G
gait manner of walking (Table G1)
| Gait pattern | Characteristics |
|---|---|
| Apropulsive gait | Typical of someone who pronates excessively during the stance phase of gait Characteristically inefficient gait pattern; subject does not achieve supination at toe off |
| Antalgic gait | Typical of the elderly Characteristically shows loss of gait fluidity and ease of movement, due to foot pain, generalized pain and disability |
| Ataxic gait | Typical of someone with cerebellar pathology Characteristically an uncoordinated gait pattern Shows dyssynergy (loss of smoothly coordinated voluntary movements), dysrhythmia (abnormal timing and coupling of movements), dysmetria (the inability to gauge distance, speed, strength and velocity of movements) This results in a wide-based gait with a slow, jerky and irregular cadence, variability of stride length and foot placement from step to step, numerous postural adjustments and easy loss of balance |
| Bouncing gait | Typical of someone with ankle equinus Characteristically shows early heel off (lift) due to soft-tissue contracture of Achilles tendon and gastrocnemius complex, shortened stride length, external hip rotation, extended knee extension throughout the stance phase, abductory twist of heel and forefoot, excessive pronation, elongated propulsive phase, forefoot subluxation and medial column collapse |
| Childhood gait | Typical of a child aged 2–6 years Characteristically shows developmental knock knee, abdomen less prominent than the toddler gait; foot type approaches the adult form with a more evident medial longitudinal arch |
| Festinant or shuffling gait | Typical of someone with Parkinson’s disease Characteristically shows difficulty in initiating gait; rapid, short, shuffling steps once mobile, with loss of arm swing, stooped stance, propulsion and retropulsion |
| Hallux limitus gait | Typical of someone with functional or actual reduced dorsiflexion at the first metatarsophalangeal joint Characteristically shows reduced heel lift, obligatory pronation about the longitudinal axis of the metatarsal joint, leading to abductory twist and increased abducted angle of gait, internal tibial torsion, internal rotation and increased transverse plane motion at knee, internal hip rotation, forward pelvic tilt and increased lumbar lordosis, thoracic kyphosis and a forward tilt of the cervical spine |
| High-steppage gait | Typical of someone with foot drop and/or distal sensory neuropathy Characteristically shows increased hip and knee flexion during the swing phase of gait in order for the foot, which is plantarflexed at the ankle, to clear the ground |
| Normal gait | See Tables G3 and G5 |
| Rheumatoid gait | Typical of someone with rheumatoid disease Characteristically shows an antalgic pattern with reduced gait velocity due to shortened stride length and reduced cadence, with an increased double-support phase and reluctance to load the forefoot and altered velocity of the centre of pressure profile |
| Scissors gait | Typical of someone with cerebral palsy Characteristically shows spasticity of hip flexors and adductors, with hyperreflexia and clonus, internal hip rotation, contraction of the knee flexors leading to toe walking and cavovarus foot deformity |
| Toddler gait | Typical of a 12–15-month-old child who has just begun to walk Characteristically shows a broad-based gait, with apparent flat foot and bow legs, partially flexed knees, lordosis and bulging of the abdomen, forward tilt of the body, arms extended sideways at the shoulders and/or the arms lifted up |
gait analysis dynamic observation, record and analysis of the structure and function of the foot, lower limb and body during walking, together with evaluation of static and/or dynamic plantar pressures at specific plantar sites during stance and motion (Tables G2 and G3)
qualitative gait analysis gait analysis based on visual observation of patient from side, rear and front during normal walking
quantitative gait analysis numerical analysis of ground reaction forces (GRF), i.e. Fx, Fy, Fz, relative to body weight
| Evaluation device | Characteristics |
|---|---|
| Static evaluation (standing patient) | |
| Plantarscope | A glass platform, whose underside is viewed as a reflection in an angled mirror. Plantar tissues blanch on loading, and areas of greatest pressure show greatest blanching |
| Podometer | As a plantarscope, but modified to include foot size measurement and calcaneal deviation in the reflected image |
| Pedobaroscope | An internally lit sheet of glass with a plastic or card interface. When the person stands on the interface the relative plantar pressures are projected as a scaled image from the reflected light |
| Dynamic evaluation (patient walking, walking/running on a treadmill) | |
| Black paper | The feet are dusted with chalk and the patient walks along the length of the sheet of paper. Gait parameters are recorded from the chalk footprints |
| Harris and Beath mat | A rubber mat, marked in intersecting squares of varying pitch, is inked and covered with paper. Areas of high plantar pressure show increased densities of ink in the footprint recorded on the paper |
| Pedobarograph | A variant of the pedobaroscope, with good resolution and a colour-coded scale of dynamic plantar pressures |
| Musgrave | A research tool: a pressure plate embedded into a walkway and linked to a video camera that gives both static and dynamic three-dimensional images of the plantar pressures |
| Kistler force plate | A research tool: a force plate embedded into a walkway linked to a video camera that gives information about forces passing through foot joints, and the foot in all three planes of space |
| TechScan | An in-shoe foil that generates images of plantar pressures during gait |
Table G3 The gait (walking) cycle
| Phase of the cycle | Period | Comment |
|---|---|---|
| Stance phase (60%) | Contact | From heel strike to foot flat Foot unlocks to act as a shock absorber and adapt to irregularities in the ground surface |
