Gait

Question 1

Define gait

Answer 1

The pattern of movement of the limbs during human locomotion over solid ground.

Question 2

Name and define the two phases of the gait cycle

Answer 2

1. Stance phase (60%) - interval in which the foot is on ground.
2. Swing phase (40%)- interval in which foot is not in contact w/ ground.

Question 3

Name the 5 phases of stance phase.

Answer 3

1. Heel strike - initial contact of heel to floor.
   - Foot is dorsiflexed & usually inverted.
   - Knee is extended (quadriceps) & hip is flexed.
2. Loading response (foot flat) - weight transferred to this leg.
3. Mid-stance - weight aligned & balanced on this leg.
4. Terminal stance (heel off) - heel lifts off floor, foot rises, toes remain in contact with floor.
5. Pre-swing (toe off) - foot continues to rise, toes lift off floor- foot is plantar flexed & slightly elevated.

NOTE: view diagram on notes

Question 4

Name the 2 phases of swing phase.

Answer 4

1. Midswing - acceleration of leg forwards.
2. Terminal swing - deacceleration leading to heel strike.

Toes are prevented from dragging on ground by simultaneous flexion of hip & knee joints & dorsi flexion of foot.

Gait cycle repeats!

NOTE: view diagram on notes

Question 5

Which muscles are involved in the initial contact (heel strike) phase of the gait cycle?

Answer 5

• Tibialis anterior - dorsiflexion of foot.
• Gluteus maximus - hip flexion

Question 6

Which muscles are involved in the Loading response phase of the gait cycle?

Answer 6

Quadriceps - extends the knee & flexes the hip.
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
- Rectus femoris

Question 7

Which muscles are involved in the Midstance phase of the gait cycle?

Answer 7

Triceps surae- stabilises knee during extension whilst standing
- gastrocnemius
- soleus

Question 8

Which muscles are involved in the Terminal stance phase of the gait cycle?

Answer 8

Triceps surae- flexes knee & plantar flex the foot at the ankle joint

Triceps sure is made up of:
- gastrocnemius
- soleus

Question 9

Which muscles are involved in the Pre swing phase of the gait cycle?

Answer 9

Rectus femoris - flexes the hip & extends the knee so it propels the swing leg forwards.

Plantar flexors - plantar flex the foot.

Flexors of the toes - lift the toes off the ground.
- Flexor hallucis longus
- Flexor hallucis brevis
- Flexor digitorum longus
- Flexor digitorum brevis

Intrinsic foot muscles - lift toes off ground.

Question 10

Which muscles are involved in the Initial & midswing phase of the gait cycle?

Answer 10

Iliopsoas & rectus femoris - flexes the hip.

Hamstrings - flex the knee
- Biceps femoris
- Semitendinosus
- Semimembranosus

Contralateral hip abductors (gluteus medius & minimus)
- stops pelvic drop & supports weight.

Question 11

Which muscles are involved in the Terminal swing phase of the gait cycle?

Answer 11

Quadriceps - hip flexor & knee extensor.

Hamstrings - hip extensor & knee flexor.

Tibialis anterior - dorsiflexion of foot.

Question 12

Describe the hip and knee cycle on a gait chart.

Answer 12

NOTE: view diagram on notes

0 is neutral

Hip cycle
- Stance phase = flexion followed by extension
- swing phase= flexion

Knee cycle-
- Stance phase = neutral, extension then full extension
- Swing phase= full flexion

Question 13

Describe a myopathic gait

Answer 13

E.g. trendelengburg

Weakness on 1 side of Hip girdle muscles (abductors) will lead to a drop in pelvis on the contralateral side while walking

With bilateral weakness, will have dropping of pelvis on both sides during walking leading to waddling! This

Seen in patients w/ muscular dystrophy.

NOTE: view Stanford video

Question 14

Describe a parkinsonian gait

Answer 14

patient has rigidity and bradykinesia.

Early stages:
- involuntary inclination to take accelerating steps
- reduced arm swing

Late stage:
- stooped w/ head & neck forward
- flexion at knees
- whole upper extremity is in flexion
- fingers usually extended.
- slow little steps (shuffling)
- difficulty initiating steps.
- tremors in legs & arm

Question 15

Describe a ataxic gait

Answer 15

Seen in cerebellar disease
- resembles alcohol intoxication

Clumsy, staggering movements w/ a wide-based gait.

While standing still, body may swagger back & forth & from side to side
- lean towards side of brain affected

Patients will not be able to walk from heel to toe or in a straight line.

Question 16

Describe a Choreiform gait

Answer 16

Seen w/ certain basal ganglia disorders e.g. Sydenham’s chorea & Huntington’s Disease

patient will display irregular, jerky, involuntary movements in all extremities.

Walking may accentuate their baseline movement disorder.

Question 17

Describe a neuropathic gait

Answer 17

Seen in patients w/ foot drop (weakness of foot dorsiflexion)

Due to an attempt to lift the leg high enough during walking so that foot does not drag on the floor- i.e. high stepping gait

If unilateral, causes include peroneal nerve palsy & L5 radiculopathy.

If bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease & peripheral neuropathies associated w/ uncontrolled diabetes.

Question 18

Describe a diplegic gait

Answer 18

Both sides affected

spasticity in lower extremities worse than upper extremities- stiff legs

Patient walks w/ abnormally narrow base, dragging both legs & scraping the toes.

Extreme tightness of hip adductors can cause legs to cross midline- scissors gait.
- patients w/ cerebral palsy may have hip adductor release surgery to minimize scissoring.

Seen in cerebral palsy.

Question 19

Describe a hemiplegic gait

Answer 19

unilateral weakness on affected side, arm flexed, adducted & internally rotated.

Leg on same side is in extension w/ plantar flexion of foot & toes.

Arm bent- spastic or floppy

drags affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) & extensor hypertonia in lower limb

broad stance

unaffected side completely normal

commonly seen in stroke

Question 20

Describe a sensory gait

Answer 20

Also called stomping gait

As our feet touch the ground, we receive propioreceptive information to tell us their location- gait occurs when there is loss of propioreceptive input

In an effort to know their location, patient will slam the foot hard onto the ground in order to sense it.
- will lift leg very high to hit ground hard

Seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting peripheral nerves (uncontrolled diabetes)