Normal gaitNormal gait is defined asis defined as• (form of bipedal locomotion)(form of bipedal locomotion) • or as a method of locomotion involving the use or as a method of locomotion involving the use

of the two legs, alternately , to provide both of the two legs, alternately , to provide both supportsupport and and propulsion at least one foot propulsion at least one foot being in contact with the ground at all times . being in contact with the ground at all times .

• It is a series of rhythmic alternating motion of It is a series of rhythmic alternating motion of arms, legs, and trunk that create forward arms, legs, and trunk that create forward motion motion

• In order to walkIn order to walk1- each leg able to support body wt without collapse1- each leg able to support body wt without collapse2- maintain static and dynamic balance during single 2- maintain static and dynamic balance during single

leg stance maintenance of upright posture.leg stance maintenance of upright posture.3- sufficient power for limb motion and to advance the 3- sufficient power for limb motion and to advance the

trunk.trunk.4- the swing leg able to advance to a position where it 4- the swing leg able to advance to a position where it

can take over the supporting role.can take over the supporting role.

For proper gaitFor proper gait5- proper proprioceptive system5- proper proprioceptive system6- normal vision6- normal vision

Causes of gait Causes of gait abnormalityabnormality

• Weakness , spasticity , balance Weakness , spasticity , balance disturbances, leg length disturbances, leg length discrepancy ……...…or deformity discrepancy ……...…or deformity which disturbs the motionwhich disturbs the motion

• The motion is a compensation to The motion is a compensation to correct for some other problem correct for some other problem

Specific gait abnormalitySpecific gait abnormality

• Lateral trunk bendingLateral trunk bending1- Trendelenburg gait1- Trendelenburg gait2- waddling gait2- waddling gait

• Standing on one leg lead to Standing on one leg lead to increase load on the stance leg due increase load on the stance leg due toto

1- whole wt on one leg1- whole wt on one leg2- the wt of swing leg2- the wt of swing leg3- gluteus medius reaction force 3- gluteus medius reaction force

Unilateral stanceUnilateral stance

Causes of Trendelenburg gaitCauses of Trendelenburg gait• Painful hipPainful hip• Abductor weaknessAbductor weakness• Abnormal hip joint, CDHAbnormal hip joint, CDH• Unequal Leg lengthUnequal Leg length• Coxa vara Coxa vara

Angle of inclination of Angle of inclination of the femurthe femur

• Anterior trunk bendingAnterior trunk bendingAt heel contact, the trunk bend forward to At heel contact, the trunk bend forward to

compensate for knee extensor weaknesscompensate for knee extensor weakness

• Posterior trunk bendingPosterior trunk bendingAt heel contact, the trunk bend backward to At heel contact, the trunk bend backward to

compensate for hip extensor weakness or to compensate for hip extensor weakness or to propel the swing leg forward to compensate propel the swing leg forward to compensate for hip flexor weakness or spasticity of hip for hip flexor weakness or spasticity of hip extensor weakness or ankylosed hip extensor weakness or ankylosed hip

Anterior trunk bending Anterior trunk bending Posterior trunk bendingPosterior trunk bending

• Increased lumbar Increased lumbar lordosislordosis

Due to flexion contracture of the Due to flexion contracture of the hip jointhip joint

• Functional leg length Functional leg length discrepancydiscrepancy

Not true discrepancyNot true discrepancy

1- circumduction1- circumduction

2- hip hiking2- hip hiking

3- high steppage 3- high steppage

4- vaulting4- vaulting

•Abnormal hip rotationAbnormal hip rotation

Causes of toe in- out gait Causes of toe in- out gait

1.1. Increased range of internal Increased range of internal rotationrotation

2.2. Decreased range of Decreased range of external rotationexternal rotation

3.3. Ms imbalanceMs imbalance

4.4. Mechanical effects of femur Mechanical effects of femur AnteversionAnteversion

N.B: The opposite is N.B: The opposite is true for hip true for hip retroversionretroversion

• Excessive knee extensionExcessive knee extension due to knee due to knee extensor weaknessextensor weakness

• Excessive knee flexion Excessive knee flexion due to due to 1- knee flexion contracture1- knee flexion contracture

2- knee flexor spasticity2- knee flexor spasticity

3-ankle stiffness3-ankle stiffness

4- Functional leg length discrepancy4- Functional leg length discrepancy

• Toe drag and foot slap Toe drag and foot slap due to inadequate due to inadequate foot dorsiflexor controlfoot dorsiflexor control

• Abnormal foot contact Abnormal foot contact due to due to 1- talipes calcaneus1- talipes calcaneus2- talipes equinus2- talipes equinus3- excessive medial contact 3- excessive medial contact 4- excessive lateral contact4- excessive lateral contact5- Stamping gait- loss of sensation5- Stamping gait- loss of sensation

• Insufficient push offInsufficient push off

Due to calf muscles weaknessDue to calf muscles weakness

• Abnormal walking baseAbnormal walking base1- increased base (abducted hip 1- increased base (abducted hip

deformity-valgus knee- instability)deformity-valgus knee- instability)

2- decreased base (adducted hip 2- decreased base (adducted hip deformity-varus knee) deformity-varus knee)

How to reduce muscle How to reduce muscle force in unilateral force in unilateral stance ?stance ?

1- reduce body weight1- reduce body weight2- Carrying a load 2- Carrying a load ipsilaterallyipsilaterally3- Use of a cane 3- Use of a cane ipsilaterallyipsilaterally

4- Compensatory lateral 4- Compensatory lateral lean of the trunklean of the trunk

5- Use of cane 5- Use of cane contralaterallycontralaterally