8/13/2019 Prot Picior 2

1/4

Joe Godges DPT 1

Normal Gait Mechanics

Normal Gait Patterns Have Two Major Periods:

1. Double Limb Support: a) weight loading

b) weight unloading2. Single Limb Support: a) stance phase of ipsilateral side

b) swing phase of contralateral side

DOUBLE LIMB SUPPORT

WEIGHT UNLOADING: Trailing foot is rolling off floor

Phases: Terminal Stance: when heel risesPre-Swing: when 1st MTP rolls off floor

Joint Motions: Terminal Stance Pre-Swing

Ankle Heel rise Max. plantarflexion (20o)

Knee Full extension Flexes to approx. 40o

Hip Max. extension (20o) Flexes to approx. 0o (neutral)

Pelvis Relative anterior rotation Less anterior rotation

Posterior depression Begin anterior elevation

Trunk Aligned between legs Aligned towards wt. loading leg

WEIGHT LOADING: Weight is transferred to contralateral leg

Phases: Initial Contact: when heel contacts floor

Loading Response: when sole of foot contacts floor

Joint Motions Initial Contact Loading Response

Ankle Neutral Plantarflexes 10o

Knee Knee extended Knee flexes 15o

Hip Flexed 25o Stable 25o flexion

Relative abduction

Pelvis Level Lateral drop to swing legTrunk Aligned between legs Aligned towards wt. bearing leg

8/13/2019 Prot Picior 2

2/4

Joe Godges DPT 2

SINGLE LIMB SUPPORT Body is aligned over the stationary foot

Contralateral leg is off the floor

STANCE PHASE: (Initial Mid-Stance,Mid-Stance, Late Mid-Stance)

Joint Motions Initial Mid-Stance Late Mid-Stance

Ankle Slight plantarflexion Max. dorsiflexion (10 o)

Knee Slight flexion Extended

Hip Flexed,

Relative adduction 10o

Extended,

Relative adduction

Pelvis Lateral drop to swing leg, externally rotated

Trunk Toward stance leg Away from stance leg

Trunk rises in an arc over the stationary foot

SWING PHASE: Leg shortens via hip and knee bend to simplify floor clearance

Sub Phases: Initial Swing: big toe leaves ground

Mid-Swing: contralateral leg is at high point mid-stance

Terminal Swing: leg reaching forward for next floor contact

Joint Motions Initial Swing Mid-Swing Terminal Swing

Ankle Plantarflexed Neutral Neutral

Knee Max. flexion (60 o) Flexion Max. extension (0o)

Hip Flexion,

Relative abduction

Max, flexion (25 o)

Max. abduction (10o)

Flexion,

Relative abducted

Pelvis Lateral drop to swing leg, medial rotatedTrunk Aligned over stance leg

Pathway of Center of Gravity

Sagittal Plane: Rhythmical up and down motion

Highest point: Over extended single leg (MSt)

Lowest point: Double limb support (PSw/LR)Vertical displacement of 4-5 cm. (sinusoidal wave)

Frontal Plane: Rhythmical side-to-side motion

Most lateral point: Mid-Stance

C. O. G. swings laterally in as arc over the stationary foot

Lateral displacement of 4-5 cm. (sinusoidal wave)

References:

Greenman PE. Clinical aspects of sacroiliac function in walking. Manual Medicine. 1990;5:125-

130.Koerner I.Observation of Human Gait. Edmonton, Alberta, Canada: University of Alberta;

1986.

Observational Gait Analysis. Downey, CA: Rancho Los Amigos Research and Education

Institute; 1993.Perry J.Gait Analysis. Normal and Pathological Function. Thorofare, NJ: Slack; 1992.

8/13/2019 Prot Picior 2

3/4

Joe Godges DPT 3

Critical Events During Gait

Joint Sagittal Plane Frontal Plane Transverse Plane

1

st

MTP 65

o

extension at PSw

Midtarsal:

Calcaneocuboid

Control of Abduction at TSt

PF of 1st Ray at TSt/PSw

(Peroneus Longus)

Oblique MT Jnt Axis stability

at TSt

Talonavicular Control of Eversion at MSt

(Tib Ant and Tib Post)

Longitudinal MT Jnt Axis

stability at TSt

Subtalar 4-6

o

eversion at IC/LR

Ankle 10o-20o DF at TSt

Control of DF (tibial

advancement) after

MSt

(Gastroc. and Soleus)

Knee Control of flexion at LR

(Quadriceps and VMO)

0o extension at TSt

60o flexion at ISw

Produce full ext. at TSw

Patellar Medial Glide

Hip Control of flexion at LR

(Hip extensors)

20o extension at TSt

Control of lateral pelvic tilt

at MSt

(Hip Abductors)

Common Lower Extremity Musculoskeletal Impairments Associated With Gait

Deviations

Joint ROM/Muscle Length

Deficits

Motor Control/Strength

Deficits

Joint Hypermobility/Instability

1st MTP Dorsiflexion Tibialis Anterior Calcaneocuboid/Oblique MTJA

Talocalcaneal Eversion Tibialis Posterior Talonavicular/Longitudinal MTJA

Talocrural Dorsiflexion Peroneus Longus

Tibiofemoral Extension Gastrocnemius/Soleus

Tibiofemoral Flexion Quadriceps/VMO

Patellofemoral Medial Glide Gluteus Medius/Minimus

Hip Extension Gluteus Maximus

8/13/2019 Prot Picior 2

4/4

Joe Godges PT, Robert Klingman PT Loma Linda U DPT Program KPSoCal Ortho PT Residency

1

Foot Capsule Disorders

"Midtarsal Joint Capsulitis"

ICD-9-CM: 845.11 Sprain of tarsometatarsal joint

Diagnostic Criteria

History: Arch area pain - medial or lateral

Pain worse with single limb support phase of gaitRecent strain or repetitive use

Physical Exam: Pain at end range of one or more of the following accessory

movement tests (dorsal glide or plantar glide of the distal bone on

a stabilized proximal bone):

Medial Foot Lateral FootTalus - Navicular Calcaneus Cuboid

Navicular - 1st Cuneiform Navicular/3rd Cuneiform Cuboid

Talus - Navicular Accessory Movement Test

Cues: Patient sits on edge of table to allow knee flexion

Proximal forearm rests on tibia, index finger metacarpal (MCP) stabilizes dorsal

surface of talus, PIP and DIP stabilize talus using sustentaculum tali of

calcaneusDistal index finger MCP provides the planter glide and PIP and DIP provide thedorsal glide of the navicular

Alter forearm/upper extremity angle to align force with the "treatment plane"

(move the navicular with a glide parallel to the plane of the talonavicular

joint)Determine symptom response, available motion, and end feel