Bsc of Science In Orthotics & Prosthetics

Year 1

Normal gait

Human locomotion
Normal human locomotion is a series of rhythmical

and varying movements of the limbs and the trunk, which lead to forward progression of the centre of gravity
One gait cycle consists of those activities occurring between

the heel strike of one leg and the next heel strike on the same side. During each gait cycle, each limb passes through a stance phase and a swing phase.

Definition of frequently used terms

Stance phase:

This begins when the heel makes contact with the ground. It ends when the toes of the same foot leave the ground. Swing phase: This begins with push-off and ends with the heel strike

Definition of frequently used terms

Gait cycle

Characteristics of the normal gait

Shock absorption phase: The phase during which

force is applied to the leading extremity and the gross vertical movements of the centre of gravity of the body are smoothed out. It lasts from heel strike to foot flat. Mid-stance phase: During this phase the supporting extremity bears the greatest weight. It lasts from foot flat to heel off. Push off phase: This phase occurs from heel off to toe-off and during if the body is propelled forward by the action of the calf muscles.

Characteristics of the normal gait

Heel strike: The instant the heel of the leading

extremity touches the ground. Foot flat: The instant, shortly after heel strike, when the sole of the foot touches the ground. Mid-stance: The instant when both heels are in apposition. Heel off: The instant when the heel of the supporting extremity leaves the ground. Toe off: The instant when the toe loses contact with the ground.

Stance Phase

Swing phase

Acceleration: The swing phase begins at the moment the toes leave the ground. At this time the foot must be accelerated so as to swing forwards and to lie in front of the body in preparation for the next heel strike. Mid-swing phase: takes place when the foot swings forwards below the body. At this time the foot must be sufficiently raised that it does not touch the ground.

Swing phase Cont

Deceleration: This takes place after the mid-swing

phase, when the forward motion of the leg is braked in order to control the foot position immediately before heel strike.

acceleration

mid-stance

deceleration

Double support
During normal walking, there is a period of double support when both limbs simultaneously touch the ground.

Time division of the gait cycle

The relative time taken for each walking phase is shown in Fig above and may be summarized as follows:
Stance phase:

60 % of the cycle

Swing phase:
Double support:

40 % of the cycle
10 % of the cycle

The number of steps per minute can be increased from about 70

during slow walking up to 130 when walking rapidly. An adult, walking at a rate of about 90 steps per minute, travels about 4 km per hour

Heel strike
Reaction:
Anterior to hip cause flexion

moment. Anterior to knee causing extension moment. Posterior to ankle causing in preventing further flexion

Heel strike cont

Hip Is flexion to 25 degrees .The gluteus maximus and hamstrings are active in preventing further flexion
Knee Is in full extension at heel strike . The extension moment is overcome by action of the hamstrings and the knee begins to flex

Ankle Is in neutral position then begins to plantar flex . This plantarflexion is controlled by action of the pre-tibial muscles

After heel strike cont

Reaction:
Anterior to hip causing

flexion moment.
Posterior to knee causing

flexion moment.
Posterior to ankle causing

plantarflexion moment.

After heel strike cont

Hip Is held in 250 of flexion by action of

gluteus maximus and the hamstrings.

Knee Is in 50 of flexion and continues to

flex. The rate of flexion is controlled by action of the quadriceps.

Ankle Is in 50 of plantar flexion and

continues to planter flex under to control of

the pre-tibial muscle.

Foot flat

Reaction:
Anterior to hip causing flexion

moment.
Posterior to knee causing

flexion moment.
Posterior to ankle causing

plantarflexion moment.

Foot flat cont

Hip : Is in 250 of flexion then

begins to extend by action of gluteus maximus and the hamstrings.

Knee: Reaches 150 of flexion and

continues to flex until it reaches 200 shortly after foot flat .It then begins to extend .The quadriceps are active in controlling to angle of flexion.

Foot flat cont

Ankle : Is in 100 of plantarflexion .

The planterflexion moments reduce as the reaction moves along the foot and the pretibial muscle activity falls off .As the ground reaction passes anterior for to the ankle joint the segments of the supporting limb begins to rotate over the fixed foot.

