Abnormal gait pattern

2.  Gait means the way a person
walks. Abnormal gait occurs
when the body system that
control the way a person walks
do not function in the usual way.
 An altered gait pattern reflects
following reasons-

3.  Illness
 genetic factors
 Injury
 Abnormalities in the legs and
feet.

4. The patient stands with unilateral weakness
on the affected side , arm flexed , adducted
and internally rotated . Leg on same side is in
extension with plantar flexion of the foot and
toes. When walking , the patient will hold his
or her arm to one side and drags his or her
arm to one side and drags his or her affected
leg in a semicircle due to weakness of distal
muscle and extensor hypertonia in lower
limb. Most common in stroke

6. DIPLEGIC GAIT
Patients have involvement on both sides with
spasticity in lower extremities worse than
upper extremities . The patient walks with an
abnormally narrow base , dragging both legs
and scraping the toes. This gait is seen in
cerebral palsy .There is also characterstic
extreme tightness of hip adductors which can
cause legs to cross the midline referred to as
a scissor gait. In countries with adequate
medical care , patients with cerebral palsy
may have hip adductor release sugery to
minimize scissoring.

8. MYOPATHIC GAIT
Hip girdle muscles are responsible for
keeping the pelvis level when walking . If you
have weakness on one side , this will lead to
a drop
in the pelvis walking . With bilateral
weakness,
you will have dropping of the pelvis on both
sides during walking leading to waddling .
This gait is seen in patient with Myopathies
such as Muscular dystrophy .

10. This gait is seen with certain basal ganglion
disorders including Sydenham’s chorea ,
Huntington ‘s disease and other forms of
chorea , athetosis or dystonia . The patient
will display irregular , jerky , involuntary
movements in all extremities . Walking may
accentuate their baseline movement disorder.

12. Most common seen in cerebellar disease ,
this gait is described as clumsy , staggering
movement with a wide based gait. While
standing still ,The patient ‘s body may
swagger
back and forth and from side to side, known
as titubation . Patient will not be able to walk
from heel to toe or in a straight line . The gait
of acute alcohol intoxication will resemble the
gait of cerebellar disease.

14. As our feet touch the ground , we receive
propioreceptive information to tell us their
location. The sensory ataxic gait occurs when
there is loss of this propioreceptive input . In
an effort to know when the feet land and their
location , the patient will slam the foot hard
on to the ground in order to sense it . This
gait can be seen in disorder of the dorsum
columns( b12 deficiency) or in disease
affecting the peripheral nerves .

16.  causes = pain with weight bearing
 Patho mechanism = weight bearing avoided
on painful limb . Decreased step length of
uninvolved side .
 Treatment= treat underlying causes ,
analgesia , assistive device in contraletral
hand

18.  Causes= true or apparent leg length
discrepancy
 Pathomechanism = shortened side- pelvic
drop , decreased hip and knee flexion , ankle
plantar flexion .
 lengthened side= hip hiking , circumduction,
excessive hip and knee flexion , foot
hyperpronation.

20.  Scissors gait= a person whose legs bend
inward will often have a scissors gait . With
this type , a person ‘s legs cross and ,may hit
each other while walking . The crisscross
motion may resemble scissors opening and
closing.
 Steppage gait = Steppage gait ( neuropathic
gait) occurs when a person’s toes point
towards the ground while walking . Often the
toes will scrape against the ground as the
person steps forward.

23.  Propulsive gait = Propulsive gait is when a
person walks with his or her head and neck
pushed forward . It can appear as though the
person is rigidity holding a slouched position.

25.  Injuries to the legs or feet
 Arthritis
 Infection in the soft tissues of the legs
 Broken bones in feet and legs
 Birth defects
 Cerebral palsy
 Stroke
 Tendonitis
 Shin splints

26.  Leg braces
 Cruthces
 Canes
 Walker

27. If an underlying conditioning is the cause of
an abnormal gait , a person ‘s walk should
correct itself when the condition is treated.
This is often true for broken bones , as they
can be treated with a cast.
other injuries may require surgery or
physical
therapy to help return the gait to normal.
for long term cases of abnormal gait , it is
likely a person will use assistive devices for
treatment. These can include;

28.  A lurching gait , characterized by posterior
leaning of the trunk at heel strike in order to
keep the hip extended during the stance
phase. It is caused by weakness of the
gluteus maximus . It is also called hip
extensor gait.
 If the gluteal maximus muscle , which is a
primary hip extensor , is weak , the patient
thrusts the thorax posteriorly at initial
contact to maintain hip extension of the
stance leg. The resulting gait involves a
characterstic backward lurch of the trunk.

