Gait Exam

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