Gait & Gait Aids
Normal Gait & Abnormal Gait
Why we should know
“Normal Gait”
If we have sound knowledge of
the characteristics of normal gait
We can accurately detect & interprete
deviations from the normal gait pattern
60%
40%
60%
40%
20-25%
Stride width
5-10cm
Cadence 70-130 step/min
Abnormal gait
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Stance phase
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Antalgic
Lateral trunk bending
Anterior trunk bending
Posterior trunk bending
Lordosis
Hyperextended knee
Excessive knee flexion
Excessive Genu Valgum or Varum
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Inadequate Dorsi-flexion control
Insufficient Push-off
Abnormal walking base
Internal or external limb rotation
Excessive medial or lateral foot contact
Vaulting
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Swing phase
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Circumduction
Hip hiking
Internal or external limb rotation
Inadequate Dorsiflexion control
Abnormal walking base
Antalgic gait
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Pain in stance phase :
knee, hip, foot pain
Lateral trunk bending
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Hip abductor weakness
Hip dislocation, coxa vara, slipped
capital femoral epiphysis
Hip pain
Perineal pressure
Involved limb relatively shorter
Compensation for abducted gait
Trendelenberg gait
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Gluteus Medius Gait
Anterior Trunk Bending
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Quadriceps
weakness
combined with
weakness of
gluteus maximus,
gastrocnemius, or
both
Pushing backward with the hand /
lateral rotation
Posterior Trunk Bending
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Gluteus Maximus (Lurch) Gait
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Hip-extensor weakness
Knee ankylosis, spasticity or
orthotic knee lock
Hip-extensor spasticity
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Hyperextended knee
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Quadriceps weakness
Capsular ligament laxity
Quadriceps spasticity
Plantar-flexion contracture or spasticity
Compensation for contralateral limb
shortening (hip-flexion or knee-flexion
contracture)
Excessive knee flexion
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Knee-flexion or hip-flexion contracture
Knee-flexor spasticity
Uncompensated quadriceps weakness
Ankle ankylosis, pes calcaneus
Plantar-flexor weakness
Involved limb relatively longer
Steppage gait
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Ankle dorsiflexor weakness : compensate by
exaggerated hip and knee flexion
Foot drop / dragging
Slap foot
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Ankle dorsiflexor weakness : early stance
phase
Insufficient Push-Off
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Flat foot gait
Plantar-flexor weakness
Rupture of the Archilles tendon or
the triceps surae
Metatarsal pain, hallux rigidus
Internal or External Limb Rotation
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Internal rotation
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Biceps femoris weakness
spasticity
External rotation
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Quadriceps weakness
Inner hamstring weakness
Spasticity
Abnormal walking base
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Wide Base (> 4 inch)
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Hip-abduction contracture
Instability due to fear, proprioceptive
deficit, cerebellar problem
Perineal pain
Genu valgum
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Narrow base (< 2 inch)
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Spasticity
Genu varum
Vaulting
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Swing-phase limb is
relatively longer
Hip hiking
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Increased ipsilateral length:
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hip -flexor or dorsiflexor
weakness
hip, knee, ankle ankylosis or
spasticity
insufficient hip or knee flexion
Contralateral shortness
Circumduction
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Spasticity
Hip flexor weakness
Hamstring paralysis
Knee or ankle ankylosis /
orthotic knee lock
Dorsiflexor weakness
Plantar-flexion contracture
Scissoring gait
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In spastic
CP with
spasticity
of adductor
m.
Crouched Gait
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Excessive flexion of
hip and knee due to
spasticity, muscle
tightness or
contracture
Spastic CP
Parkinsonian gait
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Trunk ,head ,neck forward
and knee flexed
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wide base ,small shuffling
step
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trend to fall forward and to
increase speed
(festination)
Hemiplegic gait
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Abnormal arm swing : adduction
with flexion at shoulder ,elbow ,wrist
and fingers
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extensor synergy of lower limb: leg
extension ,adduction and hip IR
,knee extension ,ankle and foot
plantarflexion and inversion.
Gait aids
Purpose of gait aids
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Increase area of support, maintain
center of gravity over support area
Redistribute weight-bearing area
Requirements
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ROM, muscle strength and endurance,
coordination, trunk balance, sensory
perception, mental status
Amount of weight-bearing permitted on
lower limb
Requirements
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Shoulder depressor – latissimus dorsi,
lower trapezius, pectoralis minor
Shoulder adductor – pectoralis major
Shoulder flexor, extensor and abductor
– deltoid
Elbow extensor – triceps
Wrist extensor – ECR, ECU
Finger flexor – FDS, FDP, FPL, FPB
Crutches
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Body weight
transmission with
bilateral axillary
crutches = 80% of BW,
nonaxillary crutches =
40-50% of BW
Good strength of
upper limbs usually
required – more weight
bearing and propulsion
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Unilateral non/partial weight bearing
eg fracture, amputee -> 3-point gait
Bilateral partial weight bearing or
incoordination/ataxia -> 2 or 4-point
gait
Bilateral weakness of lower extremities
eg paraplegia -> swing-to or through
gait
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Non-axillary crutches
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Lofstrand/forearm crutches
Platform crutch
Wooden forearm orthosis (Kenny stick)
Triceps weakness orthoses (arm
orthoses) eg Warm Spring, Everett,
Canadian crutch
Axillary crutches
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Crutch length : measure anterior
axillary fold to point 6 inches
anterolaterally from foot or to heel
plus 1-2 inches
Hand piece : elbow flexed 30
degree, wrist max extension,
finger fist
2-3 FB from apex of axilla
Compressive radial neuropathies
Lofstrand/forearm crutches
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Single aluminum tubular
adjustable shaft,
handpiece, forearm
piece 2 inches below
elbow, forearm cuff
anterior opening (hinge)
Elbow flexion 20 degree
Can release hand
without loosing crutch
Requires great skill,
good strength of UEs,
trunk balance
Platform crutch
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Painful wrist and
hand condition or
elbow contractures,
or weak hand grip
Platform, velcro strap
Elbow flexed 90
degrees
Crutch Gaits
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Point gait – stability, slow
Swing gait – more energy, fast
Four-point gait
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Good stability - at
least 3 point
contact ground
Ataxia or
incoordination
Slowest, difficulty
Three-point gait/alternating
two-point gait
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Non-weight-bearing
gait for lower limb
fracture or amputation
3-point PWB gait ->
required 18-36% more
energy per unit
distance than normal
NWB required 4161%more energy per
unit distance than
normal
Two-point gait
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Faster than 4-point
gait but less
stability
Decrease both
lower limbs weightbearing
Swing-through gait
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Fastest gait,
requires functional
abdominal muscles
Required increase
of 41-61% in net
energy cost (= 3point NWB)
Swing-to gait
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Both crutches ->
both lower limbs
almost to crutch
level
Canes
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Body weight
transmission for
unilateral cane
opposite affected
side is 20-25%
Gluteus medius
weakness, or
pathological at
knee or ankle
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Cane eliminate necessary gluteus
medius force and reduces
compressional force on hip
Measure tip of cane to level of greater trochanter,
elbow flexed 20-30 degree
Walker/Walkerette
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Wider and more
stable base of
support, but slow
gait (interfere
smooth reciprocal
gait)
For patients
requiring maximum
assistance with
balance,
uncoordinated
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Add wheels to front
legs for who lack
coordination or power
in upper limbs
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Front of walker 12 inches in front of
patient
Shoulder relaxed and elbow flexed 20
degree
Three-point gait