| Midstance | From foot flat to heel lift The total weight-bearing surface of the foot is in contact with the walking surface | |
| Propulsion | From heel lift to toe off Foot is a rigid and stable lever | |
| Swing phase (40%) | From toe off limb 1 to heel strike (limb 1) Body mass transfers from limb 1 to limb 2 |
gait cycle; walking cycle; locomotor cycle sequence of lower-limb events occurring during normal walking (on flat, level surface) and made up of alternating stance phase (itself divided into three periods, during which all or part of foot contacts the support surface) and swing phase (when limb swings forward between the end of one episode of ground contact and start of next); note: first 10% of stance phase is a period of double support, i.e. both feet are in contact with ground surface (Tables G4 and G5; Figure G1)
Table G4 Comparison of gait during walking and running
| Walking | Slow running | Fast running |
|---|---|---|
| Contact phase (60%) | Shorter contact phase (50%) | Short contact phase (40%) |
| 5 cm base of gait (intermalleolar distance) | >5 cm base of gait | |
| Short swing phase (40%) | Longer swing phase (70%) | Long swing phase (80%) |
| Short period of double support (10%) | 40% of cycle without support (= airborne phase) | 60% of cycle without support (= airborne phase) |
Table G5 Foot events occurring during normal bipedal gait
| Stance phase | Events/movements occurring |
|---|---|
| Leg 1 | |
| Heel strike (HS) | Leg 1 STJ slightly supinated, so that: • Posterior lateral area of the ‘plantar heel pad’ contacts the ground surface • Forefoot is inverted relative to the ground surface MTJ is also supinated, so that: • Tibialis anterior tendon is contracted and prominent • Limb decelerates Hallux slightly dorsiflexed due to contraction of EHL Leg 2 Knee of supporting leg is flexed Heel off on supporting leg |
| From heel strike (HS) to foot flat (FF) | Leg 1 STJ begins to pronate due to: • Internal rotations within the lower limb • Friction between the ground surface and the heel MTJ also begins to pronate as: • Tibialis anterior relaxes • Ground reaction forces act on the fifth and fourth metatarsals The plantar heel pad becomes weight-bearing The lateral area, then the whole forefoot, loads rapidly The hallux ceases to dorsiflex as soon as forefoot loading occurs Once forefoot loading in leg 1 is completed (and leg 2 has undergone toe off) the STJ should pronate no further Leg 2 Foot moving through propulsion phase, so that leg 1 loads fully as leg 2 undergoes toe off |
| From foot flat (FF) to midstance (MS) | Leg 1 The leg and pelvis undergo external rotation • STJ supinates The knee is extended • A bisecting line through the knee exits through the middle of the second metatarsal • Leg 2 begins its swing phase Midstance occurs when the leg is perpendicular to the ground • The leg is directly over the foot • STJ is neutral • Tibialis anterior is relaxed • Weight is evenly distributed across the heel pad • MTJ is fully pronated • Toes are flat to the ground surface, with no plantarflexion of the digits • Leg 2 is in the middle of the swing phase and passes leg 1 |
| Midstance (MS) to toe off (TO) | Leg 1 As the body weight moves anteriorly over the foot, simultaneously: • The knee flexes rapidly • Gastrocnemius fires to bring about heel lift (just prior to heel contact of leg 2) • Body weight transfers to the forefoot The foot is supinating (due to the pull of gastrocnemius) • There is no movement of the STJ, only movement at the MTJ • MTJ locks to convert the foot to a rigid lever Propulsion begins • Body weight is distributed across the metatarsal heads • First MTPJ is dorsiflexed but both first and fifth rays are parallel to the support surface Propulsion continues • The body weight continues to moves further forward • First metatarsal plantarflexes and plantar aspect of first MTPJ becomes prominent • Remainder of the foot supinates relative to the first ray and the height of the MLA increases • Peroneus longus fires to stabilize the first ray (peroneus longus tendon becomes prominent) • Body weight transfers from the lateral to the medial side of the foot • Lateral aspect of the forefoot lifts (assists transference of body weight to leg 2) • STJ supination reduces as foot begins to unload |
| Swing phase | Events/movements occurring |
|---|---|
| Leg 1 | |
| Early swing | Plantar aspect of first MTPJ still prominent Toes dorsiflexed at MTPJs to allow ground clearance during swing |
| Midswing | Plantar aspect of first MTPJ no longer prominent |
| Late swing | STJ and MTJ supinated due to contraction of tibialis anterior, EHL and EDL muscles |
STJ, subtalar joint; MTJ, metatarsal joint; EHL, extensor hallucis longus; MTPJ, metatarsophalangeal joint; MLA, medial longitudinal arch; EDL, extensor digitorum longus.
GALS screen mnemonic (gait, arms, legs, spine) for musculoskeletal assessment (see HOE; LFM; REMS)
galvanism see negative galvanism
ganglia groups of nerve cell bodies within brain or spinal cord
basal ganglia corpus striatum (caudate and lentiform nuclei); loss of dopamine (basal ganglia neurotransmitter) causes symptoms of Parkinson’s disease
dorsal root ganglia; DRG; spinal ganglia sensory nerve cell bodies located within spinal cord sensory nerve root (distal axons of DRG), the sensory component mixed peripheral nerve; proximal axons synapse with either ipsilateral dorsal ganglia (for touch, pressure or vibration awareness) or contralateral thalamus (for pain or temperature awareness)
ganglion; ganglionic cyst soft, fluctuant, loculated swelling formed by herniation of a joint capsule, or from a tendon sheath where it emerges from the overlying retinaculum, e.g. at dorsal tarsal area
dry gangrene area becomes cold, black, dried and shrivelled, with clear line of demarcation between gangrenous and non-gangrenous tissues
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