Gait

• Normal human gait repeats a basic

sequence of limb motions that serve to
progress the body along a desired path
while maintaining weight-bearing
stability, conserving energy, and absorbing
the shock of floor impact.

Rancho Los Amigos

National Rehab Center
 Gait
• Movements that produces locomotion
• Characteristics:
– Energy-economical, particularly walking
– Flexibility to cope with different speeds,
terrains etc.
– Sophisticated control mechanisms (bipedal
gait inherently unstable)

2
 Gait
• Gait - manner or style of walking
• Walking is a learned complex behavior
involving the alternate balancing of the
body’s weight over a single support while
controlling forward motion
• At least one foot is always in contact with
the ground and the forward fall of the
body weight is the major propelling force
 Gait Cycle
• Normal Gait
– Series of rhythmical , alternating movements
of the trunk & limbs which result in the
forward progression of the center of gravity
– Series of ‘controlled falls’
 Gait Cycle
• The time from the point at which the heel
of one foot touches the ground to the time
it touches the ground again
 Gait Cycle
• Objectives
– Resist/Dissipate Forces
– Maintain Balance
– Move Body in Intended Direction
– Conserve Energy
 Resist/Dissipate Forces
• Source of Forces
– Gravity
– Muscle Contraction
– Inertia
 Maintain Balance
• Support
• Keep upright
• Avoid collapse
• Obstacle avoidance and foot placement
• Foot clearance
• Negotiate your way through the world
 Maintain Balance
• Dynamic Movement
• Influenced by external
factors
• Single versus Double
Support
• Depends on Multiple
Systems
• Adaptations in Base of
Support
 Move Body in Intended
Direction
• Safely move the center of mass (CM)
forward
• Turn when necessary
• Maintain an oscillatory pattern
• Re-Positioning of Center of Gravity
• Re-Positioning of Limb Segments
 Energy conservation
• Smoothness

• Minimize pain

• Adapt gait to avoid

painful forces or motions
Gait Cycle - Definitions:
 Gait Cycle - Definitions:
• Step Length
– Distance between corresponding successive
points of heel contact of the opposite feet
• Stride Length
– Distance between successive points of heel
contact of the same foot
– Double the step length
 Gait Cycle - Definitions:
• Walking Base
– Side-to-side distance between the line of the
two feet
– Also known as ‘stride width’
• Cadence
– Number of steps per unit time
– Cultural/social variations
 Gait Cycle
• During one gait cycle, each extremity
passes through two phases
• Stance phase - a given foot is in contact
with the ground, heel-strike to toe-off,
60%
• Swing phase - a given foot is in the air, toe-
off to heel stride, 40%
Gait Cycle
 Gait Cycle
Initial Initial
Contact Contac
t
Stride

Stance (60%) Swing(40

%)
Double Single Double
Support Support Support

0% 10 50 60 1
 Gait Cycle
• Stance phase
– Contact Period
• Heel strike to forefoot loading
– Midstance Period
• Forefoot loading to heel raise
– Propulsive Period
• Heel raise to toe off
 Contact Period
• Heel strike to forefoot loading
• Foot pronates at subtalar joint
• Only time (stance phase) normal pronation
occurs
• This absorbs shock & adapts foot to uneven
surfaces
• Ground reaction forces peak
• Leg is internally rotating
• Ends with metatarsal heads contacting ground
 Midstance Period
• Forefoot loading to heel raise
• Foot stops pronating & starts supinating
due to Tibialis posterior & Soleus contract
• And external rotation of the leg
• Other leg in swing phase – all weight on
one foot
• Vertical ground reaction forces decrease –
body is directly over foot
• Ends as heel leaves ground
 Propulsive Period
• Heel raise to toe off
• Subtalar joint supination continues until just
after toe off
• Leg continues to externally rotate
• Vertical ground reaction forces peak – forefoot
only bearing weight on this side
• Forces move from lateral to medial passing
through the hallux
• First MPJ must function correctly for maximum
efficiency
• Toes are loaded to stabilise MPJ’s
 Gait Cycle

• Swing phase
– Acceleration
– Midswing
– Deceleration
 Swing Phase
• Foot accelerates to “catch up” with body
• Leg internally rotates (from external
position)
• Foot pronates to aid ground clearance
• Foot decelerates and slightly supinates in
preparation for heel strike
• Time Frame:
A. Stance vs. Swing:
• Stance phase = 60% of gait cycle
• Swing phase = 40%
B. Single vs. Double support:
• Single support= 40% of gait cycle
• Double support= 20%
 Gait Cycle - Components:

