mitchell l. goldflies, m.d.. overview introduction stance swing normal and abnormal gait
TRANSCRIPT
Mitchell L. Goldflies, M.D.
Overview
Introduction Stance Swing Normal and Abnormal Gait
Introduction
Stance
60 % of gait cycle Foot is in contact with
ground Conversion of potential
energy into kinetic energy During stance phase hip
extends and pelvis rotates backward gradually
Stance
5 phases:ContactLoadingMidstanceTerminalPreswing
Stance
Stance - Contact
Length of stance phase:Begin – contact of the heel to the
groundEnd – remainder of the foot contacts
the ground
Stance - Contact
Objective of stance phase:Forward progressionShock absorptionAdaption to terrainPreparation for loading phase
Stance - Contact At initial ground contact:
Knee extendedHip flexedAnkle neutralFoot pronating at subtalar joint Leg internally rotating
Stance - Contact
At forefoot contact:Knee flexesAnkle plantarflexesSTJ pronates
Stance - Contact
Muscles:Long extensors decelerate plantarflexion
Tibialis posterior decelerates pronation
Gastrocnemius decelerates internal tibial rotation
Stance - Contact
Stance – Loading
Objective:Initial double-limb supportBody weight is transferred onto the stance limb
Stance – Loading
Body:Knee flexes 15◦ Ankle plantarflexes15◦
Muscles:Pretibials – shock absorbers
during this phase
Stance - Midstance
Objective: Limb and trunk stabilityProgression over stationary foot
Body:Knee/hip begin extensionSTJ neutral
Stance - Midstance
Muscles:Tibialis posterior/soleus start to supinate STJ
Peroneus longus stabilizes first ray
Triceps surae decelerate forward displacement of tibia and plantarflex ankle joint
Stance - Terminal
Objective:Forward progressionFoot becomes rigid lever
Stance - Terminal
Body:Knee flexesAnkle plantar flexesSTJ supinates, rapidlyFirst ray plantarflexes1st MPJ dorsiflexes – toe-off through tip of hallux
Stance - Terminal Muscles:
Soleus and tibialis posterior assist heel lift
Peroneus longus stabilizes first ray
FHL, FHB, AbH, AdH stabilize hallux
EHL dorsiflexes hallux
Stance - Preswing
Objective:Forward progressionFoot becomes “rigid lever”
30 – 60% of gait cycleSecond period of double limb support
Stance - Preswing
Stance - Preswing
Body:Knee flexesAnkle plantar flexesSubtalar joint rapidly supinatesFirst ray plantarflexes1st MPJ dorsiflexes
Stance - Preswing
Muscles:Soleus and tibialis posterior assist heel lift
Peroneus longus stabilizes first ray
FHL, FHB, AbH, AdH stabilize hallux
EHL dorsiflexes hallux
Swing
Objective:Forward progressionGround clearance
Swing Body:
Hip continues to flexKnee extends from flexed
positionAnkle dorsiflexesSTJ slightly pronated at toe-off
Swing
MusclesLong extensors dorsiflex foot for toe clearance
Tibialis anterior dorsiflexes the first ray
Swing Phases
Initial swing:○ Begins at toe off and continues until
maximum knee flexion (60◦)Mid swing:
○ Maximum knee flexion until tibia is vertical/perpendicular to the ground
Terminal swing:○ Beings when tibia is vertical and ends
at initial contact
Swing Contraction of quadriceps
before toe offHelps to initial leg forward swingPrevents heel from rising to high
in the posterior direction Hamstrings become active
before heel strikeDecelerate forward swing of legControls heel position at foot
strike
Gait Analysis
Assessment procedures required to properly asses gait:Weight acceptance – initial contact/loading
responseStance – midstance/terminal stanceForward progression – terminal
stance/preswingSwing – initial swing/midswing/terminal
swing
Gait Analysis
Normal Gait Used to describe patterns that
have been generalized across sex, age, genetic predisposition, and anthropometric variables
