Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot

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


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


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


Event: Pelvic drop of same side in swing

Normal: NoneSignificance of DeviationIf present suspect:• Opposite side hip abductor

weakness• Loading a short limb• Scolosis


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


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


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


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


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


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


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


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


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


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

Documents

Observational Gait Analysis - Peter · PDF fileEvaluation of Short Leg Palpate pelvic crest ASIS and PSIS ... Observational Gait Analysis MTJ – Midstance & propulsion - key for foot