Mid stance

Reaction:
Passes through hip joint ,no

moment .
Posterior to knee causing a

flexion moment.
Anterior to ankle causing

dorsiflexion moment.

Mid stance cont

Hip : Is in 100 of flexion and begins to extend as the ground reaction moves posterior to the hip joint shortly after mid stance .
Knee: Reaches 100 of flexion and continues to extend. Quadriceps action has fallen off and it is suspected that the Soleus is active in controlling knee flexion .

Mid stance cont

Ankle : 50 of dorsiflexion and continues to dorsiflex due to ground reaction by the calf group of muscle

Heel off

Reaction:
Posterior to hip causing

extension moment.
Anterior to knee causing

extension moment.
Anterior to ankle causing

dorsiflexion moment.

Heel off cont

Hip : Reaches about 13 degrees of extension then begins to flex. The iliacus and opsoas major are active in controlling extension and initiating flexion. Knee: Is flexed to about 2 degrees which is the maximum extension reached at this point in the gait cycle . The gastrocnemius may be active in preventing further extension.

Heel off cont

Ankle : Reached 15 degrees

of dorsiflexion after which it plantarflexion due to a powerful contraction of the calf muscles which counteracts the dorsiflexion moment and assists in propelling the body forward.

Toe off

Reaction: By the toe

off the reaction has lost most of its significance as the majority of weight is borne by the

other foot

Toe off cont

Hip: is in 10 degrees of extension and continues to flex due to the plantarflexion of the foot and activity of the Rectus femoris.
Knee: is flexed to about 40 degrees and continues to flex under the small ground reaction moment and plantarflexion of the foot

Toe off cont

Ankle: has reached 200 of plantarflexion due to contraction of the calf muscles. These muscles become inactive directly after toe off.

Acceleration
Hip: is in 100 of extension and flexes as the hip flexors accelerate the limb forward
Knee: is in 200 of plantarflexion directly after toe off. It then begis to dorsiflex under action of the pretibial group of muscles.

Mid swing
Hip is flexed about 200 and

continues to flex
Knee: reached about 650 of flexion

then begins to extend under pendulum action.

Ankle: has reached its neutral

position and is held there by slight activity of the pretibial muscle

Deceleration

Hip: reached 25 degrees of flexion

and is restrained by gluteus maximus and the hamstrings

Knee: is in full extension and

restrained by the hamstrings. Ankle: is still held in the neutral

position by action of the pretibial

muscles.

General characteristics of normal gait

Vertical displacement of the center of gravity
Lateral displacement of the center of gravity Width Of walking base

Horizontal tilt of the pelvis

Flexion of the knee during the stance phase Walking speed

Vertical Displacement
During a normal walking patter,the center of gravity

moves rhythmically up and down whilst moving forwards.The highest point is reached when the stance leg is at the middle of its stance phase;the lowest point is reached at the timeof double support,when both feet are in contac with the ground.This vertical displacement rarely exceeds 50mm in male adults.

Lateral Displacement
When weight is transferred from one leg to the

other,the pelvis and torso move to the weight bearing side.the center of gravity not only performs a rhythmic up and down movement during forward motion.but also swings from side to side.the amplitude of this displacement,too,generally lies within 50mm.

Width of walking base

The separation of the two lines is the measure of the

width of walking base.The average measure in adults iis 50-100mm heel width.

Horizontal tilt of the pelvis

During normal walking,the pelvis tilts laterally,first

around the one supporting hip joint,then around the other.The magnitude of rotation from the horizontal is small,and rarely exceeds 5

Flexion of the knee during the stance phase

Shortly after heel strike,the knee begins to

flex,continuing during the early stance phase until an angle of about 20 is reached.This flexion is matched to the movements of the ankle and of the hips,so as to reduce the knee during the stance phase is of particular significance in the smoothing of the vertical displacement of the center of gravity during walking.

Speed
The number of steps per minute can be increased

from about 70 during slow walking up to 130 when walking rapidly.An adult,walking at a rate of about 90 steps per minute,travels about 4km per hour .

Factors affecting gait

Force of gravity
Forces of muscular contraction Inertial effects

Angular relationships between the parts of the leg

during the various phases of the gait