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Gait

Mitchell L. Goldflies, M.D. Gait. 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

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Gait

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  1. Mitchell L. Goldflies, M.D. Gait

  2. Overview • Introduction • Stance • Swing • Normal and Abnormal Gait

  3. Introduction

  4. 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

  5. Stance • 5 phases: • Contact • Loading • Midstance • Terminal • Preswing

  6. Stance

  7. Stance - Contact • Length of stance phase: • Begin – contact of the heel to the ground • End – remainder of the foot contacts the ground

  8. Stance - Contact • Objective of stance phase: • Forward progression • Shock absorption • Adaption to terrain • Preparation for loading phase

  9. Stance - Contact • At initial ground contact: • Knee extended • Hip flexed • Ankle neutral • Foot pronating at subtalar joint • Leg internally rotating

  10. Stance - Contact • At forefoot contact: • Knee flexes • Ankle plantarflexes • STJ pronates

  11. Stance - Contact • Muscles: • Long extensors decelerate plantarflexion • Tibialis posterior decelerates pronation • Gastrocnemius decelerates internal tibial rotation

  12. Stance - Contact

  13. Stance – Loading • Objective: • Initial double-limb support • Body weight is transferred onto the stance limb

  14. Stance – Loading • Body: • Knee flexes 15◦ • Ankle plantarflexes15◦ • Muscles: • Pretibials – shock absorbers during this phase

  15. Stance - Midstance • Objective: • Limb and trunk stability • Progression over stationary foot • Body: • Knee/hip begin extension • STJ neutral

  16. 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

  17. Stance - Terminal • Objective: • Forward progression • Foot becomes rigid lever

  18. Stance - Terminal • Body: • Knee flexes • Ankle plantar flexes • STJ supinates, rapidly • First ray plantarflexes • 1st MPJ dorsiflexes – toe-off through tip of hallux

  19. Stance - Terminal • Muscles: • Soleus and tibialis posterior assist heel lift • Peroneus longus stabilizes first ray • FHL, FHB, AbH, AdH stabilize hallux • EHL dorsiflexes hallux

  20. Stance - Preswing • Objective: • Forward progression • Foot becomes “rigid lever” • 30 – 60% of gait cycle • Second period of double limb support

  21. Stance - Preswing

  22. Stance - Preswing • Body: • Knee flexes • Ankle plantar flexes • Subtalar joint rapidly supinates • First ray plantarflexes • 1st MPJ dorsiflexes

  23. Stance - Preswing • Muscles: • Soleus and tibialis posterior assist heel lift • Peroneus longus stabilizes first ray • FHL, FHB, AbH, AdH stabilize hallux • EHL dorsiflexes hallux

  24. Swing • Objective: • Forward progression • Ground clearance

  25. Swing • Body: • Hip continues to flex • Knee extends from flexed position • Ankle dorsiflexes • STJ slightly pronated at toe-off

  26. Swing • Muscles • Long extensors dorsiflex foot for toe clearance • Tibialis anterior dorsiflexes the first ray

  27. 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

  28. Swing • Contraction of quadriceps before toe off • Helps to initial leg forward swing • Prevents heel from rising to high in the posterior direction • Hamstrings become active before heel strike • Decelerate forward swing of leg • Controls heel position at foot strike

  29. Gait Analysis • Assessment procedures required to properly asses gait: • Weight acceptance – initial contact/loading response • Stance – midstance/terminal stance • Forward progression – terminal stance/preswing • Swing – initial swing/midswing/terminal swing

  30. Gait Analysis

  31. 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

  32. Normal Gait • Maximizes center of gravity through: • Knee motion • Knee flexion after heel strike • Pelvic rotation • Pelvic tilt • Lateral displacement of pelvis • Foot and ankle motion

  33. Normal Gait

  34. Abnormal Gait • Consequence of: • Pain • Weakness • Difference in limb length

  35. Abnormal Gait

  36. Abnormal Gait • Antalgic gait • Pain common cause of limp • Shortened stance phase on affected side • In stance phase - with pain in hip joint, trunk motion toward painful side

  37. Abnormal Gait • Dorsiflexor gait pattern • Swing phase – difficulty in clearing toes

  38. Abnormal Gait • Gluteus maximus gait pattern • Contracts at moment of heel-strike • Slows 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

  39. Abnormal Gait Gluteus maximus gait pattern

  40. Abnormal Gait • Gluteus medius gait pattern • Characterized by Trendelenberg gait pattern • Stance - opposite side of pelvis tilts downward during toward weaker side resulting from a weakened medius

  41. Abnormal Gait Gluteus medius gait pattern

  42. Abnormal Gait • Gluteus medius gait pattern • Trunk lurches toward weakened side to compensate • Center 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

  43. Abnormal Gait Gluteus medius gait pattern

  44. Abnormal Gait • Paralyzed quadriceps gait pattern • Gait may appear normal when walking on level surface with a paralyzed quadriceps • Quads not necessary for knee joint stability at full extension

  45. Abnormal Gait • Paralyzed quadriceps gait pattern • Those 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

  46. Discussion

  47. Conclusion

  48. Questions?

  49. 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 .

  50. 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

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