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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Gait

 - See:
      - Ankle and Subtalar Joint in Gait:
      - Hip and Pelvis in Gait
      - Knee Joint in Locomotion
      - Muscle Activity During Gait
      - Stance Phase
             - Weight Acceptance
             - Single Limb Stance
             - Heel Off
             - Weight Release
      - Swing Phase


 - Normal Gait: (two phases):
    - stance phase:
           - begins w/ heel-strike and ends w/ toe-off &, in terms of duration, constitutes 63% of the cycle of gait (during walking):
                 - hence, during ambulation there are two periods of double support (beginning and end of stance phase);
           - w/ running, toe off occurs earlier in the gait cycle, and there is no point when both feet are on the ground, and instead there are two 
                 time points when both feet are off the ground simultaneously (just before and after stance phase);
                 - the faster the run, the less time is spent in stance phase;
    - swing phase:
           - begins w/ toe-off & ends w/ heel-strike, comprising 28% of cycle;
    - duration of each phase is same for both limbs, circumstance, among others, that confers upon normal gait appearance of symmetry & rhythm;
    - abnormality of gait is usually a consequence of pain, weakness, or a difference in the lengths of the limbs;
    - normal gait tends to minimize displacement of center of gravity through
           - pelvic rotation
           - pelvic tilt
           - knee flexion after heel strike
           - foot and ankle motion
           - knee motion
           - lateral displacement of pelvis


 - Gait Abnormalities 
    - myopathic disorders and neuropathic disorders
    - antalgic gait: (painful gait)
         - pain is a common cause of limp;
         - characteristic of antalgic limp is shortened stance phase on affected side;
         - when pain arises in hip joint (coxalgia), there is also lurch of trunk toward the painful side during the stance phase;
                 - moving center of gravity of body toward painful hip decreases moment arm of body wt to hip joint, reducing total force on the hip; 
                 - this should not be confused w/ a Trendelenburg gait;
    - gluteus maximus gait pattern: (see: gluteus maximus)
         - begins to contract at moment of heel-strike, slowing forward motion of trunk by arresting flexion of hip & initiating extension;
         - when gluteus maximus is weak, trunk lurches backward (gluteus maximus lurch) at heel-strike on weakened side to interrupt forward motion of the trunk;
    - gluteus medius gait pattern: (see gluteus medius);
         - characterized by a Trendelenberg gait pattern; 
         - abductor insufficiency and is most commonly seen in patients with polio
         - weakened medius; allows opposite side of pelvis to tilt downward during stance on weakened side; 
                 - contralateral hemipelvis drops during the single-limb stance phase on the affected side 
         - in effort to compensate, the trunk lurches toward weakened side (abductor lurch) during stance;
         - this action moves the center of gravity nearer fulcrum on weak side, shortening the moment arm from the center of gravity to hip joint & reducing
                 effort required of the abductors of hip; 
         - references:
                - The significance of the Trendelenburg test 
                - Can Trendelenburg's sign be positive if the hip is normal?
    - paralyzed quadriceps gait pattern:
         - when quadriceps is paralyzed, walking on level surface may appear to be entirely normal;
         - at suitable speed the limb behaves as a pendulum, fully extending knee joint preparatory to heel-strike;
         - at full extension, action of quads is not necessary for stability of knee joint;
         - if line of gravity is maintained anterior to the axis of motion of knee joint, full extension persists thru stance phase;
         - such pt, however, will be unable to run & may have difficulty walking on rough or inclined surfaces & stairs, because in those instances full extension
                is not attained & knee tends to buckle into flexion;
         - when this muscle is quite weak, a long leg brace may be needed to support the knee joint in full extension;
    - triceps gaint pattern: (calcaneus gait pattern)
         - references:
                - Function of the triceps surae during gait. Compensatory mechanisms for unilateral loss.
                - Role of the posterior calf muscles in normal gait.
    - dorsiflexor gait pattern: (drop foot or steppage gait)
         - difficulty in clearing toes during swing phase, pt must ER leg & flex knee & hip


Current Concepts: Geriatrics: Gait Disorders in the Elderly.

Disarticulation of the knee in children. A functional assessment.

Gait patterns in spastic hemiplegia in children and young adults.

Function of the triceps surae during gait. Compensatory mechanisms for unilateral loss.

Role of the posterior calf muscles in normal gait.

Adult-onset hemiplegia: changes in gait after muscle-balancing procedures to correct the equinus deformity.

Biomechanical gait evaluation of pre and postoperative total knee replacement patients

Comparative assessment of gait after limb-salvage procedures

The function of the toes in walking, jogging and running.

The Effect of Limb Length Discrepancy on Gait

Running Injuries: a biomechanical approach

Extrinsic muscle activity, foot motion and ankle joint moments during the stance phase of walking.  




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, May 24, 2012 12:48 pm