Human Gait - Basics, Pathology & Analysis.pptx

This presentation delineates an overview of basics, pathology of gait and how to analyze it. It defines key terminology like the gait cycle, stride, step, and phases of gait. The major determinants of normal gait are described, including pelvic rotation and tilt, knee flexion, and foot and muscle mechanics. Pathologies are discussed for each phase of gait, such as foot slap, genu recurvatum, and Trendelenburg gait. Causes and clinical presentations of various gait deviations are outlined. In summary, the document serves as a comprehensive reference for understanding normal and abnormal human locomotion.

1. Dr Md. Mamunul ABEDIN MBBS, BCS (Health), FCPS trainee (Physical Medicine and Rehabilitation) Assistant Registrar Dept of Physical Medicine & Rehabilitation ShSMCH , Dhaka, Bangladesh GAIT Basics , Pathology , Analysis

2. Dr Abedin MM Basics Gait : Series of rhythmical, alternating movements of the trunk & limbs which result in the forward progression of the center of gravity. The Gait Cycle : A single sequence of functions of one limb. Heel strike to subsequent heel strike of the same foot. 2

3. Basics Two Phases: Stance Phase: limb is in contact with the ground. - 5 subdivisions - 60 % Swing Phase: foot is in the air. - 3 subdivisions - 40% 3 Dr Abedin MM

4. Stance Phase Initial contact (IC) : Instant the foot contacts the ground. Loading response (LR) : Initial contact to contralateral toe off. Midstance ( MSt ) : Contralateral toe off to ipsilateral heel off. Terminal stance ( TSt ) : Ipsilateral heel off to initial contact of the contralateral limb. Preswing ( PSw ) : Initial contact of the contralateral limb to just prior to toe off of ipsilateral limb. 4 Dr Abedin MM

5. Right Initial Contact 5 Both Feet on the Ground 2% Dr Abedin MM

6. 6 Left Toe Off Right LOADING RESPONSE Both Feet on the Ground 10% Dr Abedin MM

7. 7 Left foot is still on air Right MIDSTANCE Right Heel Off 30% Dr Abedin MM

8. Dr M M Abedin 8 Right TERMINAL STANCE Both Feet on the Ground Left Initial Contact 50% Dr Abedin MM

9. 9 Right PRESWING Left LOADING RESPONSE Both Feet on the Ground Right Toe Off 60% Dr Abedin MM

10. Stance Phase 10 Dr Abedin MM

11. SWING Phase Initial swing : Lift of the extremity from the ground to position of maximum knee flexion. Midswing : Immediately following knee flexion to vertical tibia position. Terminal swing : Following vertical tibia position to just prior to initial contact. 11 Dr Abedin MM

12. 12 Right INITIAL SWING Both FOOT ALIGNED 73% Dr Abedin MM

13. 13 Right MIDSWING Right Tibia VERTICAL 87% Dr Abedin MM

14. 14 Right TERMINAL SWING 100% Right Initial CONTACT Dr Abedin MM

15. SWING Phase 15 Dr Abedin MM

16. Kinematic Summary 16 Phase Knee Tibia on Femur Calcaneus Subtalar Motion Midfoot Function Forefoot IC Extended Laterally Rotated 2 ° Inverted Supinated Locked Adducted LR Flexing Medially Rotated Everting to 5 ° Ev Pronating Unlocking (Absobing Shock) Abducting Early MSt Extending Laterally Rotated Everting to 7 ° Ev Pronating Unlocking Abducting Late MSt Extending Laterally Rotated Inverting to 5 ° Iv Supinating Locking Adducting TSt Extended Laterally Rotated Inverting to 5 ° Iv Supinated Locked Adducted PSw Flexing Medially rotating 6 ° Iv Supinated Unloading Adducted Dr Abedin MM

