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Ankle Arcs of Motion

ankle motion are not large, but they are critical for progression and shock
absorption during stance .
In swing, ankle motion contributes to limb advancement.
During each gait cycle the ankle travels through four arcs of motion
Twice during each gait cycle the ankle alternately plantar flexes (PF) and
then dorsiflexes (DF).
The first three arcs of motion occur in stance (PF,DF, PF).
During swing the ankle only dorsiflexes.
The sequence and timing of ankle motion arcs following initial floor contact with
the heel are presented in
Table 4.1.
Each arc of ankle motion relates closely to the foot's support pattern.
Initial contact by the heel occurs with the ankle at neutra! (or plantar flexed)
This is followed by the first plantar flexion arc during the loading
response (0-10% CC).
With the onset of forefoot contact (foot flat) the ankle changes its direction
toward dorsiflexion. Now the foot is stationary, and the tibia becomes the moving
segment.
Neutral alignment is reached at the 20% point in the gait cycle.
Dorsiflexion continues through mid stance and the first half of terminal stance,
reaching the maximum 10 angle by 48%
This position is held until the end of the single support period.
Following the onset of terminal double support, there is rapid ankle plantar
flexion, reaching the maximum 30 angle at the end of stance.
Toe-off initiates the final dorsiflexion action.
A neutral position (0)is reached by mid swing and maintained during
the rest of the phase.
Often there is a drop into 3_5PFduring terminal swing.

Table 4.1
Ankle Motion During A Stride
Plantar flexion to 700
(O-12%gc)

Dorsiflexion to 10
Plantar flexion 20
Dorsiflexion to neutral

(12-48%gc) (in shoes it is 5)


(48-62%gc)
(62-100%gc)

Knee

he knee is the junction of the two long bones (femur and tibia) that
constitute the major segments of the lower limb. SmaIl arcs of motion
result in significant changes in either foot or body location.
Consequently, knee mobility and stability are major factors in the
normal pattern of walking.
During stance the knee is the basic determinant of limb stability.
In swing, knee flexibility is the primary factor in the limb's freedom to
advance. The number of two joint muscles involved in knee control aIso
indicates close functional coordination with the hip and the ankle.
Motion
The knee is a very complex joint characterized by a larze range of
motion in the sagittaI plane and small arcs of coronaI and transverse
mobility.
Sagition (flexionand extension) is used for progression .and limb
advancement in swing.
Motion in coronal plane facilitates vertical balance over the limb,
particularly during single support.
Transverse rotation accommodates the changes in alignment as the
body swings from behind to ahead of the supporting limb.
Unless joint mobility is exaggerated by pathology, visual analysis
identifies on1y the sagittal motion. Instrumented measurement
systems are needed to identify the other events.

Sagittal Motion
During each stride, the knee passes through four arcs of motion, with
flexion and extension occurring in an alternating fashion.
Normal knee motion during walking represents greater and lesser
degrees of flexion within the full range of 0to 70.
The type and extent of motion occurring at the knee is related to the
functional demands of the individual gait phases.
At initial contact the knee is flexed about 5. Subjects vary in their knee
posture at initial contact between slight hyperextension (-2) and
flexion (5).
Following the onset of stance, the knee rapidly flexes throughout the
loading phase. The rate of flexion at this time (300/ sec) almost equals
that occurring in swing. With the onset of single limb support (12% GC),
the knee immediately completes its stance phase flexion (18at
15%GC). This is the time when the flexed knee is under maximum
weight-bearing load.
The differences in knee position at initial contact were unrelated to
walking speed. There was a notable influence by walking speed,
however, on the amount of flexion occurring during the loading
response. Slowing the pace led to a greater change than going faster.
Compared to the motion at 90m/ min,walking at 60m/min reduced
knee flexion by 67%, while increasing the gait speed to 120m/min led
to 38% more knee flexion in loading.?
During the rest of mid stance, the knee gradually extends. Minimum
stance phase flexion (averaging 3) is reached about midway in terminal
stance (40%GC) and persists for only a short time before the knee
slowly begins to flex again. The rate of knee extension is approximately
half that of flexion during limb loading. The second wave of knee
flexion begins during the end of terminal stance. Approximately
7flexion is present at the time single limb support is completed

by the other foot contacting the floor. With the onset of double limb
support the knee flexes rapidly, A 40 position is reached by the end of
pre-swing (62%GC).
Knee flexion continues at the same fast rate throughout initial swing.
The final position of 60 is the maximum knee angle occurring during
the gait cycle.
Murray reported 70 flexion.l! To reach this position in the time
available (pre-swing and initial swing phases), the knee flexes at
3S00jsec. Following a momentary pause in mid swing, the knee begins
to extend as rapidly as it flexed in the preceding phases. Half of the
recovery toward maximum extension occurs during mid swing. Knee
extension continues in terminal swing until fuIl extension (3 flexion) is
gained. Actual knee position varies among individuals. Some attain
slight hyperextension (30). Others maintain a minor degree of flexion
(5).Peak knee extension is attained slightly before the end of the swing
phase (97% GC). Then the knee tends to drop into a minor degree of
flexion. The final knee posture at the end of terminal swing averages 5
flexion.
Transverse Rotation
From a position of maximum external rotation at the end of stance, the
entire limb (pelvis, femur, tibia) begins internal rotation at toe-off and
continues through swing and loading response. During the rest of
stance these body segments externally rotate.
Skeletal pins in the femur and tibia demonstrated an average of 9
rotation within the knee.l? Triaxial goniometric recordings identified a
greater range of rotation (13)
The magnitude as well as the direction of rotation changes with the gait
phases.
At initial contact the femur is in slight external rotation relative to the
tibia (i.e., the knee is locked). During the loading response, internal
rotation of the tibia is markedly accelerated, and the femur follows but
at a slightly slower rate. While the entire limb responds, the motion is

