apropulsive gait

apropulsive gait

(see Table 1)
Table 1: Gait patterns
Gait patternCharacteristics
Apropulsive gaitTypical of someone who pronates excessively during the stance phase of gait
Characteristically inefficient gait pattern; subject does not achieve supination at toe off
Antalgic gaitTypical of the elderly
Characteristically shows loss of gait fluidity and ease of movement, due to foot pain, generalized pain and disability
Ataxic gaitTypical 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 gaitTypical 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 gaitTypical 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 gaitTypical 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 gaitTypical 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 gaitTypical 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 Table 2 and Table 3
Rheumatoid gaitTypical 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 gaitTypical 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 gaitTypical 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
Table 2: The gait (walking) cycle
Phase of the cyclePeriodComment
Stance phase (60%)ContactFrom heel strike to foot flat
Foot unlocks to act as a shock absorber and adapt to irregularities in the ground surface
MidstanceFrom foot flat to heel lift
The total weight-bearing surface of the foot is in contact with the walking surface
PropulsionFrom 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
Table 3: Foot events occurring during normal bipedal gait
Stance phaseEvents/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 phaseEvents/movements occurring
Leg 1
Early swingPlantar aspect of first MTPJ still prominent
Toes dorsiflexed at MTPJs to allow ground clearance during swing
MidswingPlantar aspect of first MTPJ no longer prominent
Late swingSTJ 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.