What is Gait?
By Louis Corpora
What is Gait- Overview
What is gait? Gait is simply the way someone walks. Gait is broken up into two different phases: stance and swing phase. The stance phase consists of 60% of the gait cycle, while the swing consists of 40%. Stance is when the foot is entirely on the ground while the opposite leg swings. Swing is when the leg swings after stance. Gait has 6 phases in this order: heel strike, foot flat, mid stance, heel off, toe-off, and swing (initial, mid, and terminal swing). These phases are named exactly by how they would look when a person normally walks.
Often we hear about gait when it’s described as abnormal. This could be due to injuries, orthopedic or neurological conditions, or our anatomical structure. We will now touch on different gait abnormalities for the hip, knee, and ankle/foot. These abnormalities can be caused by musculoskeletal problems, injuries, or neurological conditions.
Hip abductor weakness can have a tremendous effect on gait. During the stance phase, the hip on the stance side has a job to stabilize the pelvis, not allow the other side to drop. Weakness in the abductors will manifest in hip drop on the side of the swing leg, commonly seen in a runway model when their hips drop side to side when they walk. This is called Trendelenburg gait. Hip abductor weakness can also be seen when the stance hip “hikes” toward the same side to avoid dropping the other side.
Hip adductor contractures, commonly seen in neurological conditions, will manifest in the swing leg crossing the midline. This is called a scissor gait pattern.
Hip flexor weakness can result in decreased ability to advance the swing leg. People will also have difficulty clearing a step or curb. A common compensation is circumduction of the swing leg to clear the floor. This is also seen many times with decreased knee range of motion.
The quad plays a big role in accepting the weight of the body during the stance phase. With quad weakness, the hip extensors may compensate by taking the leg back into a straightened position. Similarly, when the quad is weak or if the knee is unstable, the knee will abruptly slam back into hyperextension to avoid buckling.
With decreased knee flexion, whether from knee surgery (especially right after) or a contracture, patients will likely have gait abnormalities. They will typically compensate by toe walking on the affected leg to make up for the lost leg length.
Those with limited ankle dorsiflexion will have decreased ability for their foot to clear the ground when they advance their swing leg. These patients will likely compensate via increased hip flexion during the swing to clear the ground or circumduce the same (swing) leg. People with extreme tightness or contracture of the calf will have difficulty with dorsiflexing (flexing foot up) the foot. They will compensate with toe-walking during the stance phase and excessively flexing the hip and knee for foot clearance.
We will now discuss gait abnormalities caused by neurological conditions. Diseases such as Parkinson’s, Multiple Sclerosis (MS), or Stroke can manifest in increased muscle stiffness or contractures to a joint, causing gait to become abnormal. These neurological conditions may also cause decreased strength and coordination, making gait unsteady.
A patient who had a stroke will likely have a hemiplegic gait pattern causing weakness on one side of the body. The upper extremity is typically seen curled up and close to the body. The lower extremity is usually turned inward, knee straight, and foot pointed. Gait will be slow, and the patient will compensate the weak side with circumduction or hip hiking to clear the leg from the floor.
Someone with Parkinson’s will manifest in a slew of gait abnormalities. Due to increased joint stiffness and rigidity, they’ll have decreased arm swing. They also present with a stooped posture with the trunk in a forward flexed position with the knees bent, making walking difficult and arduous. Their gait will be slow with short and choppy steps. There are times when they have freezing episodes where they cannot advance. Sometimes there will be a burst of short quick steps, which may be difficult for them to slow down. This is known as festinating.
MS affects walking in a variety of ways. Fatigue is a common trait in those with MS and will cause gait to deteriorate (especially in hotter temperatures). Spasticity or muscle tightness can also cause gait problems. These patients also have sensory issues in the feet, making it difficult to feel their feet during gait. As a result, balance problems arise.
Diagnosis of Gait Deformities
When a patient sees a physical therapist (PT) for weakness, pain, or post-op surgery, the therapist will review the patient’s chart and obtain a thorough history of the condition. The PT will then assess the patient’s strength, range of motion, and flexibility of the affected area and surrounding joints. Once all the data is collected, the PT will assess the patient’s gait by asking them to walk. The PT will observe the patient’s gait to confirm his or her findings and then develop a treatment plan to improve the found impairments.
Treatment & Management of Gait Issues
For long-term management of lower extremity conditions, a patient will use an assistive device to walk. These include a walker, cane, ankle-foot orthosis (AFO), or crutches. These devices can also be used for short-term conditions or injuries. A walker can be used for general lower extremity weakness in those with higher fall risk. A cane is good if one leg is weak or painful or if the patient is a low fall risk. The cane should be used in the hand opposite of the painful side.
AFO’s are best used in those with drop foot due to dorsiflexor weakness or calf tightness. The AFO holds the ankle joint in a 90-degree position, not allowing the foot to drop during the swing. Crutches are used when a leg is in pain from surgery or an injury. Crutches are typically used in younger patients. Depending on MD orders, the patient might walk without touching the affected leg on the floor. Other times the patient will walk toe-touch weight-bearing or as tolerated.
Physical therapists will evaluate and treat patients based on their specific needs. If certain muscles are weak, the PT will work with the patient’s goals and strengthen the weak muscles causing abnormal gait patterns such as hip abductor weakness or quad weakness.
If there is a decrease in the knee range of motion, the PT will improve the patient’s knee bending and straightening to emulate a normalized gait. The PT will identify whatever impairments the patient has, design a specific plan catering to their needs, and carry out interventions to improve their gait pattern to walk to their fullest potential.