Sunday's Video of the Week on Gait Evaluation: The Key to the Movement Analysis of the Human Body

Key Points Presented:

1. Walking is done with complete symmetry and reproducible timing.
2. Analysis of Gait is important in treating all spine and lower extremity problems.
3. Before we know how to recognize what is a problem in gait, we must know what is considered normal gait. 
4. A normal gait cycle is from Heel Strike of one Foot to the next Heel Strike of the same foot.
5. The normal gait cycle is divided into the Stance and Swing Phases.
6. The Stance Phase (foot is on ground) is 60% of a normal step, and the Swing Phase (foot off the ground) occupies the remaining 40%. 
7. Double Stance or Double Support is when both feet are on the ground at the same time.
8. In Running, there is no double support phase. When both feet are off the ground, it is called the Double Float phase.
9. The Critical Incidents in the Stance Phase to watch are Heel Strike, Foot Flat, Heel Off, and Toe Off.
10. The Periods of the Stance Phase of Gait are Heel Strike Period (heel strike to foot flat), Midstance Period (foot flat to heel off), and the Push Off Phase (heel off to toe off). 
11. The Critical Incidents in the Swing Phases are Toe Off, Toe Clearance, and Heel Strike.
12. The Periods of the Swing Phase of Gait are Acceleration or Initial Swing (toe off to toe clearance), Mid Swing (toe clearance to heel decent), and Deceleration (heel decent to heel strike). 
13. Heel Strike: Knee very straight with stabilization contraction of the hamstrings just prior, and contraction of the quadriceps just following (to avoid falling forward). 
14. Midstance: From foot flat to heel off, the two limbs are vertical and passing each other.
15. My Mantra in Gait Analysis: Heel Off of one foot should occur just prior to heel contact of the opposite foot.
16. Just prior to toe off in the Push Off Phase, the iliopsoas muscle contracts flex the hip. This leads to knee flexion which allows the foot to clear the ground.
17. During this Push Off Phase, the foot dorsiflexors are contracting to have the toes clear the ground.
18. Midswing is where the swing leg is passing, and going in front off, the support leg.
19. Deceleration of the Swing Leg to slow it down for Heel Strike is caused by Hamstring and Glut contractions.
20. Other Components of Gait to observe that are important are: Pelvic Tilt, Pelvic Rotation, Lateral Shift, Width of Base, Stride Length, and Step Length.
21. Pelvic Tilt, Pelvic Rotation, and Lateral Shift all help to conserve energy by accomplishing a smooth motion. 
22. The Width of Base is normally 2 to 4 inches in double support.
23. The Stride Length is the length from heel strike of one foot to heel strike of the same foot.
24. The Step Length is the length from heel strike of one foot to heel strike of the opposite foot.
25. Normal Gait: Stride and Step Lengths of both feet are equal.
26. Abnormal Gait is also called a Limp and has many causes. 
27. During the stance phase of gait, pain, muscle weakness, and joint abnormalities produce there many effects causing abnormal gait patterns.
28. Antalgic Gait due to pain shortens the support phase and increases the swing phase of that extremity.
29. Quadriceps Weakness shows up at Heel Strike with knees bent not straight.
30. Foot Flat Gait is where following heel strike the foot dorsiflexors are weak and allow the foot to slap hard down against the ground. 
31. Back Knee Gait is hyper-extension of the knee during midstance due to limited ankle dorsifexion (fixed or tight muscles called Equinus) or weakness in the quadriceps.
32. Abductory Lurch or Gluteus Medius Gait (trunk 1 inch shift to one side) where the weight shifts excessively over the painful hip or away from the weakness. This is seen predominantly by trunk lean.
33. Trendelenberg Gait used when no pain involved and the weight shits to one side due to a collapse downward of the hip during swing phase. This is seen predominantly by hip sway.
34. Gluteus Maximus Gait is seen by posterior thrust of the trunk due to glut max weakness.
35. Flat Foot or Calcaneal Gait where the foot is rigid and no toe off is seen. The foot is just lifted off the ground. This is also seen in Calf Muscle Weakness that limits proper push off.
36. Swing Phase Abnormalities are Steppage Gait or Drop Foot Gait. With weak ankle dorsiflexors, the hip flexors are recruited to lift the foot off the ground with abnormal hip flexion.
37. Hip Hike Gait with weak ankle dorsiflexors the hip is raised to allow toe clearance. 
38. Circumduction Gait like Hip Hike Gait allows the toes to clear the floor by throwing the leg out to the side.
39. Abnormal Pelvic Rotation due to Hip Flexor Weakness to throw the pelvis forward when the hip flexors can not achieve that forward progression.
40. Wide Based Gait to add stability.