at moment of heel-strikeSlows trunk’s forward motion by

stopping flexion of hip and initiating extension

Weak gluteus maximus cause trunk to lurch forward at heel strike on weaker side, which interrupts forward motion

Abnormal Gait Gluteus

maximus gait

pattern

Abnormal Gait

Gluteus medius gait patternCharacterized by

Trendelenberg gait patternStance - opposite side of pelvis

tilts downward during toward weaker side resulting from a weakened medius

Abnormal Gait

Gluteus medius gait pattern

Abnormal Gait

Gluteus medius gait patternTrunk lurches toward weakened

side to compensateCenter of gravity shifts to fulcrum

on weaker side, which shortens the moment arm from the center of gravity to hip joint, therefore reducing effort required of hip abductors

Abnormal Gait

Gluteus medius gait pattern

Abnormal Gait

Paralyzed quadriceps gait patternGait may appear normal when

walking on level surface with a paralyzed quadriceps

Quads not necessary for knee joint stability at full extension

Abnormal Gait

Paralyzed quadriceps gait patternThose with paralyzed quads will be

unable to run and experience difficulty on rough/inclined surfaces or stairs

Long leg knee brace might be needed to support knee joint in full extension

Triceps gait pattern

Discussion

Conclusion

Questions?

References Goldflies, M.L, Andriacchi, T.P., and Galante, J.O. The

Relationship Between Varus Deformity and Moments at the Knee During Gait and the Changes at the knee after High Tibial Osteotomy. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981.

  Andriacchi, T.P., Goldflies, M.L, Galante, J.O. and Stern,

D.S. Moments Exerted on the Lower Extremities During Running. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981.

  Andriacchi, T.P., Goldflies, M.L, Galante, J.O. Normal

Variation in Joint Moments During Level Walking, 1980 .

References

http://moon.ouhsc.edu/dthompso/GAIT/TERMS.HTM

  http://www.drpribut.com/sports/spgait.html

  http://www.emedicine.com/pmr/topic225.htm

  http://www.latrobe.edu.au/podiatry/Thegaitcycle.html

  http://www.oandp.org/jpo/library/1993_02_039.asp

  http://www.oandp.org/jpo/library/1997_02_049.asp 

References

http://www.wheelessonline.com/ortho/gait

  http://www.wheelessonline.com/ortho/stance_phase_of_gait

  http://www.wheelessonline.com/ortho/swing_phase_of_gait

Image Sources http://www.newscientist.com/blog/shortsharpscience/2007_0

5_01_archive.html

www.foot-fixer.com/contactus.html

http://www.northcoastfootcare.com/footcare-info/foot-problems.html

web.techwalking.com:462/gait_lab.html

http://www.stepfamilytalk.com/walk-a-little-slower-daddy/

http://www.nature.com/nrn/journal/v3/n10/fig_tab/nrn939_F1.html

Image Sources www.dubinchiro.com/features/shin1.html

http://www.hopkins-arthritis.org/physician-corner/radiology-rounds/radiology_14/images/slide1.jpg

http://www.aboutjoints.com/physicianinfo/topics/anatomyhip/anatomyhipimages/hipfigure1.33.jpg

http://storybridge.org/wordpress/wp-content/uploads/female_screenshot.png

Image Sources http://i164.photobucket.com/albums/u38/oscarandy122586/

FOOTPRINTS.jpg

http://www.drpribut.com/sports/spgait.html