17. Major Muscle Activity IC LR MSt TSt PSw Ankle PF PF DF DF DF Dorsi-flexors Dorsi-flexors Plantar Flexors Plantar Flexors Passive Recoil Knee Brief Extension Flexion Flex to Extension Extension Flexion Vasti Vasti Vasti - Flexion, No Activity –Extension Posterior Knee Structures Rectus Femoris Hip Flexion Flexion Flex to Extension Extension Decreasing Extension Hip Extensors Hip Extensors No activity None Adductor Longus & Rectus Femoris 17 Dr Abedin MM

18. 18 Dr Abedin MM Major Muscle Activity

19. Gait Pathology Initial Contact Initial Contact through Midstance Initial Contact through Preswing Loading Response through Preswing Midstance through Preswing Swing Phase 19 Stance Phase Dr Abedin MM

20. Initial Contact Probable Causes: Weak Dorsi-flexors (3/5 ) 20 Pathology: Foot Slap Dr Abedin MM

21. Pathology: Genu Recurvatum Excessive Foot Supination Excessive Trunk Extension Excessive Trunk Flexion 21 Dr Abedin MM Initial Contact through Midstance

22. Pathology: Genu Recurvatum Excessive Foot Supination Excessive Trunk Extension Excessive Trunk Flexion 22 Dr Abedin MM Initial Contact through Midstance Probable Causes: Weak, short, or spastic quadriceps Compensated hamstring weakness Achilles tendon contracture Plantar flexor spasticity

23. Pathology: Genu Recurvatum Excessive Foot Supination Excessive Trunk Extension Excessive Trunk Flexion 23 Dr Abedin MM Initial Contact through Midstance Probable Causes: Compensated forefoot valgus deformity Pes cavus Short limb

24. Pathology: Genu Recurvatum Excessive Foot Supination Excessive Trunk Extension Excessive Trunk Flexion 24 Dr Abedin MM Initial Contact through Midstance Probable Causes: Weak hip extensor or flexor Hip pain Decreased knee ROM Reason for deviation: Leaning backwards during stance phase shifts body’s COG posterior to hip  reducing need for active hip extension torque.

25. Pathology: Genu Recurvatum Excessive Foot Supination Excessive Trunk Extension Excessive Trunk Flexion 25 Dr Abedin MM Initial Contact through Midstance Probable Causes: Weak gluteus maximus and quadriceps Hip flexion contracture

26. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 26 Dr Abedin MM Initial Contact through Preswing

27. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 27 Dr Abedin MM Initial Contact through Preswing Probable Causes: Hamstring contracture Increased ankle DF Weak PF Long limb Hip flexion contracture

28. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 28 Dr Abedin MM Initial Contact through Preswing Probable Causes: Tight medial hamstrings Anteverted femoral shaft Weakness of opposite muscle group (In Toe)

29. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 29 Dr Abedin MM Initial Contact through Preswing (Out Toe) Probable Causes: Tight lateral hamstrings Retroverted femoral shaft Weakness of opposite muscle group

30. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 30 Dr Abedin MM Initial Contact through Preswing Probable Causes: Hip abductor muscle contracture Instability G enu valgum Leg length discrepancy

31. Pathology: Excessive Knee Flexion Excessive Medial Femur Rotation Excessive Lateral Femur Rotation Wide Base of Support Narrow Base of Support 31 Dr Abedin MM Initial Contact through Preswing Probable Causes: Hip adductor muscle contracture G enu varum

32. Pathology: Pelvic Drop ( Uncompensated Trendelenburg Gait) Excessive Trunk Lateral Flexion ( Compensated Trendelenburg Gait) Waddling Gait 32 Dr Abedin MM Loading Response through Preswing

33. Pathology: Pelvic Drop ( Uncompensated Trendelenburg Gait) Excessive Trunk Lateral Flexion ( Compensated Trendelenburg Gait) Waddling Gait 33 Dr Abedin MM Loading Response through Preswing Probable Causes: Ipsilateral gluteus medius weakness

34. Pathology: Pelvic Drop ( Uncompensated Trendelenburg Gait) Excessive Trunk Lateral Flexion ( Compensated Trendelenburg Gait) Waddling Gait 34 Dr Abedin MM Loading Response through Preswing Probable Causes: Ipsilateral gluteus medius weakness Hip pain Hip dislocation, Coxa vara Relatively Shorter Limb