• Support:
(1) Single Support: only one foot in contact with
the floor
(2) Double Support: both feet in contact with floor
 Cycle Divisions
• Stance Phase
• Begins with heel strike and ends when the
toe leaves the ground
• Weight is transferred from the heel to the
head of the metatarsals as the center of
gravity passes forward over the foot
• divided into 5 phases
 Cycle Divisions
• Initial contact
– Beginning of Loading
– Foot Position may vary,
but is generally
supinated
– Represents end of
single support on the
opposite side
 Cycle Divisions
• Initial contact
– Contact should be through lateral aspect of
plantar surface
– Opposite limb is ending with toe-off
– Subtalar joint – supinated @ 5 degrees
– Talocrural joint – dorsiflexed
– Both limbs in contact with surface
 Cycle Divisions
• Loading response
– The limb reacts to the weight of the
body by rolling forward on the heel
to sustain body momentum
– The foot is brought into full contact
with the ground
– Maximum Impact Loading occurs
 Cycle Divisions
• Loading response
– Response to absorption of body weight by
initiating flattening of the foot
– Subtalar joint – pronates
• Unlocks midtarsal joints, allowing foot to become
flexible
• Tibial internal rotation – increased medial forces
at foot, leg, knee
– Talocrural joint – plantarflexes
– Foot rapidly moves into pronation
 Cycle Divisions
• Midstance
– Begins the interval of single
stance
– An ankle rocking action occurs
to bring the body weight over
the planted foot this helps
sustain the body’s forward
momentum
– All weight supported by single
leg
 Cycle Divisions
• Midstance
– Subtalar joint – supinates
• Locks midtarsal joints, makes foot a rigid lever
• Preparing for efficiency during propulsion
– Talocrural joint – dorsiflexes
 Cycle Divisions
• Terminal stance
– Begins with raising the
heel (heel-off)
– The lower limb rolls
forward on to its forefoot
and the body advances
ahead of the sole-
supporting foot
 Terminal Stance
• Terminal stance
– Provides new base of support
– Toes extended, tibia externally rotated
– Subtalar joint – supinated
– Foot remains pronated initially then re-
supinates
 Cycle Divisions
• Preswing
– The lower limb is positioned
to quickly swing forward
beneath the advancing body
– The body weight is
unloaded from one limb
and transferred to the
opposite limb
– Toe-off
 Preswing
• Transitional period of double support
• Limb is uploaded and prepared to
swing
• Begins with initial contact of
contralateral limb and ends with toe-
off of stance limb
 Cycle Divisions
• Swing phase
– Begins as soon as the toes leave the surface
and terminates when the limb next makes
contact with the surface
– Momentum gained at toe-off helps carry leg
through the swing phase
– Consists of three phases
 Cycle Divisions
• Initial swing
– The foot is pushed off the ground
– The limb is accelerated forward
helping to provide the force to
sustain forward body movement
– Femur advances
– Ankle dorsiflexes, allowing toe
clearance
– Subtalar joint - pronation
 Cycle Divisions
• Midswing
– The limb passes beneath the
body to where the tibia is
vertical
– CG directly over opposite
supporting foot
– Propulsion continues
– Talocrural joint – dorsiflexed to
neutral or slight dorsiflexion
 Cycle Divisions
• Terminal swing
– The limb decelerates forward
motion in preparation for the
initial contact (IC) of the stance
to initiate a new step
– Subtalar joint – supination
– Foot supinated and positioned
for foot strike
 CG Excursion
• Pelvic Rotation
• Pelvic lateral tilt
+ drop
• Knee, Ankle
and foot
interaction
 Pelvic Rotation

- Pelvic moves fwd with swing limb

- Trials behind with the following limb

- Flattens the arc of CM motion by

increasing the effective leg-length at

these times
Pelvic Lateral Tilt and Drop
 Stance Knee Flexion
- Shortens the leg during stance
- Flexion at the beginning and end of
stance smoothes the abrupt changes in
CG
- Flattens the arc
 Pre-Requisites of Good Gait

• Stability in stance

• Foot clearance in swing

• Pre-positioning of the foot

• Adequate step length

• Energy conservation
 Stability in Stance

• High neuro-muscular control required in

single support phase of gait

• Use of walking aids if neuro-muscular

status is compromised – creates
triangular base
 Adequate Step Length

• Ensures correct flow of momentum

• Correct distribution of weight which

helps with balance

 Shock Absorption
• 90% shock absorbed by quadriceps
contraction during the weight acceptance
phase of gait
• 10% from:
– Fat pad/ligaments providing elastic
property and rheology (useful when 60%
BW falls on heel at initial contact)
 Shock Absorption

