Gait in orthopaedics with total of six topics : Definition of gait, Types of gait, Causes of abnormal gait, Gait cycle or phases, Examination or assessment of gait, Treatment of gait.
1. Definition :
During locomotion, a gait is a pattern of limb motions. The numerous ways in which a human can move, either naturally or as a result of specific training, are referred to as human gaits.
2. Types of Gait :
There are mainly two types of gait – Normal gait and abnormal gait.
I. Normal gait :
During typical walking, each leg alternates between stance and swing phases. The gait is graced by the rhythmic repeating of such cycles. Because normal gait is mechanically efficient, just a little amount of energy is expended while walking. When the gait rhythm is disrupted for any reason, one ends up expending extra energy to walk, and hence becomes easily exhausted.
II. Abnormal gait :
Gait abnormalities can be caused by a variety of factors. In most cases, a number of factors come into play.
Now there are various types with different causes of abnormal gait, and they are :
Causes of abnormal gait :
1. SSS gait – Stiff knee, Stiff limb, Stiff hip gait :
- Stiff knee gait – This is caused by painful stiff knee and Tuberculous knee.
- Stiff limb gait – This occurs mainly due to congenital short femur and due to secondary fracture.
- Stiff hip gait – This can occurs due to Tuberculous hip, ankylosing spondylitis and rheumatoid hip.
2. Antalgic gait or painful gait :
Antalgic gait is one of the most common types of altered gait in individuals who visit the emergency room or their primary care physician’s office. It refers to an irregular pattern of walking caused by pain and resulting in a limp, in which the stance phase is shorter than the swing phase.
This can occur due to any cause which can make the leg painful like inflammation, fall from any top, and kind of injury.
3. Hand-Knee gait :
This occur In a quadriceps deficient knee with flexion deformity, the person walks with his hand on the knee to keep it from buckling.
The one and only cause is – Polio.
4. Foot drop gait :
This occurs because of the descent of the foot, the leg must be elevated higher to gain clearance.
Fall on foot, can make damage to the common peroneal nerve palsy and Sciatic nerve palsy.
5. Scissor gait :
Scissor gait is a type of gait anomaly most commonly seen in people with spastic cerebral palsy. An upper motor neuron lesion is linked to that disorder and others like it.
6. Trendelenburg gait :
When weight is carried on the affected side, the body swings to that side.
This can occur due to Gluteus maximus paralysis, Femoral neck fracture, dislocation of hip.
3. Gait Cycle/Phases :
I. Stance phase :
The segment of the gait cycle when the foot is on the ground is known as the stance phase. It begins with the heel strike and concludes with the toe off. It accounts for 60% of the gait cycle and is made up of three main events.
- Heel strike – This is taken when the hell strikes the ground
- Mid stance – When he whole foot remains flat on the ground.
- Push off – When the body is driven by a push from the foot, the heel first, then the toes, lift off the ground.
II. Swing phase :
When the foot is off the ground, this is the phase of the gait cycle. It begins with toe off and ends with the foot preparing to touch the earth once more. It accounts for 40% of the gait cycle and consists primarily of the following events:
- Acceleration – The leg goes forward with the help of hip flexors once the foot is off the ground.
- Mid swing – This is the swinging leg’s middle section.
- Deceleration – To prepare the foot for heel strike, the swinging leg is delayed.
4. Examination/Assessment :
For the following reasons, gait analysis is an important aspect of orthopaedic examination:
a) It provides insight into the source of gait abnormalities and, as a result, the diagnosis.
b) It provides an estimate of the degree of handicap caused by the aberrant gait, allowing treatment to focus on correcting the gait.
We check mainly five things to diagnose gait, and they are :
- Cadence – A person’s cadence is determined by a variety of things. The number of steps per unit of time is what it’s called. It takes roughly 100-115 steps per minute to walk normally.
- Comfortable walking speed – It is the speed at which the least amount of energy is consumed per unit distance. In a regular walk, it’s around 80 metres per minute.
- Step length – It’s the distance between the opposite feet’s corresponding sequential places of heel contact. The right step length is equal to the left step length in a typical gait.
- Stride length – The distance between any two consecutive points of heel contact on the same foot is denoted as the diatnce. The stride length in a normal gait is twice the step length.
- Walking base or Stride width – It’s the distance between the two feet’s line of step from side to side.
Based on the above five criteria we can detect whether the gait is normal or abnormal. And if abnormal gait is found, then based on the other features we can find the specific cause like if fever is present, then we can simply diagnose any infection or inflammation. Other case if neurological problem is causing this problem, then there can be presence of numbness at the particular side. So by this way we can find the specific cause.
5. Treatment :
Treatment of abnormal gait is cause specific, as you have seen earlier that there are different types of abnormal gait, and there are different causes.
Mainly we treat with medications and prevention guides.
- Like if the gait is occurring due to secondary tuberculosis, then we have to treat accordingly.
- If osteoarthritis is the cause then we will treat with medications.
- Taking specific precautions to prevent fall from any top.