35. Pathology: Pelvic Drop ( Uncompensated Trendelenburg Gait) Excessive Trunk Lateral Flexion ( Compensated Trendelenburg Gait) Waddling Gait 35 Dr Abedin MM Loading Response through Preswing Probable Causes: Bilateral gluteus medius weakness

36. Pathology: Excessive Foot Pronation Bouncing or Exaggerated Insufficient Push-off Inadequate Hip Extension 36 Dr Abedin MM Midstance through Preswing

37. Pathology: Excessive Foot Pronation Bouncing or Exaggerated Insufficient Push-off Inadequate Hip Extension 37 Dr Abedin MM Midstance through Preswing Probable Causes: Compensated forefoot/ hindfoot varus deformity Uncompensated forefoot valgus deformity Pes planus Decreased ankle dorsiflexion Increased tibial varum Long limb Uncompensated internal rotation of tibia or femur Weak tibialis posterior

38. Pathology: Excessive Foot Pronation Bouncing or Exaggerated Insufficient Push-off Inadequate Hip Extension 38 Dr Abedin MM Midstance through Preswing Probable Causes: Achilles tendon contracture G astroc -soleus spasticity

39. Pathology: Excessive Foot Pronation Bouncing or Exaggerated Insufficient Push-off Inadequate Hip Extension 39 Dr Abedin MM Midstance through Preswing Probable Causes: Gastroc -soleus weakness Achilles tendon rupture Metatarsalgia H allux rigidus

40. Pathology: Excessive Foot Pronation Bouncing or Exaggerated Insufficient Push-off Inadequate Hip Extension 40 Dr Abedin MM Midstance through Preswing Probable Causes: Hip flexor contracture W eak hip extensor

41. 41 Dr Abedin MM

42. Pathology: Steppage Gait / Foot Drop Circumduction Hip Hiking 42 Dr Abedin MM Swing Phase

43. Pathology: Steppage Gait / Foot Drop Circumduction Hip Hiking 43 Dr Abedin MM Swing Phase Probable Causes: Severely weak dorsiflexors E quinus deformity P lantar flexor S pasticity

44. Pathology: Steppage Gait / Foot Drop Circumduction Hip Hiking 44 Dr Abedin MM Swing Phase Probable Causes: Long limb Abductor muscle shortening or overuse Stiff knee

45. Pathology: Steppage Gait / Foot Drop Circumduction Hip Hiking 45 Dr Abedin MM Swing Phase Probable Causes: Long L imb Quadratus Lumborum shortening Weak Hamstring Stiff Knee

46. Observational Analysis Process 46 Dr Abedin MM

47. Observational Analysis Process Observe the patient/client’s gait from both sagittal and frontal views Identify the major deviations Determine Velocity, Cadence, Stride Develop hypotheses of the likely causes Plan and perform a clinical examination to determine impairments Determine the cause of the deviations Set reasonable goals, develop and implement a treatment plan 47 Dr Abedin MM

48. Procedures Directly observe or obtain a videotape Minimal, tight clothing should be worn Instruct the patient to walk barefoot at a comfortable speed Observe the client’s walking from multiple views Identify prominent gait deviations Determine the reference limb for analysis Identify the deviations (Start at the foot) 48 Dr Abedin MM

49. Causes of Gait Deviations Primary : directly caused by an impairment (4 major categories) 1. Deformity 2. Weakness 3. Impaired motor control 4. Pain Secondary : results from an abnormal posture at adjacent joint Compensatory : movements accommodating for an impairment 49 Dr Abedin MM

50. Examples of the causes 50 Excess dorsiflexion (DF) in Mid Stance due to weak calf muscles Excess DF in Mid Stance due to a knee flexion contracture rather than weak calf muscles. Secondary Primary Dr Abedin MM