greater at the knee: Transfer of the subtalar inversion to the tibia has
unlocked the knee.
According to electrogoniometer data, internal rotation might persist. As
the knee fully extends in terminal stance, there also is external rotation
and the knee is locked.
With body weight shifted to the other foot in pre-swing, the knee
internally rotates as it is flexed and adducted. This could relate to
adductor longus action at the hip.
Initial swing continues intemal rotation of the whole limb. There is an
increase in tibial rotation that ceased with knee extension.
This would be a second knee locking episode.
Coronal Plane Motion
Within each gait cycle the knee moves into both abduction and
adduction.
During stance the motion is abduction.
During swing the knee returned to a more neutral posture by adducting
8.
HIP
Function at the hip differs from the other joints in several respects. The
hip represents the junction between the passenger and locomotor
units. As a result, it is designed to more overtly provide threedimensional motion with specific muscle control for each direction of
activity. Sagittal plane motion (progression) involves the largest arc,
while muscular requirements are brief. In the coronal plane,motion is
limited, but the muscular demands are substantial.Transverse rotation
remains a subtle event.
The functional focus of the hip musculature also varies with the period
in the gait cycle. During stance, the primary
role of the hip muscles is stabilization of the superimposed trunk.
In swing, limb control is the primary objective.
In addition there is an arc of pelvic tilt that may either add to or
subtract from the arc of hip motion created by thigh displacement.

Sagittal Plane Motion


The hip moves through only two arcs of motion during a normal stride:
extension during stance and flexion in swing. The exchange of motion
from one direction to the other is gradual, occupying a whole gait
phase for each reversal. A normal arc of hip motion averages 40,
A technic that is more consistent with clinical practice is to consider the
vertical thigh in quiet standing to be the zero position. Using the Iatter
reference posture results in the peaks of hip motion being 10
extension and 30flexion (Figure 6.1).
Independent analysis of the pattern of normal thigh extension and
flexion to stride length. The pelvis is treated as a separate segment,
riding on top of a thigh that is rotating over the supporting foot during
stance.
At initial contact, the thigh is flexed 20from the vertical. During the
loading response, thigh position is relatively stable, perhaps losing 2 or
3 of flexion. With the onset of mid stance, the hip progressively
extends.
Continuing at the same rate in terminal stance, the thigh reaches
neutral alignrnent at the 38% gait cycle point. The thigh then assumes a
posteriorly aligned posture with peak hip extension (10) or a trailing
thigh of 20 occurring as the other foot contacts the ground (50%
CC).During pre-swing the hip reverses its direction of movement and
begins flexing. A neutral position of the hip (0) is reached at the end of
the stance period (60% CC), while the thigh still shows a few degrees of
extension. The motion toward flexion continues through the first two
phases of swing. During initial swing, the hip attains a large portion of
its flexion range with the thigh at 15.
In mid swing the final 10 are accomplished. The final 25 flexed
position of the thigh is maintained within five degrees through terminal
swing.
These thigh motions have been modified by 3 or 4 of tilt of the pelvis.
The pelvis alternately follows the swing limb on one side and then the
other,each position changes twice in one stride. Hence, upward tilt of

the pelvis increases the thigh angle in early mid stance and again in
initial swing.
Conversely, a downward filt of the pelvis increases thigh extension in
terminal stance and terminal swing.
Clinically,it is very important to separate motion of the thigh from that
of the pelvis, as they respond differently to the various types of
pathology that modify the patients ability to walk. By relating the
position of the thigh to the axis vertical to the horizon, the
displacement of the limb in space is defined independent of pelvic
motion.. Thigh flexion at initial contact is correspondingly reduced to
20, and extension in terminal stance is increased to 20 (Figure 6.2).
Coronal Plane Motion
The hip moves through a small arc of adduction and abduction as the
unloaded side of the pelvis follows the swinging limb. This action begins
with the onset of stance. At initial contact, the hip is adducted about
10 in the coronal plane due to the anatomical angle between femur
and tibia. Superimposed on this posture is a small arc of passive
motion. Adduction occurs during loading response .This reverses to
neutral in mid and terminal stance.Then in initial swing, relative hip
abduction occurs (5).
Transverse Plane Motion During each stride the limb moves through an
arc of internal rotation followed by a similar arc of external rotation.
Pelvis and thigh skeletal pins demonstrated that at initial contact the
limb is neutral. Peak internal rotation occurs at the end of the loading
response (CTO), and maximum external rotation is found at the end of
pre-swing (ITO). The total arc of transverse hip motion averages 8.
When this arc is added to the pelvic motion (7.7), total thigh rotation
averages 15.

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