Duration of stance/swing phases are the same for each limb
Normal Gait
Maximizes center of gravity through:Knee motionKnee flexion after heel strikePelvic rotationPelvic tiltLateral displacement of pelvisFoot and ankle motion
Normal Gait
Abnormal Gait
Consequence of:PainWeaknessDifference in limb length
Abnormal Gait
Abnormal Gait
Antalgic gaitPain common cause of limp
Shortened stance phase on affected side
In stance phase - with pain in hip joint, trunk motion toward painful side
Abnormal Gait
Dorsiflexor gait patternSwing phase – difficulty in clearing toes
Abnormal Gait Gluteus maximus gait pattern
Contracts at moment of heel-strikeSlows trunk’s forward motion by
stopping flexion of hip and initiating extension
Weak gluteus maximus cause trunk to lurch forward at heel strike on weaker side, which interrupts forward motion
Abnormal Gait Gluteus
maximus gait
pattern
Abnormal Gait
Gluteus medius gait patternCharacterized by
Trendelenberg gait patternStance - opposite side of pelvis
tilts downward during toward weaker side resulting from a weakened medius
Abnormal Gait
Gluteus medius gait pattern
Abnormal Gait
Gluteus medius gait patternTrunk lurches toward weakened
side to compensateCenter of gravity shifts to fulcrum
on weaker side, which shortens the moment arm from the center of gravity to hip joint, therefore reducing effort required of hip abductors
Abnormal Gait
Gluteus medius gait pattern
Abnormal Gait
Paralyzed quadriceps gait patternGait may appear normal when
walking on level surface with a paralyzed quadriceps
Quads not necessary for knee joint stability at full extension
Abnormal Gait
Paralyzed quadriceps gait patternThose with paralyzed quads will be
unable to run and experience difficulty on rough/inclined surfaces or stairs
Long leg knee brace might be needed to support knee joint in full extension
Triceps gait pattern
Discussion
Conclusion
Questions?
References Goldflies, M.L, Andriacchi, T.P., and Galante, J.O. The
Relationship Between Varus Deformity and Moments at the Knee During Gait and the Changes at the knee after High Tibial Osteotomy. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981.
Andriacchi, T.P., Goldflies, M.L, Galante, J.O. and Stern,
D.S. Moments Exerted on the Lower Extremities During Running. 27th Annual ORS, Las Vegas Nevada, Feb. 24 - 26, 1981.
Andriacchi, T.P., Goldflies, M.L, Galante, J.O. Normal
Variation in Joint Moments During Level Walking, 1980 .
References
http://moon.ouhsc.edu/dthompso/GAIT/TERMS.HTM
http://www.drpribut.com/sports/spgait.html
http://www.emedicine.com/pmr/topic225.htm
http://www.latrobe.edu.au/podiatry/Thegaitcycle.html
http://www.oandp.org/jpo/library/1993_02_039.asp
http://www.oandp.org/jpo/library/1997_02_049.asp
References
http://www.wheelessonline.com/ortho/gait
http://www.wheelessonline.com/ortho/stance_phase_of_gait
http://www.wheelessonline.com/ortho/swing_phase_of_gait
Image Sources http://www.newscientist.com/blog/shortsharpscience/2007_0
5_01_archive.html
www.foot-fixer.com/contactus.html
http://www.northcoastfootcare.com/footcare-info/foot-problems.html
web.techwalking.com:462/gait_lab.html
http://www.stepfamilytalk.com/walk-a-little-slower-daddy/
http://www.nature.com/nrn/journal/v3/n10/fig_tab/nrn939_F1.html
Image Sources www.dubinchiro.com/features/shin1.html
http://www.hopkins-arthritis.org/physician-corner/radiology-rounds/radiology_14/images/slide1.jpg
http://www.aboutjoints.com/physicianinfo/topics/anatomyhip/anatomyhipimages/hipfigure1.33.jpg
http://storybridge.org/wordpress/wp-content/uploads/female_screenshot.png
Image Sources http://i164.photobucket.com/albums/u38/oscarandy122586/
FOOTPRINTS.jpg
http://www.drpribut.com/sports/spgait.html