51. 51 Contralateral pelvic drop due to weak hip abductors Ipsilateral trunk lean in stance to compensate for weak hip abductors Primary Compensatory Examples of the causes Dr Abedin MM

52. 52 Forefoot contact at Initial Contact due to inadequate knee extension in Terminal Swing Secondary Examples of the causes Forefoot contact at Initial Contact due to Plantar flexion (PF) contracture Primary Hyperextension of Knee during Midstance Compensatory Dr Abedin MM

53. MSK Disorders Injuries ( e.g.: Sprains , strains, tendinosis, fractures, dislocations, overuse, peripheral nerve injury ) Degenerative diseases ( e.g.: osteoarthritis ) Systemic diseases ( e.g.: RA ) History of poliomyelitis Spina bifida Guillain-Barre syndrome Muscular dystrophy 53 Dr Abedin MM

54. CNS Disorders Stroke Multiple sclerosis Spinal cord injury Traumatic or acquired brain injury Parkinson’s disease Cerebral palsy Amyotrophic lateral sclerosis 54 Dr Abedin MM

55. Gait Deviations Ankle, Foot, Toes 55 Dr Abedin MM

56. 56 Gait Deviations Ankle, Foot, Toes Deviation Definition Forefoot Contact Initial ground contact with forefoot Flatfoot Contact Initial ground contact with both forefoot & hindfoot Abbr. Heel Contact At IC, interval of heel only is shortened Foot Slap Rapid PF after heel strike Inadeq . DF Less than normal DF Inadeq . PF Less than normal PF Excess Iv (Pes Cavus ) More than normal calcaneal/ forefoot inversion Excess Ev (Pes Planus) More than normal calcaneal/ forefoot eversion Early Heel Off Heel off in Mid-stance No Heel Off Heel does not rise in Terminal Stance Inaeq MTP X Less than normal MTP ext in TSt & PSw Excess IP Flex (Clawed) More than normal IP flexion with/out MTP extension Toe Drag Contact of foot with the ground during ISw / MSw Contralateral Vault (PF) Excess ankle PF + prolonged wt bearing of contra limb Dr Abedin MM

57. Gait Phase Possible causes IC Primary : Weak DF (<3/5) PF contracture/ Hypomobility Abnormal plantar flexor activity Secondary : To inadequate knee extension in TSw To a knee flexion contracture Abnormal hamstring activity Compensatory : - To reduce the effects of the heel rocker due to weak Quadriceps 57 Abbreviated Heel Contact ( Abb HC): At IC, the interval of heel only is shortened. Flatfoot Contact (Flat Ft): IC made with both hind & forefoot. Gait Deviations Ankle, Foot, Toes Dr Abedin MM

58. Gait Phase Possible causes IC Primary: Weak DF Weak Knee Extension Combination Compensatory: To accommodate for a shorter limb To avoid heel pain 58 Forefoot Contact: Initial ground contact made with the forefoot Foot Slap: Rapid PF after heel strike Gait Phase Possible causes LR Primary: - Weak DF (3/5) Gait Deviations Ankle, Foot, Toes Dr Abedin MM

59. Inadequate Plantar flexion : 59 Inadequate Dorsi-flexion : Inadequate DF for the phase. Phase Ankle Motion IC ° LR 5 ° PF MSt 5 ° DF TSt 10 ° DF PSw 15 ° PF ISw DF to 5 ° PF MSw DF to 0 ° TSw ° Probable Causes: Primary: Weak DF (<3/5) PF contracture/ Spasticity Ankle pain, joint effusion Compensatory: - To avoid the ankle rocker secondary to weak plantar flexors . Secondary: To absent/ short heel rocker Gait Deviations Ankle, Foot, Toes Dr Abedin MM

60. Gait Phase Possible causes IC Primary : Weak dorsiflexors (<3/5) Abnormal plantar flexor PF contracture Ankle pain, joint effusion Mid & Terminal Stance Primary : PF contracture (Rigid) Plantar flexor spasticity Ankle pain, joint effusion Compensatory : - To avoid the ankle rocker secondary to weak plantar flexors . Swing Same as IC 60 Inadequate Dorsi-flexion: Inadequate DF for the phase Gait Deviations Ankle, Foot, Toes Dr Abedin MM

