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Gait Analysis: Understanding and Improving Walking Patterns
A gait analysis is an assessment of the body’s motion, usually by walking or running. To identify any irregularities in movement, gait analysis can be used. A person’s gait results from a complicated interplay between the vestibular, somatosensory, and visual systems. Abnormalities in posture and gait can result from issues with any of these systems, as well as issues with the affected joints.
The process takes two to four hours. For a diagnosis to be effective, patients need to be able to walk ten consecutive steps without help.
Goals Behind the Gait Analysis
Ailments or diseases can lead to incorrect walking patterns, which are known as gait abnormalities. Pain in the feet, knees, ankles, back, or hips may result from such abnormalities. Additionally, gait analysis is called walking or motion analysis. This analysis is beneficial because:
- Determine the cause of any bone, neuron, or muscular issues.
- Find the cause of a patient’s suffering when they are walking or standing.
- Assist in the diagnosis of skeletal misalignments or abnormalities.
- Aid in identifying nerve or muscle dysfunction.
- Examine the course of illnesses such as muscular dystrophy and arthritis.
Method to Analyze Walking Patterns
- Computerized video cameras that can capture movements in slow motion
- To track motion on the camera, markers are applied to the skin.
- Sensors on a platform that detect the length of a stride and the force of each step.
- To track muscle contraction, electrodes will be used.
- Three-dimensional joint movement measurement using infrared markers
Gait analysis cycle
The two stages of gait pattern are:
- stance
- swing
Stance Phase
When at least one side of the foot touches the ground during the stance phase, sixty percent of the gait cycle takes place. It is separated into five smaller phases as well:
- Initial contact (strike with the heel)
- loading response (flat foot)
- Mid stance
- Terminal stance (heel off)
- pre-swing (toe off)
Swing Phase
Forty percent of the gait cycle is made up of the swing phase, in which the foot does not touch the ground and the other leg and foot bear the weight of the body. This will include:
- Initial swing
- Mid-swing
- Late swing
Gait cycle sub-phases
Initial Contact (or Heel Strike): 0%
The instant the foot hits the ground, and the double support’s initial stage starts. Thus, it makes contact with the ground and starts to accept weight.
Loading Response (or Foot Flat): 0-10%
Starts from the point of first contact and keeps on until the foot on the opposing side comes off the ground. The foot continues to carry weight and absorb shock by rolling into pronation.
Midstance: 10-30%
begins when the foot on the other side lifts off the ground and continues until the heel on the opposite side does the same. With only one leg providing support, the body transitions from force absorption at impact to forward force propulsion.
Terminal Stance (or Heel Off): 30-50%
Starts as soon as the heel lifts off the ground and keeps going until the opposing foot makes contact with the earth. This action helps to drive the body forward in addition to providing stability and support for a single limb. The metatarsal heads bear more of the body weight.
Pre-Swing (or toe off): 50-60%
It begins when the foot on the opposite side strikes the ground and continues until the foot on the other side lifts off the ground.
Early Swing: 60-75%
It starts when the foot lifts off the ground and continues until it is in line with the opposite ankle.
Mid-Swing: 75-85%
It starts with the position of the foot and ankle and continues until the tibia of the swing leg is vertical.
Late Swing/Deceleration: 85-100%
Starts with the tibia of the swing leg being vertical and finishes with initial contact.
Abnormal gait types
Antalgic gait
Walking with a limp due to pain is known as an antalgic gait. You will abbreviate your stance phase to compensate if walking causes pain in your knee, ankle, or foot. This implies that you will balance one leg over another or lean to prevent pain and not support your entire weight.
Causes
- Anything that causes pain in your hips, spine, or lower limbs
- Pain can result from accidents or injuries.
- This may cause swelling, which could alter the gait pattern.
- Rheumatoid arthritis
- Gout,
- Osteoarthritis,
- Nerve damage
- An alteration in the gait pattern may result from an infection in the tissues, leg bones, or spine.
Further possibilities:
Tumors in your lower limbs or spine, as well as complications with your arteries, veins, and blood vessels, such as deep vein thrombosis, can cause antalgic gait.
Treatments
Often, a minor injury that causes a limp will heal on its own. Stay off your foot or leg and avoid any intensive activity until it heals.
Additional treatments
- antibiotics for illnesses
- Loss of weight
- Physical treatment
- For injuries, elevate, cool, and rest.