– Synovial fluid with its viscoelatic

properties which allow it to dissipate
forces
– Cartilage and Capsules absorbing
synovial fluid
– Bone trabecular formations and ability
to bend
 Forces
• The principal forces are:
– Body weight (BW)
– Ground reaction force (GRF)
– Muscle force (MF)
 Body Weight
• Always acts vertically downwards from
the CG
• If its line of action does not pass through
a joint, it will produce a torque about
that joint
• The torque will cause rotation at the
joint unless it is opposed by another
force (e.g. muscle, or ligament)
• BW contributes to GRF
 Ground Reaction Forces (GRF)

• “Reaction” force
• Forces exerted between the body and the
ground during ambulation
• GRFs are composed of vector forces
acting in vertical, fore-aft, and medial-
lateral directions
 Ground Reaction Force
• Push exerted by ground on foot, as a
consequence of Newton’s 3rd Law.
• Equal magnitude, opposite direction, same
point of application as action force.
• If line of the reaction force does not pass
through a joint, it will produce a torque
about that joint
 Muscle force
• Contribute to ground reaction force
• Ensure balance
• Increase energy economy
• Allow flexible gait patterns
• Slow down and/or prevent limb
movements
Muscle Activity in the Gait Cycle

.
 Muscle Activity in the Gait Cycle
Stance Phase:
• The gluteus maximus and hamstrings
extend the hip early in the stance phase
• The hip flexors check this movement
before toe-off
• The gluteus medius and minimus abduct
the hip
• The hip medial rotators act in the first half
of the stance phase
• Late in the stance phase the adductors and
lateral rotators check the momentum
generated by the former muscles
 Muscle Activity in the Gait Cycle
Stance Phase:
• The quadriceps femoris acts at the
beginning of the stance phase extending the
knee
• The hamstrings flex the knee just before
toe-off
• The dorsiflexors of the foot act immediately
after heel strike to check plantar flexion
under the force of gravity and bring the foot
into full contact with the ground
 Muscle Activity in the Gait Cycle
Stance Phase:
• The plantar flexors act throughout the
second half of the stance phase powering
the forward thrust of the body using the
thigh and leg as a single unit
• The body is powered forward by the
plantar flexors and hip extensors
• As the body weight comes onto the foot the
intrinsic foot muscles contract to support
the plantar ligaments
 Muscle Activity in the Gait Cycle
Swing Phase:
• The hip flexors already function at the end
of the stance phase continue into early
swing phase along with the adductors and
lateral rotators
• They are essentially silent in midswing
relying on momentum of the thigh mass to
bring the thigh forward
 Muscle Activity in the Gait Cycle
Swing Phase:
• Thigh momentum is checked at the end of
the swing phase by the hip extensors
• The hamstrings function late in the stance
phase and continue into early swing phase
to flex the knee
• The forward momentum of the limb in the
swing results in the transition from flexion
to extension at the knee with some
assistance from the quadriceps muscles
 Muscle Activity in the Gait Cycle

• This momentum is checked by the

hamstrings prior to heel strike
• Dorsiflexors and the ankle act throughout
the swing phase
Muscle Activity in the Gait Cycle

Eccentric
Concentric
Muscle Activity in the Gait Cycle
• Pretibial Muscles
– Anterior tibial, EDL, EHL
– Prior to and during heel strike
• Eccentric contraction - lowers foot to the ground
– Prior to and during preswing
• Concentric contraction – DF foot, clear toes off ground
• Calf Muscles
– Gastrocs, Soleus (FDL, FHL, Posterior tibial)
– Foot flat
• Eccentric contraction - control of tibia over the foot
– Heel off
• Concentric contraction – ankle plantarflexion
Muscle Activity in the Gait Cycle
• Quadriceps
– Vastus medialis/lateralis/intermedius, RF
– Before Heel Strike
• Concentric contraction – initiate knee extension
– Swing phase
• Eccentric contraction – slow down leg (tibia)
• Hamstrings
– Biceps, Semitendinosus, Semimembranosus
– Heel strike
• Eccentric contraction - HS peaks – protects knee from
hyperextension
– Swing phase
• Concentric contraction – knee flexion, hip extension
Muscle Activity in the Gait Cycle
• Hip Abductors
– Gluteus medius, Gluteus minimus, TFL
– Stance phase
• Concentric contraction - stabilize pelvis
• Hip Adductors
– Adductor longus/brevis, Gracilis, Adductor
magnus (horizontal and vertical heads)
– Early and late stance
• Concentric contraction –stabilize pelvis
Muscle Activity in the Gait Cycle
• Gluteus Maximus
– Stance phase
• Eccentric contraction – decelerate forward
momentum
– Pre-Swing phase
• Concentric contraction – hip extension
• Erector Spinae
– Heel strike through Toe-off
– Maintain trunk posture
• Foot Intrinsics
– Stance phase
• Concentric contraction – support plantar fascia