61. Gait Phase Possible causes Mid Stance Primary : Skeletal Deformity Over activity of plantar flexors PF contracture/ Hypomobility Secondary : To excess knee flexion Compensatory : - Voluntary PF to accommodate for a short reference limb 61 Early Heel Off: Heel off in Mid-Stance Gait Deviations Ankle, Foot, Toes Dr Abedin MM

62. Gait Phase Possible causes Terminal Stance Primary : Weak plantar flexors (<4/5) Forefoot pain Secondary : To inadequate toe extension To excess ankle DF To knee hyperextension 62 No Heel Off: Heel does not rise in Terminal Stance Gait Deviations Ankle, Foot, Toes Dr Abedin MM

63. Gait Phase Possible causes Stance & Swing Primary : Hindfoot varus, Uncompensated Forefoot varus Impaired AT/PT/Soleus activity Equinovarus contracture Secondary : To genu varum To hip rotational deformities Swing Only Primary : All of the above Flaccid paralysis of pretibials (AT, EHL, EDL) 63 Excess Inversion (Pes Cavus ) : More than normal calcaneal/forefoot inversion for the phases Gait Deviations Ankle, Foot, Toes Dr Abedin MM

64. Gait Phase Possible causes Stance Primary : Hindfoot valgus, Uncompensated Forefoot valgus Weak invertors (AT, PT) Secondary : To a compensated forefoot varus To a genu valgus To hip rotational deformities Compensatory : For limited ankle DF ROM 64 Excess Eversion (Pes Planus) : More than normal calcaneal/forefoot eversion for the phases Gait Deviations Ankle, Foot, Toes Dr Abedin MM

65. Gait Phase Possible causes Initial Swing Primary : Inadequate Knee flexion Secondary : To excess contralateral knee flexion Mid Swing Primary : Inadequate DF (3/5) Secondary : To inadequate hip flexion Excess contralateral knee flexion 65 Toe drag: Contact of foot with the ground during Initial/ Midswing. Gait Deviations Ankle, Foot, Toes Dr Abedin MM

66. Gait Phase Possible causes Swing Compensatory : Voluntary contralateral PF (heel rise or toe walking) to lengthen stance limb and achieve swing limb toe clearance when there is: A longer Swing limb Inadequate knee flexion in Initial swing Inadequate DF in Mid Swing 66 Contralateral Vault: Excess ankle PF with prolonged forefoot weight bearing of the contralateral stance limb during reference limb swing. Gait Deviations Ankle, Foot, Toes Dr Abedin MM

67. Gait Phase Possible causes Terminal Stance & Pre Swing Primary : Hallux rigidus Abnormal FHL & FDL Secondary : To avoid forefoot pain To no heel off 67 Inadequate MTP extension: Excess ankle PF with prolonged forefoot weight bearing of the contralateral stance limb during reference limb swing. Gait Deviations Ankle, Foot, Toes Dr Abedin MM

68. 68 Gait Deviations KNEE Dr Abedin MM

69. Gait Phase Possible causes Stance Primary : Knee flexion contracture Abnormal knee flexors Knee pain, Joint effusion Secondary : To excess DF posture To excess hip flexion posture Swing Primary : + Weak Quadriceps + above Compensatory : To allow forefoot/flatfoot contact 69 Inadequate Extension: Less than normal extension for the phase. Phase Knee F/X IC ° + 5° LR 15 ° MSt ° TSt ° PSw 40 ° ISw 60 ° MSw 25 ° TSw ° Gait Deviations KNEE Dr Abedin MM

