Definition
Limp - asymmetrical gait pattern
Note: Children assume adult walking patterns by the age of eight
Normal Gait
1. Rate
- increased, decreased or normal
2. Rhythm
- normal or limp
- limp is a disturbance in normal rhythm
- numerous causes - see below
3. Gait cycle
- individual cycle
- from one foot strike to the same foot strike
- stance 60% swing 40%
Phases
Initial contact - knee extended
Loading response - knee flexed, ankle DF
Mid stance
Terminal stance - hip extends, heel rise
Pre swing - ankle PF
Initial swing
- need foot clearance
- knee flexed, ankle DF
Mid swing
Terminal swing
Elements of gait asymmetry
STRAWS
Short
Trendelenburg (gait or lurch)
Rigid - hip / knee / ankle
Antalgic - painful, shortened stance phase
Weak - hip (trendelenberg), knee (back knee gait), ankle (high stepping)
Supratentorial (CNS - spastic / ataxic / toe walking / crouch / jump)
Gait Examination
Examine in coronal plane (from front) and in sagittal plane (from side)
Foot
Coronal
- foot progression angle
- bilateral in / out toeing
- old SUFE (walk with ER)
Sagittal (F/E)
- should have 3 rocker phases (might have just one or two)
- Heel Strike / Plant / Toe off
- nil heel strike in toe walker / cp - equinus may be fixed or not
- high stepping gait if weak
- equinus if LLD (shouldn't be fixed)
Knee
Coronal
- varus / valgus malalignment & thrust
- squinting / medially facing patella secondary increase PFA
Sagittal (F/E)
- achieving full extension in stance (not in a cp)
- back leg gait (weak knee extensors eg polio)
- may hold flexed in LLD
Hip
Coronal
- abductor lurch
- scissoring (adductor tightness in cp, increased PFA)
Sagittal (F/E)
- hyperflexion / FFD (hyperlordosis)
- weak hip flexors - back extension
Pelvis
Coronal
- pelvic asymmetry secondary to LLD / scoliosis
Sagittal
- hyperlordosis (hip FFD)
Trunk
Coronal - swaying side to side
Head - up and down with LLD
UL
- a hemiplegic will swing only one arm
Specific Gait patterns
Short
- head and shoulders drop as patient steps onto short limb (bobbing up & down of head and shoulders in sagittal plane)
- Pelvis drops on affected side with heel strike and exaggerated head motion in sagittal plane
- vaulting gait
- flexion knee, equinus ankle
Stiff
Hip
- head & torso sways front to back in sagittal plane as walks
- Decreased hip flexion on swing phase and lumbar motion increases (AP sway)
Knee
- hip circumducts
- little flexion / extension through stance
Ankle
- may turn foot out to use STJ
- limitation F/E in sagittal plane
- DDX unilateral fixed equinus
- Tight TA / Hemiplegic CP / Short leg / Foot drop
Pain
- shortened stance phase
Weak
Hip
- Trendelenberg / abductor lurch
- head and shoulders sway side to side
Knee
- weak quads
- back knee gait
Ankle
- Foot drop gait
- High stepping gait
Neuromuscular
Spastic gait
Diplegic
1. Equinus gait - nil heel strike in rocker phases
2. Jump gait - ankle equinus, knee flexion
3. Crouch gait - ankle / knee + hip flexion
4. Scissoring gait
Hemiplegic
- unilateral loss heel strike, knee held flexed
- nil movement of arm in swing
Ataxia
- broad based gait