import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Gait Analysis Gait observation is often the first and most revealing part of a lower limb examination. Examiners expect you to systematically describe the gait cycle, identify common abnormal patterns (antalgic, Trendelenburg, foot drop), and correlate findings with underlying pathology. Always observe gait BEFORE proceeding to focused examination. ## Quick Reference One-Pager ## Introduction and Setup **Environment Requirements:** - Adequate space for walking (at least 10 meters if possible) - Good lighting - Flat, firm surface - Patient appropriately undressed (shorts and bare feet ideal) **Consent Script:** "I'd like to watch you walk. Please walk at your normal pace to the end of the room and back. Then I'll ask you to do some additional walking tests." **Equipment:** - Note any walking aids (stick, frame, crutches) - Footwear should be observed initially, then removed - Orthotics noted ## Normal Gait Cycle **One gait cycle = Heel strike to next heel strike of same foot** **STANCE PHASE (60% of cycle):** 1. **Initial Contact (Heel Strike)**: Heel contacts ground 2. **Loading Response**: Weight transfer to limb 3. **Midstance**: Single limb support, body passes over foot 4. **Terminal Stance (Heel Off)**: Heel rises, push-off begins 5. **Pre-swing (Toe Off)**: Toes leave ground **SWING PHASE (40% of cycle):** 1. **Initial Swing**: Foot clears ground 2. **Mid-swing**: Limb passes under body 3. **Terminal Swing**: Limb extends for next heel strike **Key Parameters:** - **Cadence**: Steps per minute (normal: 100-120) - **Stride length**: Distance between successive heel strikes of same foot (normal: 1.4m) - **Step length**: Distance between heel strike of one foot and next foot - **Step width**: Distance between feet (normal: 5-10cm) - **Walking speed**: Normal approximately 1.4 m/s **Determinants of Gait (Saunders):** Six mechanisms that minimize vertical and lateral displacement of the center of mass, making gait energy-efficient: 1. Pelvic rotation 2. Pelvic tilt 3. Knee flexion in stance 4. Foot mechanism (ankle motion) 5. Knee mechanism 6. Lateral pelvic displacement ## Systematic Observation **Observe:** - Arm swing (asymmetry, absence) - Trunk position and sway - Pelvic drop (Trendelenburg) - Knee alignment (varus thrust, valgus thrust) - Foot progression angle (in-toeing, out-toeing) - Foot position at heel strike **Observe:** - Heel strike present or absent - Knee flexion (stiff knee, hyperextension) - Hip flexion and extension range - Forward trunk lean - Arm swing amplitude - Ankle dorsiflexion at swing **Observe:** - Shoulder and pelvic level - Trunk shift (compensated Trendelenburg) - Pelvic rotation symmetry - Heel alignment (varus/valgus) - Calf muscle bulk symmetry - Foot progression angle ## Pathological Gait Patterns ### Pain-Related Gaits ### Weakness-Related Gaits ### Neurological Gaits ### Structural Gaits ## Special Walking Tests ## Cerebral Palsy Gait Patterns **Hemiplegic CP (Winters Classification):** - Type I: Drop foot only (ankle) - Type II: Drop foot + equinus (ankle + knee) - Type III: Equinus + knee recurvatum (ankle + knee + hip) - Type IV: Stiff knee + hip involvement (global) **Diplegic CP (Common Patterns):** - True equinus: Ankle plantarflexion, knee extension - Jump gait: Equinus + knee flexion + hip flexion - Apparent equinus: Hip and knee flexion cause relative equinus - Crouch gait: Excessive knee flexion (most severe) ## Complete the Examination **Always state to the examiner:** "To complete my gait assessment, I would like to: - Perform **focused examination** of the relevant joint(s) identified - Conduct **neurological examination** of the lower limbs - Assess **leg length** formally - Examine **footwear** for wear pattern - Consider **video gait analysis** if complex (CP, multiplanar deformity)" ## Summary Presentation ## Common Conditions by Gait Pattern ## Gait in Children | Age | Milestone | |-----|-----------| | 12-15 months | Independent walking begins | | 2 years | Running, heel-toe pattern emerging | | 3 years | Heel strike present, arm swing developing | | 7 years | Adult gait pattern mature | **Normal Variants (Physiological):** - Flat feet (arch develops by 6 years) - In-toeing/out-toeing (often resolves by 8 years) - Genu varum (bowed legs, normal under 2 years) - Genu valgum (knock knees, normal 3-6 years) **Pathological (Require Investigation):** - Asymmetric gait - Pain - Progressive deformity - Delay beyond expected correction age - Associated symptoms (weakness, stiffness) ## Examiner Tips