70. Gait Phase Possible causes L R Primary : Weak/ Abnormal Quadriceps Tibiofemoral / Patellofemoral pain Skeletal deformity Secondary : To excess PF posture To forefoot/flatfoot contact Compensatory : For anterior cruciate ligament deficiency 70 Inadequate Flexion: Less than normal flexion for the phase. Phase Knee F/X IC ° + 5° LR 15 ° MSt ° TSt ° PSw 40 ° ISw 60 ° MSw 25 ° TSw ° Gait Deviations KNEE Dr Abedin MM

71. Gait Phase Possible causes Swing Primary : Same as Loading Secondary : To inadequate hip flexion, kne flexion in pre-swing hip extension in terminal stance To ‘no heel off’ in Terminal Stance 71 Inadequate Flexion: Less than normal flexion for the phase. Phase Knee F/X IC ° + 5° LR 15 ° MSt ° TSt ° PSw 40 ° ISw 60 ° MSw 25 ° TSw ° Gait Deviations KNEE Dr Abedin MM

72. Gait Phase Possible causes Swing Primary : Abnormal hip & knee flexor activity Compensatory : To assure toe clearance 72 Excess Flexion: More than normal flexion for the phase Gait Deviations KNEE Dr Abedin MM

73. Gait Phase Possible causes Stance Primary : Weak quadriceps Secondary : To a PF posture Compensatory : To increase limb stability with weak quadriceps and plantar flexors 73 Hyperextension: More than normal extension for the phase Extensor thrust: Rapid movement toward extension Gait Deviations KNEE Dr Abedin MM

74. 74 Varus (Bow-Leg) : Adduction of distal tibia relative to femur. Valgus (Knock-Knee) : Abduction of distal tibia relative to femur. Gait Deviations KNEE Dr Abedin MM

75. Varus Valgus Primary : Skeletal deformity Ligamentous laxity OA Secondary : To an uncompensated hindfoot varus deformity To a compensated forefoot valgus deformity Primary : Skeletal deformity Ligamentous laxity RA Secondary : To an uncompensated hindfoot varus deformity To a compensated forefoot valgus deformity To an ipsilateral trunk lean 75 Varus (Bow-Leg) : Adduction of distal tibia relative to femur. Valgus (Knock-Knee) : Abduction of distal tibia relative to femur. Gait Deviations KNEE Dr Abedin MM

76. 76 Gait Deviations THIGH Dr Abedin MM

77. Gait Phase Possible causes Stance Primary : Hip flexion contracture Abnormal hip flexors Hip pain, Joint effusion Secondary : To excess knee flexion To ‘no heel off’ in Terminal stance 77 Inadequate Extension (Crouched Gait): Inadequate extension in Stance phase. Phase Thigh F/X IC 2 5° LR 2 5° MSt ° TSt 15 ° X PSw Flexing ISw 15 ° F MSw 25 ° F TSw 25 ° Gait Deviations THIGH Dr Abedin MM

78. Gait Phase Possible causes IC & LR Primary : Impaired motor control Skeletal deformity Secondary : To inadequate hip flexion in Terminal swing Compensatory : to decrease demand on weak hip extensors in LR 78 Inadequate Flexion: Less than normal flexion for the phase. Phase Thigh F/X IC 2 5° LR 2 5° MSt ° TSt 15 ° X PSw Flexing ISw 15 ° F MSw 25 ° F TSw 25 ° Gait Deviations THIGH Dr Abedin MM

79. Gait Phase Possible causes Swing Primary : Weak hip Flexors Abnormal Hamstring activity Secondary : To toe drag Compensatory : to decrease demand on weak hip extensors in preparation for IC & LR 79 Inadequate Flexion: Less than normal flexion for the phase. Phase Thigh F/X IC 2 5° LR 2 5° MSt ° TSt 15 ° X PSw Flexing ISw 15 ° F MSw 25 ° F TSw 25 ° Gait Deviations THIGH Dr Abedin MM

80. Gait Phase Possible causes Swing Compensatory : For inadequate knee flexion in initial swing for toe clearance For inadequate DF in Midswing for toe clearance For a longer swing limb For CL knee flexion, which functionally shortens the stance limb. 80 Excess Flexion: More than normal flexion for the Swing phase. Gait Deviations THIGH Dr Abedin MM

