GAIT CYCLE

1. Stride (gait cycle) is the sequence of events taking place between successive heel contacts
of the same foot.
2. Step is the sequence of events that occurs within successive heel contacts of the opposite
feet.
3. Stride length is the distance between two successive heel contacts of the same foot.
4. Step length is the distance between successive heel contacts of the two different feet.
5. Step width is the lateral distance between the heel centers of two consecutive foot
contacts and is on average around 8-10 cm.
6. Foot angle, the amount of “toe-out,” is the angle between the line of progression of the
body and the long axis of the foot; about 5-70.
7. Cadence or step rate is the number of steps per minute.
8. Stride time is time required to complete a stride.
9. Step time is time required to complete a step.
10. Walking speed measures distance covered in a given amount of time.
11. Normal walking speed in healthy adults is 1,37 m/sec (1 second covers 1,44 m distance).
12. Minimum standards based on community-living activities are:
a. Walk 300 m in less than 11,5 minutes (walking speed of 0,45 m/sec or 1 mph).
b. Walk at a speed of 1,3 m/ sec (3 mph) for 13-27 m to cross a street safely.
13. Gait cycle is comprised of 60% stance phase and 40% swing phase.

SUBDIVISION OF STANCE AND SWING PHASE

1. Stance phase is comprised of initial contact, loading response, mid stance, terminal stance
and pre-swing.
2. Swing phase is subdivided into intial swing, mid swing and terminal swing.
3. Heel contact is defined as the instant the heel comes in contact with the ground.
4. Foot flat corresponds to the instant the entire plantar surface of the foot comes in
contact with the ground.
5. Mid stance is most often defined as:
a. The point at which the body’s weight passes directly over the supporting lower
extremity, or.
b. The time when the foot of the lower extremity in the swing phase passes the lower
extremity in the stance phase (i.e., the feet are side by side), or.
c. The time when the greater trochanter of the femur is vertically above the midpoint
of the supporting foot in the sagittal plane.
6. Heel off corresponds to the instant the heel comes off the ground.
7. Toe off is defined as the instant the toes come off the ground.
8. Early swing is the period from the time of toe off to mid swing.
9. Mid swing corresponds to the time from slightly before to slightly after the mid stance
event of the opposite lower extremity, when the foot of the swing limb passes next to the
foot of the stance limb.
10. Late swing is the period from the end of mid swing to foot contact with the ground.
11. Push off corresponds to the movement of ankle plantar flexion at 40% to 60% of the gait
cycle.
KARAKTERISTIK NORMAL GAIT
1. Vertical displacement of CoG
a. Menjaga pusat gravitasi dari gerakan vertikal ≤5 cm.
b. Titik tertinggi pada midstance.
c. Titik terendah pada terminal stance, terminal swing dan initial contact.
2. Lateral displacement of CoG
a. Gerakan horizontal pelvis ke sisi weight bearing sebesar 2-5 cm.
b. Menyebabkan adanya adduksi relatif dari kaki yang menopang berat badan.
3. Lebar dari basis
a. Normalnya adalah 5-10 cm.
4. Horizontal dip dari pelvis
5. Fleksi lutut saat stance phase
a. Fleksi lutut dimulai dari terminal swing, initial contact dan terminal stance hingga
mid stace dan mid swing.
b. Pada fleksi lutut juga terjadi dorsifleksi ankle.
6. Cadence
a. Normal : 70-130 langkah/ menit.
b. Laki-laki : 111 langkah/ menit.
c. Perempuan : 117 langkah/ menit.
d. Step rate : 1,87 langkah/ detik.