- pain killers
- anti-inflammatory drugs
- splints or casts for broken bones
- Canes, crutches, or walkers
- Surgery
Ataxic gait
Ataxia is caused by injury to the cerebellum or nerve connections in the brain. Generally, the cerebellum regulates the coordination of muscles. Demyelinating lesions affecting the vestibular system along with the central or peripheral sensory tracts can cause sensory ataxia. Additionally, several medical conditions, including genetic disorders, strokes, tumors, multiple sclerosis, degenerative diseases, and alcohol abuse, can result in ataxia. It can also be caused by anti-seizure medications or by some chemotherapy treatments.
Treatments may include:
Canes and walkers are examples of devices that could support independence for patients. Regular exercise, occupational therapy, speech therapy, and physical therapy may also be beneficial.
Parkinsonian Gait
In general, those who have Parkinsonian gait take shuffling, little steps. Thus, they can struggle to get back on their feet.
Also, Parkinsonian gait abnormalities can occur episodically or continuously. Episodic changes, like a freezing of gait, might happen due to environmental conditions or emotions. Walking with continuous modifications to your gait, such as going slower than you imagined, is referred to as continuous change.
Although the occurrence of Parkinsonian gait can vary from person to person,
Thus, the majority of people share several extremely common behaviors. Among them are:
- Moving slowly and clumsily
- Traveling more slowly than is reasonable given your age.
- Festinating, or the state in which you walk faster and shorter than usual, gives the impression that you’re moving quickly.
- Stumbling forward
- While walking, they may move their arms rarely.
- The freezing of gait can be triggered by environmental factors or emotions.
- falling a lot.
Treatments may include:
- Parkinsonian gait can be treated with levodopa (L-dopa). When combined with L-dopa, deep brain stimulation will improve gait in some patients.
- Exercises to improve gait
- Music therapy
- walking visualization
- Tai chi (increases stability and coordination)
Hemiplegic gait
Hemiplegic gait is a type of walking abnormality that commonly occurs in individuals who have suffered from a stroke or other neurological conditions that cause paralysis or significant weakness on one side of the body. This condition is characterized by a distinct walking pattern where the affected leg is stiff and swings in a semicircular motion with each step, while the affected arm is often held close to the body with limited movement. Thus, it occurs due to muscle spasticity, weakness, and poor coordination on the affected side.
Symptoms
It may include difficulty with balance, dragging or circumduction of the affected leg, reduced arm swing on the affected side, and overall asymmetry in movement. The affected individual may also experience foot drop, where the front part of the foot drags on the ground.
Treatment
It focuses on improving mobility and reducing muscle stiffness and spasticity. Thus, physical therapy strengthens muscles, improves balance, and enhances coordination. Occupational therapy can help with arm and hand movements, while assistive devices like braces or walkers may be used to support walking. So, medications or Botox injections are sometimes administered to reduce muscle spasticity. Advanced treatments may include surgical interventions or functional electrical stimulation (FES) to improve muscle function. Thus, the goal of treatment is to enhance the individual’s quality of life by improving their ability to walk and perform daily activities independently.
Steppage gait
Steppage gait, also known as neuropathic gait, is a distinctive walking pattern characterized by an exaggerated lifting of the foot and knee during the swing phase of walking. This gait abnormality occurs due to weakness or paralysis of the muscles responsible for dorsiflexion, which are the muscles that lift the foot upwards. As a result, individuals with steppage gait lift their legs higher than normal to prevent the toes from dragging on the ground, leading to a “slapping” sound when the foot strikes the floor. This condition is often associated with peripheral nerve damage, such as in cases of peroneal nerve injury, lumbar disc herniation, or neurological disorders like Charcot-Marie-Tooth disease.
Symptoms
It includes frequent tripping or stumbling due to the inability to lift the foot properly, foot drop, and muscle atrophy in the lower leg. The gait itself is often the most noticeable sign, with patients visibly lifting their knees higher than usual during walking.
Treatments
It depends on the underlying cause. Physical therapy is commonly recommended to strengthen the affected muscles and improve gait mechanics. Orthotic devices like ankle-foot orthoses (AFOs) can help support the foot and improve walking stability. In some cases, surgical intervention may be necessary to address the underlying nerve or spinal issues causing the gait abnormality. Additionally, addressing the root cause, such as managing diabetes in diabetic neuropathy or repairing nerve damage, is crucial in the comprehensive treatment of steppage gait.