81. Gait Phase Possible causes 81 Medial Rotation: Position of the Femur with femoral condyles facing medially. Gait Deviations THIGH Dr Abedin MM

82. Gait Phase Possible causes 82 Lateral Rotation: Position of the Femur with femoral condyles facing laterally. Gait Deviations THIGH Dr Abedin MM

83. Gait Phase Possible causes Stance Primary : Skeletal deformity Secondary : To a pelvic obliquity To a contralateral pelvic hike To a spinal deformity (Scoliosis) To increase base of support Compensatory: for longer reference limb (LLD) 83 Abduction: Abduction of the femur beyond neutral. Gait Deviations THIGH Dr Abedin MM

84. Gait Phase Possible causes Swing Compensatory: To clear a longer swing limb To clear a functionally longer swing limb (Inadequate hip/ knee flexion, inadequate DF) 84 Abduction: Abduction of the femur beyond neutral. Gait Deviations THIGH Dr Abedin MM

85. Gait Phase Possible causes 85 Adduction (Scissoring Gait) : Adduction of the femur beyond neutral. Gait Deviations THIGH Dr Abedin MM

86. Gait Phase Possible causes 86 Contralateral Drop (Trendelenburg Gait) : > 5 ° of iliac crest on swing limb during stance on the reference limb. Gait Deviations PELVIS Dr Abedin MM

87. Gait Phase Possible causes 87 Ipsilateral Drop: Adduction of the femur beyond neutral. Gait Deviations PELVIS Dr Abedin MM

88. 88 Dr Abedin MM Some special gait https:// www.youtube.com/watch?v=FFki8FtaByw

89. 89 Hemiplegic Gait Knee : Held in extension Leg : Swings away from the center of the body Hip : hikes upward (Circumduction) Foot : Drop UL : Shoulder adduction, elbow & wrist flexion with Clenched fist Unilateral upper motor neuron lesions with spastic hemiplegia Dr Abedin MM

90. 90 Scissoring Gait Hypertonia in the legs and hips : flexion -> C rouched stance Overactive Hip adductors : causing the knees and thighs to touch or cross in a “ S cissor-like ” movement In cerebral palsy, ankle plantar flexion : forcing the patient to tiptoe walk Bilateral corticospinal tract lesions: CP, incomplete SCI, and MS Dr Abedin MM

91. 91 ATAXIC Gait Broad-based stance and irregular step and stride length Tendency to sway Tandem gait exacerbate cerebellar ataxia Cerebellar dysfunction or severe sensory loss Dr Abedin MM

92. 92 Myopathic Gait Broad-based gait and a “ waddling-type ” appearance When going from floor to standing, the patient will use their arms and hands to climb up their legs—known as Gowers sign W eakness of the proximal leg muscles Dr Abedin MM

93. 93 Trendelenburg Gait During the stance phase, the abductor muscle allows the pelvis to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to maintain the pelvis level during the gait cycle. This results in a waddling-type gait with an exaggerated compensatory sway of the trunk toward the weight-bearing side. W eakness of the abductor muscles (glut . medius and glut . minimus ) Dr Abedin MM

94. 94 Parkinsonian Gait Stooped posture , narrow base of support , and a shuffling gait with small steps Slowing of the gait ( Bradykinesia ) Lean forward while walking so the steps become hurried, resulting in shuffling of the feet ( F estination ) loss of normal arm swing Parkinson disease and other disorders of the basal ganglia Dr Abedin MM

95. 95 Steppage Gait Foot drop C ompensat ion: by lifting the affected extremity higher than normal to avoid dragging the foot Leads to poor heel strike with the foot slapping on the floor Diseases of the peripheral nervous system including L5 radiculopathy, lumbar plexopathies , and peroneal nerve palsy Dr Abedin MM

96. Sample of Reporting 96 Dr Abedin MM

97. Sample of Reporting (contd.) 97 Dr Abedin MM