GAIT in Physiotherapy

INTRODUCTION
Bipedal walking is an important characteristic of humans. This page presents information

about the different phases of the gait cycle; important functions of the foot while walking
and gait analysis which is a key skill for physiotherapists.
Definitions:
Sandra J. Shultz describes gait as: “...someone’s manner of ambulation or locomotion,

involves the total body. Gait speed determines the contribution of each body segment.
Normal walking speed primarily involves the lower extremities, with the arms and trunk
providing stability and balance. The faster the speed, the more the body depends on the
upper extremities and trunk for propulsion as well as balance and stability. The legs
continue to do the most work as the joints produce greater ranges of motion trough greater
muscle responses. In the bipedal system the three major joints of the lower body and pelvis
work with each other as muscles and momentum move the body forward. The degree to
which the body’s centre of gravity moves during forward translation defines efficiency. The
body’s centre moves both side to side and up and down during gait.”
THE GAIT CYCLE
The sequences for walking that occur may be summarized as follows:
1. Registration and activation of the gait command within the central ner vous system.
2. Transmission of the gait systems to the peripheral nervous system.
3. Contraction of muscles.
4. Generation of several forces.
5. Regulation of joint forces and moments across synovial joints and skeletal segments.
6. Generation of ground reaction forces.
Classification of the gait cycle involves two main phases: the stance phase and the swing
phase. The stance phase occupies 60% of the gait cycle while the swing phase occupies only
40% of it. Gait involves a combination of open- and close-chain activities.
A more detailed classification of gait recognizes six phases:
1. Heel Strike
2. Foot Flat
3. Mid-Stance
4. Heel-Off
5. Toe-Off
6. Mid-Swing
Phrases of the Gait Cycle:
 Hill Strike: Also known as initial contact, is a short period which begins the
moment the foot touches the ground and is the first phase of double support. 30°
flexion of the hip and full extension in the knee is observed. The ankle moves from a
neutral (supinated 5°) position into plantar flexion. After this, knee flexion (5°)
begins and increases, just as the plantar flexion of the heel increased. The plantar
flexion is allowed by eccentric contraction of the tibialis anterior, extension of the
knee is caused by a contraction of the quadriceps, flexion is caused by a contraction
of the hamstrings, and the flexion of the hip is caused by the contraction of the rectus
femoris.
 Foot Flat: In foot flat, or loading response phase, the body absorbs the impact of
the foot by rolling in pronation. The hip moves slowly into extension, caused by a
contraction of the adductor magnus and gluteus maximus muscles. The knee flexes to
15° to 20° of flexion. Ankle plantar flexion increases to 10-15°.
 Midstance: In midstance the hip moves from 10° of flexion to extension by
contraction of the gluteus medius muscle. The knee reaches maximal flexion and
then begins to extend. The ankle becomes supinated and dorsiflexed (5°), which is
caused by some contraction of the triceps surae muscles. During this phase, the body
is supported by one single leg. At this moment the body begins to move from force
absorption at impact to force propulsion forward.
 Heel Off: Heel off begins when the heel leaves the floor. In this phase, the body
weight is divided over the metatarsal heads. Here can we see 10-13° of hip
hyperextension, which then goes into flexion. The knee becomes flexed (0 -5°) and
the ankle supinates and plantar flexes.
 Toe Off: In the toe-off/pre-swing phase, the hip becomes less extended. The knee is
flexed 35-40° and plantar flexion of the ankle increases to 20°. In toe-off, like the
name says, the toes leave the ground.
Early Swing:
In the early swing phase the hip extends to 10° and then flexes due to contraction of the
iliopsoas muscle 20° with lateral rotation. The knee flexes to 40-60°, and the ankle goes
from 20° of plantar flexion to dorsiflexion, to end in a neutral position.
Mid Swing:
In the midswing phase the hip flexes to 30° (by contraction of the adductors) and the
ankle becomes dorsiflexed due to a contraction of the tibialis anterior muscle. The knee
flexes 60° but then extends approximately 30° due to contraction of the sartorius
muscle. This extension is caused by the quadriceps muscles.
Late Swing:
The late swing/declaration phase begins with hip flexion of 25-30°, a locked extension
of the knee and a neutral position of the ankle.
FOOT PATHOLOGY
 Leg Length Discrepancy

 Antalgic Gait
Leg Length Discrepancy:
Leg length discrepancy can be as a result of an asymmetrical pelvic, tibia or femur length or
for other reasons such as a scoliosis or contractures. The gait pattern will present as a pelvic
dip to the shortened side during stance phase with possible ‘toe walking’ on that limb. The
opposite leg is likely to increase its knee and hip flexion to reduce its length .
Antalgic Gait:
Antalgic gait due to knee pain presents with decreased weight bearing on the
affected side. The knee remains in flexion and possible toe weight bearing
occurs during stance phase .
Antalgic gait due to ankle pain may present with a reduced stride length and
decreased weight bearing on the affected limb. If the problem is pain in the
forefoot then toe off will be avoided and heel weight bearing used. If the pain
is more in the heel, toe weight bearing is more likely. General ankle pain may
result in weight bearing on the lateral border .
Antalgic gait due to hip pain results in reduced stance phase on that side.
The trunk is propelled quickly forwards with the opposite shoulder lifted in an
attempt to even the weight distribution over the limb and reduce weight
bearing. Swing phase is also reduced .

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GAIT in Physiotherapy

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INTRODUCTION

Bipedal walking is an important characteristic of humans. This page presents information

Sandra J. Shultz describes gait as: “...someone’s manner of ambulation or locomotion,

THE GAIT CYCLE

The sequences for walking that occur may be summarized as follows:

A more detailed classification of gait recognizes six phases:

Phrases of the Gait Cycle:

 Leg Length Discrepancy

Leg Length Discrepancy:

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