Diplegic gait (spastic gait)
Diplegic gait is a type of walking abnormality commonly associated with conditions such as cerebral palsy, particularly spastic diplegia. In this gait pattern, individuals experience muscle stiffness and spasticity, primarily in the legs, which leads to a characteristic walking style. The legs often cross in a scissor-like manner due to increased muscle tone in the adductors (muscles that bring the legs together).
The knees and hips may be flexed, and the person may walk on their toes due to tightness in the calf muscles. A diplegic gait often includes characteristics of a scissor gait, such as the crossing of the legs, but also includes other features like walking on the toes due to tight calf muscles, stiff or jerky movements, and a generally reduced range of motion.
Symptoms of diplegic gait
It includes difficulty with balance and coordination, reduced range of motion in the lower limbs, and excessive muscle tone, which makes walking slow and effortful. In severe cases, it may cause pain and discomfort. Additionally, it complicates mobility.
Treatment
It involves a multidisciplinary approach, including physical therapy to strengthen muscles and improve flexibility, orthotic devices like braces to support the legs, and sometimes surgical interventions to release tight muscles or correct bone deformities. Doctors may use medications such as muscle relaxants or botulinum toxin (Botox) injections to reduce spasticity. Additionally, in some cases, they may consider advanced treatments like selective dorsal rhizotomy (SDR), a surgical procedure that reduces spasticity. Thus, early and ongoing treatment is crucial to improving mobility and quality of life for individuals with diplegic gait.
Scissor gait
It is a type of walking abnormality characterized by the knees and thighs crossing or “scissoring” as the person walks, giving the appearance of the legs being squeezed together. Spasticity in the leg muscles often causes this gait pattern, commonly linked to neurological conditions like cerebral palsy, multiple sclerosis, or stroke. So, people with scissor gait may have difficulty maintaining balance and may appear to walk on their toes with a narrow, inward-turned stance.
Symptoms include
There may be stiffness and tightness in the legs, especially in the hip adductor muscles, difficulty walking or an abnormal walking pattern, and a tendency to trip or stumble due to the crossing of the legs. So, over time, this can lead to joint deformities, pain, and difficulty with mobility.
Treatments
Treatment for scissor gait involves identifying the underlying causes and improving mobility. Additionally, this may involve physical therapy to strengthen and stretch the affected muscles. The use of braces or orthotic devices to support proper alignment. In some cases, medication helps to reduce muscle spasticity. In some cases, surgical intervention is necessary to release tight muscles or correct deformities. Thus, early intervention and consistent management are crucial to improving outcomes and enhancing the quality of life for those affected by this.
Waddling gait
The waddling gait is an unusual method of walking that can be described by a body movement that mimics the action of a duck. This abnormality often occurs due to weakness or dysfunction in the hip muscles, particularly the gluteal muscles, which are essential for stabilizing the pelvis during walking. People with a waddling gait tend to have difficulty keeping their hips level, causing one side of the pelvis to drop as they take a step, leading to the characteristic waddling motion.
Symptoms
It includes an exaggerated sway of the hips, difficulty in balancing, and a rolling motion while walking. This can be accompanied by muscle weakness, a reduced range of motion in the hips, and, in some cases, pain. Thus, the various underlying factors, including muscular dystrophy, hip dysplasia, spinal muscular atrophy, or other neuromuscular conditions, cause this condition.
Treatments
It focuses on addressing the underlying cause. Physical therapy will help to strengthen the hip muscles and improve gait patterns. The use of assistive devices like walkers or braces to enhance stability. So, in some cases, surgical intervention is necessary if structural abnormalities are present. Additionally, managing any associated pain and improving overall mobility through targeted exercises can help alleviate the symptoms and improve the quality of life for individuals affected by this gait disorder.
Benefits of analysis
- Identify abnormalities in the walking patterns.
- Guide Rehabilitation
- Optimize Athletic Performance
- Prescribe Custom Solutions
Sources
- https://www.orthomedctr.com/gait-analysis.php#:~:text=Gait%20analysis%20is%20an%20assessment,detect%20any%20abnormalities%20in%20locomotion.
- https://www.physio-pedia.com/Gait
- https://www.webmd.com/pain-management/what-is-antalgic-gait
- https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652
- https://www.healthline.com/health/parkinsons/gait#symptoms
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088193/
- https://www.ncbi.nlm.nih.gov/books/NBK547672/
- https://www.healthline.com/health/waddling-gait#pregnancy
- https://www.flintrehab.com/spastic-diplegia/
- https://samarpanphysioclinic.com/list-of-abnormal-gait-physiotherapy-treatment/
Written by Snegkha S