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AN INTRODUCTION TO THE GAIT CYCLE AND GAIT EXAMINATION Shayne Trinder DPodM, MChs, FCPodS Podiatrist

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AN INTRODUCTION TO THE GAIT CYCLE AND GAIT EXAMINATION Shayne Trinder DPodM, MChs, FCPodS Podiatrist - PowerPoint PPT Presentation


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AN INTRODUCTION TO THE GAIT CYCLE AND GAIT EXAMINATION Shayne Trinder DPodM, MChs, FCPodS Podiatrist. THE GAIT CYCLE. bare weight provide a means for locomotion maintain equilibrium . WEIGHT BEARING PROPERTIES. Bony Features - shape of bones maintain stability

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slide1
AN INTRODUCTION TO

THE GAIT CYCLE

AND

GAIT EXAMINATION

Shayne Trinder DPodM, MChs, FCPodS

Podiatrist

the gait cycle

THE GAIT CYCLE

bare weight

provide a means for locomotion

maintain equilibrium

weight bearing properties
WEIGHT BEARING PROPERTIES

Bony Features

- shape of bones maintain stability

Ligaments Strong

- maintain stable configuration

Support weight of body

- with minimal expenditure of energy

stability at stance
STABILITY AT STANCE
  • Centre of mass of body
  • Position of joints during normal upright standing
  • Stable position maintained through close packing of joints
  • Strong supporting ligaments
  • Can be maintained while bearing weight with minimal expenditure of energy (i.e. muscle contraction)
locomotion
LOCOMOTION

Position of the Lower Extremity

Weight bearing / Fixed (Closed chain)

i.e. foot is on the ground

- body moves over the leg

Non weight bearing / Free (Open chain)

i.e. foot is off the ground

- leg moves under the body

Same relative motion occurs in both position - different bones will move

the gait cycle1
THE GAIT CYCLE
  • STANCE PHASE 65%
    • Contact Period - heel strike to forefoot loading
    • Midstance Period - forefoot loading to heel raise
    • Propulsive Period - heel raise to toe off
  • SWING PHASE 35%
    • Acceleration
    • Deceleration
contact period
CONTACT PERIOD
  • Heel strike to forefoot loading
  • Foot pronates at subtalar joint
  • Only time (stance phase) normal pronation occurs
  • This absorbs shock & adapts foot to uneven surfaces
  • Ground reaction forces peak
  • Leg is internally rotating
  • Ends with metatarsal heads contacting ground
midstance period
MIDSTANCE PERIOD
  • Forefoot loading to heel raise
  • Foot stops pronating & starts supinating due to Tibialis posterior & Soleus contract
  • And external rotation of the leg
  • Other leg in swing phase – all weight on one foot
  • Vertical ground reaction forces decrease – body is directly over foot
  • Ends as heel leaves ground
propulsive period
PROPULSIVE PERIOD
  • Heel raise to toe off
  • Subtalar joint supination continues until just after toe off
  • Leg continues to externally rotate
  • Vertical ground reaction forces peak – forefoot only bearing weight on this side
  • Forces move from lateral to medial passing through the hallux
  • First MPJ must function correctly for maximum efficiency
  • Toes are loaded to stabilise MPJ’s
swing phase
SWING PHASE
  • Foot accelerates to “catch up” with body
  • Leg internally rotates (from external position)
  • Foot pronates to aid ground clearance
  • Foot decelerates and slightly supinates in preparation for heel strike
normal standing position
“NORMAL” STANDING POSITION
  • Feet slightly abducted & shoulder width apart
  • Knees pointing forwards & extended
  • Heels are vertical
  • Ankles are approximately 900 leg
  • All MPJ’s & toes are in contact with the ground
gait examination
GAIT EXAMINATION
  • Take a history
  • Couch examination
  • Static examination
  • Allow patient time to relax
  • Reasonable length walkway - gait pattern changes before & after turn
  • Various systematic ways
  • Look for the obvious!
couch examination
COUCH EXAMINATION
  • Observe deformities & lesions
  • Check ROM’s
  • Check muscle tightness/strength
  • Neurological & vascular assessment
static examination
STATIC EXAMINATION
  • Feet non-weight bearing (hanging) with weight bearing
  • Standing from front
    • Shoulders, hips, knees, feet
  • From behind
    • Shoulders, hips, calcaneus
general points
GENERAL POINTS
  • Is the gait fast or slow?
  • Is it smooth?
  • Does the patient appear relaxed & comfortable or pained?
  • Is it noisy?
slide27
FEET
  • Heel strike – towards lateral side?
  • Is forefoot loading lateral to medial?
  • Is normal pronation occurring?
  • Any medial bulging?
  • Arch normal, high, low or non-existent?
  • Are the feet abducted, adducted or straight?
feet 2
FEET 2
  • Is the 1st MPJ functioning properly?
  • Are the toes bearing weight?
  • When is the heel lifting?
  • Is toe off through the hallux?
  • Does the swing phase appear normal?
  • Are the feet too close or is the base of gait wide?
slide29
LEGS
  • Are the knees pointing forwards?
  • Is there genu valgum or varum?
  • Is there tibial varum present?
  • Do they appear internally or externally rotated?
  • Knees from the side – are they fully extending?
hips body
HIPS & BODY
  • Is there any excessive movements at the hips – rotations or listing?
  • From the side – are there any excessive curves?
head shoulders
HEAD & SHOULDERS
  • Are the shoulders level?
  • Do the arms swing equally?
  • Does the head & neck appear normal?
diagnosis
DIAGNOSIS
  • What’s causing the symptoms?
    • Level of the problem
    • Tissues involved
  • What might be preventing healing?
    • Malalignments
    • Tight muscles
  • Other factors
    • Employment/recreation
    • Footwear
what can we do
WHAT CAN WE DO?
  • Muscle stretching/strengthening
    • Balancing forces
  • Mobilizations
    • Movement is good
  • Foot orthoses
    • Spoilt for choice
  • Footwear
    • Appropriate for the task
foot orthoses
FOOT ORTHOSES
  • Control excessive pronation
  • Improve stability - lateral
  • Improve 1st MPJ function
  • Increase mechanical efficiency
  • Improve proprioceptive feedback
  • Increase shock absorption
  • Reduce leg length discrepancy
foot orthoses1
FOOT ORTHOSES
  • Choices, choices, choices
    • Casted v non-casted
    • Semi-customized v OTC
    • Cushioning v stability
    • Quality v quantity
  • Right type for the patient
    • What fits the problem
footwear
FOOTWEAR
  • Does the patient need?
    • More room
    • Less room
    • Increased stability
    • Greater cushioning
    • Something else!
conclusion
CONCLUSION
  • Thorough history
  • Careful examination
  • Identify the problem
  • Discuss with patient
  • Decide on course of action
  • Prescribe appropriate treatment
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