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ABNORMAL GAIT

 INTRODUCTION:

An abnormal gait is when a person’s walk is different from what would be classed as ‘normal’. Gait is another word for walking pattern. A person with an abnormal gait will have a distinctive change in their pattern of walking.

NORMAL GAIT:

Normal gait is a ‘normal’ walking pattern. Normal gait requires strength, balance, sensation and coordination. Heel strike to heel strike or one stride length is known as a gait cycle. There is always a slight variation in everyone’s pattern of gait.

The gait cycles consists of a stance phase and a swing phase.

  • Stance phase:
    Heel strike
    This is when the heel of the first foot makes initial contact with the floor. The main muscles used for heel strike are dorsi flexors (the ones that pull your toes up), hip flexors, Gluteus (bottom) and Hamstring (back of the thigh) muscles. Heel strike is the stage at which the walker is most stable.

    Foot flat/mid stance
    This is when the foot is flat on the ground. The foot takes the weight of the body and the body carries the weight forward. The main muscles used for this movement are hip extensors. There is also slight knee flexion. The body is least stable at this point.

    Heel off, push off and toe off
    This is when the heel lifts off the ground. The toes push up to lift the whole foot up clearing the foot off the floor. The main muscles involved are the hip extensors and plantar flexors (the ones that pull the toes down) along with the calf muscles.

  • Swing phase :
    This stage occurs after heel off. The limb that is lifted off the floor moves forward and shortens. This allows for the foot to clear the ground. For a successful swing phase to occur there are three stages that must take place.

    Acceleration
    This is the force generated by the hip flexors (the muscles that pull the whole leg forward) these move the limb forwards.

    Mid-swing
    This is when the limb passes the stance limb. At this stage the limb is at its shortest to provide a good foot clearance.

    Deceleration
    This is the final part. The limb prepares for heel strike. The lower leg muscles help to control this.

CAUSES:

There are several common reasons that cause a person to have an abnormal gait these include:
  • Fracture
  • Neurological
  • Pain
  • Muscle weakness
  • Stiffness
  • Joint problems
  • Age related changes
  • Leg length discrepancy

TYPES OF ABNORMAL GAIT:

Foot drop(High stepping gait) – A person with foot drop is unable to raise their foot at the ankle. The muscles affected are the dorsi flexors (those that life the foot at the ankle) This is characterized in someone’s walking when their foot slaps down to the floor rather than being placed naturally. A person suffering from foot drop may have to excessively lift their hip to compensate for the inability to clear the foot properly.


Trendelenburg – is caused by weakness of the Gluteal (buttock) muscles. This weakness can lead to instability in a person. This is characterized by dropping of the pelvis to one side of the body whilst walking causing more knee flexion (bending of the knee) to clear the foot.



Parkinsonism(Stamping gait) – This is characterized by a shuffled walk. A person suffering from parkinsonism may find their steps become shorter. It is more common in someone suffering with later stages of Parkinson’s disease. They may have problems stopping, starting and turning around during walking. They may appear to be falling forward or in a forward flexed posture.



Circumduction(Heamiplegic gait) – This is characterized by dragging of the foot to try and clear it. Circumduction occurs because of a lack of movement at the knee (limited knee flexion) or a leg length discrepancy (one leg could be shorter than the other) Muscles affected are the knee flexors. e.g stroke.



Scissor gait – This is characterized by the legs being slightly bent at both the hip and the knee, when walking the thighs tend to cross each other similar to that of a scissor movement. Scissor gait is common in those with cerebral palsy and the person will tend to walk on their tip toes (plantar flexed). The muscles affected are the plantar flexors (pull your toes down), dorsi flexors (pull your toes up), abductors (muscles close to the hip that bring the whole leg away from the other leg) and adductors (muscles close to the hip that bring the whole leg towards the other leg) e.g cerebral palsy.


Sensory Ataxic – This is characterized by a heavy heel strike or unsteady stomping whilst walking. Postural instability (when someone finds it hard to balance in an upright position) is usually present. Sensory ataxia is caused by a loss of sensation in the joints.


Toe Walking – This characterized when someone walks on their toes tending not to place any weight on the heel part of their foot. Toe walking is commonly caused by muscle spasticity in the plantar flexor (those that pull your toes down) muscles.




PHYSIOTHERAPY MANAGEMENT:

    Physiotherapists can analyse gait to diagnose  of all the problem and identify the areas that require improvement. 
Physiotherapy can be beneficial for abnormal gait in the following ways:
  • Improving balance.
  • Improving strength.
  • Help to be independent with daily activities indoors such as walking from bedroom to bathroom.
  • Reduce risk of falling.
  • Reduce risk of injury around your home.
  • Help to become independent with daily activities such as washing, dressing, cooking.
  • Allowing to continue independently.
  • Provide with advice and guidance on coping.
  • Help to understand why it have abnormal gait, how to improve it and provide treatment.
  • Help to gain confidence.
MEANS:
There are various treatments that physiotherapists may carry out for people with abnormal gait. A structured program to suit patient needs will be developed. 
Physio treatment may involve:
  • Gait re-education.
  • Balance and co ordination work.
  • Lower limb strengthening exercise.
  • Hydrotherapy.
  • Mobility rehabilitation.
  • Active and passive movements.
  • Provide e appropriate Orthotics or equipment if necessary.
  • Advice and guidance on coping with abnormal gait.
  • Stretching exercises.
  • Risk assessments.


THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER
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