ENERGY CONSERVATION AND GAIT

1. Energy is consumed in walking in three different ways:
a. Moving body mass in required distance (horizontal pane).
b. Up-and-down motion of body (vertical pane).
c. Basal metabolic rate.
2. Inman’s determinants of gait to minimize vertical displacement:
a. Pelvic rotation.
1) External rotation from midstance to pre swing.
2) Internal rotation from initial swing to loading response.
b. Pelvic list or pelvic obliquity or pelvic Trendelenburg motion.
1) A drop in pelvic vertical height on the non-weight-bearing limb.
2) Reduces peak height of the center of mass (COM).
c. Knee flexion in stance phase.
1) At initial contact and loading response provides shock-absorbing mechanism.
2) Thus, maintaining momentum for stopping or restarting the cycle.
 d. Foot mechanism (ankle flexion – extension mechanism)
1) At heel strike, ankle plantar flexion smoothens the curve of the falling pelvis.
2) It is associated with controlled plantar flexion during initial contact to
midstance.
3) Interaction between posterior talar articular facet (of calcaneus bone) and
posterior calcaneal articular facet (of talus bone) is called subtalar joint.
1) 2-30 inversion at the time of heel contact.
2) Imediate rapid eversion that continues to midstance, with 2 0 angle at the
maximum everted positon.
e. Knee mechanism
1) After midstance, the knee extends as the ankle plantar flexes and the foot
supinates to restore the length to the leg and diminish the fall of the pelvis at
the opposite heel strike.
f. Lateral displacement of the pelvis.
1) Pelvis and trunk must move from non-weight-bearing to weight-bearing
(stance) limb to balance the COM.
2) Some degree of knee valgus and hip adduction.
3) By doing that pelvis displaces laterally to stance limb.
3. Combined effects:
a. Determinants a to e decrease vertical excursion by 50%.
b. Determinant f decreases horizontal excursion by 40%.
c. Both decreases vertical and horizontal excursion to 2 inches.
4. Three components of the “three rockers:”
a. Up to midstance phase, ankle dorsiflexion of weight-bearing limb decreases leg
vertical height.
b. Up to terminal stance phase, ankle plantar flexion provides extra stride length for
the non-weight-bearing limb.
c. Also provides limitation in amount of drop that is experienced by the pelvis.
ABNORMAL GAIT
1. Abnormal movement patterns significance:
a. Potential detrimental functional consequence (and thus significant):
1) Increased fall risk.
2) Excessive energy expenditure.
3) Adverse joint stresses.
b. Cosmetic (less) significance.
c. Functional benefit after adaptation.
2. General assessment:
a. Symmetry and smoothness of abnormal movements.
b. Compensating efforts.
c. Additional situations:
1) An increase or decrease of gait speed.
2) With aids and off aids.
3) Incline or decline surfaces.
3. General interventions:
a. Set specific goals.
b. Train other agonist and stabilizing muscles in muscle weakness.
c. Prosthesis, brace or surgical efforts in spasticity.
4. Transfemoral (above-knee) amputation.
a. The shorter the residual limb is the shorter the lever available to control prosthesis.
b. Iscial containment (ischial medial-lateral socket) is more preferrable than older
quadrilateral socket design.
c. TF amputee with normal residual limb strength, the prosthetic knee joint axis
should be placed anterior to the TKA, where GFR line also passes anterior to the
knee.
d. TF amputee with a weakened residual limb, the prosthetic knee joint axis should be
placed posterior to the TKA line to afford greater knee stability with greather
difficulty achieving knee flexion.
5. Foot drop gait.
a. Condition resulting from:
1) Weakened dorsiflexor muscles : spring-assisted ankle-foot orthosis (AFO).
2) Ankle plantarflexor spasticity : spring-assisted AFO.
3) Ankle plantarflexor contracture : rigid, solid AFO.
b. Compensation for all swing phase:
1) Excessive hip hiking and knee flexion (i.e., steppage gait).
2) Foot slap.
6. Weak calf gait.
a. Ankle plantar flexors contracts eccentrically to control the rate at which the tibia
advances forward (anteriorly) over the supporting foot (contralateral swinging
limb).
b. Condition resulting from:
1) Achilles tendon injury.
2) Tibial nerve injury.
3) S1 radiculopathy.
4) Lower lumbar myelomeningocele.
c. Results in (at midstance and terminal stance phase):
1) Untimely forward progression of tibia.
2) Excessive ankle dorsiflexion:
a) Prevents “heel kick” leading to shortened stride length.
b) Ipsilateral pelvic (more pronounced) drop.
7. Gluteus medius gait.
a. Hip abductor:
1) Primary : gluteus medius.
2) Secondary : gluteus minimus and tensor fascia latae.
b. The function of hip abductors is to maintain femur – pelvic angle at the entirety of
stance phase.
c. Weakness in hip abductors results in decreased ipsilateral femur – pelvic angle
(increased pelvic list and lateral protrusion of pelvis) and interrupted foot clearance
in pre-swing phase and initial swing phase of contralateral limb.
d. Compensation:
1) Excessive ipsilateral trunk leaning.
2) Medial pelvic deviation.
e. Less evident with faster walking.
8. Possible causes for excessive hip frontal plane motion during walking:
a. Weakness of hip abductor.
b. Reduced “shortening” of the swing limb.
c. Discrepancy in limb length.
9. Spastic gait.
a. Poststroke (following middle cerebral artery stroke).
1) Abnormal movements:
a) Spastic paretic stiff-legged gait:
 Reduced knee flexion in all phases.
b) Dynamic recurvatum:
 Knee hyperextention during stance phase.
c) Equinus:
 Excessive ankle plantar flexion.
2) Resultants:
a) Compensatory mechanisms:
 Hip circumduction.
 Hip hiking.
 Contralateral pelvic & trunk elevation (tilt).
b) Overstretch of ligament and posterior capsular structures.
c) Prolonged period of weight transfer during DLS.
b. Diplegic cerebral palsy.
1) Four types:
a) Jump. c) Recurvatum.
b) Crouch. d) Stiff.
2) Jump gait:
a) Excessive knee flexion in early stance phase.
b) Normal knee extension in midstance and late stance phase.
3) Crouch gait:
a) Excessive knee flexion throughout stance phase.
b) Scissor gait:
 Hip adduction and internal rotation.
 Equinus (excessive ankle plantar flexion).
 Forefoot abduction.
10. Gait abnormalities associated with aging.
a. Reduced walking speed.
b. Abnormalities:
1) Reduced peak hip extension.
2) Increased anterior pelvic tilt.
3) Reduced ankle plantar flexion and power generation.