29.  If the hip abductor muscles ( gluteus medius
minimus) are weak , the stabilizing effect of
these muscles during stance phase is lost ,
and the patient exhibits an excessive lateral
list in which the thorax is thrust laterally to
keep the center of gravity over the stance leg
. If there is bilateral weakness of the gluteus
medius muscles , resulting in a wobbing gait
or chorus girl swing .This gait may also be
seen in patients with congenital dislocation of
the hip and coxa vara.

31.  Quadriceps gait =Quads action is needed
during heel strike and foot flat when there is
a flexion movement acting at the knee.
COMPENSATION- with quads weakness the
individual may lean forward over the
quadriceps . This will force the knee
backward
 Genu recurvatum gait = Hamstrings are
weak,
2 things may happen
 During stance phase – knee will go in
hyperextension
 During stance phase – hamstrings slow down
the swing forward.

33.  Calcaneal gait = A gait disturbance ,
charactersized by walking on the heel, due to
paralysis of the muscles , seen following
poliomyelitis and in some other neurologic
diseases.
 Equinus gait = Toe walking patho
mechanical gait of childhood , charactersized
by habitual tiptoe walking , may occur simply.
From habit , or characterized talipes
equinovarus ,spasticity or other
neuromuscular disorders leading to posterior
muscles group contracture , or loss of
function of the anterior muscle group of the
lower limb.

36. Particularly important muscles for gait include
the hip extensors, knee extensors, plantar
flexors, and dorsiflexors. A significsant
weakness in any of these muscle group will
adversely affect the quality of the gait
pattern.
People with gait abnormalities you should
consult with their physicians before
performing any physical activity.
 Allow plenty of time to complete daily
activities, especially walking.
 Wear appropriate shoes and clothing that will
not hinder your ability to walk freely.

37.  Wear prescribed leg braces and in shoe
splints for proper foot alignment during
standing and walking.
 Use a cane or walker if necessary for added
support and balance .
 Check skin after bouts of walking and
standing to avoid skin breakdown and ulcers’

38.  Gait is the style , manner or a pattern of
walking.
 Walking pattern or style may differ from
individual to individual.
 Dependence upon age, sex, mood, disease
 walking is a highly coordinated process
involving CNS, muscles , bones and joints
 These activity requires Coordination, Balance,
kinesthetic sense, proper muscle strength

39.  It is the activity , which occurs between the
points of the initial contact of the same
extremity two times.
PHASES OF GAIT CYCLE
gait cycle consists of two phases
1. Stance phase
2. Swing phase
STANCE PHASE
The activity which occurs during the foot
having the contact with the ground.
Contributes approximately about 60 % of gait
cycle

40. SWING phase
The activity which occurs when the foot is not
in contact with the ground .
 Contributes approximately about 40% of gait
cycle.
CADENCE= no of steps / min
STRIDE LENGTH= distance between the heel
strike of one lower extremity to the heel
strike of the same lower extremity once again
to the ground
STRIDE DURATION = It is the time taken for
completion of heel strike of one extremity to
the heel strike of the same extremity again

41. STEP LENGTH
This is the distance between the heel strike of
one lower extremity to the heel strike of
another extremity
STEP DURATION
It is the time taken for completion of one step
WIDTH OF BASE OF SUPPORT
Linear distance between the mid point of one
foot to the other foot is called as width of
base of support .It is about 2- 4 inches.

42.  Used to minimize excursion of COG in
vertical and horizontal planes.
 reduce significantly energy consumption
THE DETERMINANTS ARE
1. Lateral pelvic tilt
2. pelvic rotation
3. knee flexion in stance phase
4. knee , ankle and foot interactions
5. Physiological valgus of knee

43.  STANCE PHASE= The stance phase is that
part of a gait cycle during which the foot
remains in contact with the ground. For
analyzing gait cycle one foot is taken as
reference and the movements of the
reference foot are studied
 In stance phase the refernce foot undergoes
five movements
1. Initial contact ( heel strike) = the heel is
the first bone of the reference to touch the
ground

44.  The swing phase is the part of the gait cycle
during which the refernce foot is not in
contact with the ground and swings in the air.
It constitutes about 40 % of gait cycle.
 it has 3 parts
1. Initial swing
2. mid swing
3. terminal swing
 SINGLE SUPPORT= in single support only
one foot is in contact with the ground
 Double SUPPORT= in double both feet are
in contact with the ground.

45. 2 = Loading response ( foot flat ) = in loading
response phase , the weight is transferred
on to the referenced leg . It is important for
weight bearing , shock absorption and
toward progression.
3 = Terminal stance = In this phase , the heel
of reference foot rises while its toes are still
in contact with the ground.
4= Toe off ( pre swing) = the toe of reference
foot rises and swings in air . This is the
beginning of the swing phase of the gait
cycle.