Six terms are used to describe directions relative to the center of the body. The anterior surface articulates with the most inferior and lateral of the metatarsal bones—the cuboid.
Three cuneiform bones, which lie in a row, distal to the navicular
The lower end of the tibia forms the upper and medial surface of the ankle joint with a subcutaneous medial projection called the medial malleolus. The lower part is also expanded to form the lateral part of the ankle joint with a subcutaneous lateral projection known as the lateral malleolus.
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The lateral collateral ligament (LCL) which similarly opposes adduction
The posterior joint capsule, which prevents hyperextension (excessive extension) of the joint
The anterior cruciate ligament (ACL), in the center of the joint between the condyles, which is attached to the tibia anteriorly and the
The posterior cruciate ligament (PCL), also in the center of the joint, which is attached to the tibia posteriorly and the femur anteriorly,
The patellofemoral joint lies between the posterior surface of the patella and the anterior surface of the femur. The medial articular surface is located between the talus and the inner aspect of the medial malleolus of the tibia.
Gluteus maximus originates from the back of the pelvis and is inserted into the back of the shaft of the femur near its top. It extends
The gluteus maximus originates from the back of the pelvis and inserts on the back of the shaft of the femur near its top.
Gluteus médius and gluteus minimus originate from the side of the
Adductor magnus, adductor brevis and adductor longus originate from the ischium and pubis of the pelvis.
Adductor magnus, adductor brevis and adductor longus all originate from the ischium and pubis of the pelvis. They insert in a line down the
Quadratus femoris, piriformis, obturator internus, obturator externus, gemellus superior and gemellus inferior originate in the pelvis and insert
Pectineus also originates in the pelvis and inserts on the femur. It flexes and adducts the hip
Rectus femoris originates from around the anterior inferior iliac spine of the pelvis and inserts into the quadriceps tendon. It flexes the
Tensor fascia lata originates from the pelvis close to the anterior superior iliac spine and is inserted in the fascia lata - a broad band of
Sartorius is a strap-like muscle originating at the anterior superior iliac spine of the pelvis and winding around the front of the thigh, to
Semimembranosus and semitendinosus are two of the hamstrings
Biceps femoris is the third hamstring. It has two origins - the 'long head' comes from the ischial tuberosity and the 'short head' from the
Gracilis runs down the medial side of the thigh from the pubis to the back of the tibia on its medial side. It adducts the hip and flexes the
Vastus medialis, vastus intermedius and vastus lateralis are the three remaining elements of the quadriceps muscle. They all originate from
Basic sciences 15 the upper part of the femur, on the medial, anterior and lateral sides respectively, and together form (with the rectus femoris) the quadriceps tendon. It flexes and helps unlock the knee by internally rotating the tibia at the beginning.
Popliteus is a small muscle behind the knee. It flexes and helps to unlock the knee by internally rotating the tibia at the beginning of
Gastrocnemius originates from the back of the medial and lateral condyles of the femur. Its tendon joins with that of the soleus (and
Plantaris is a very slender muscle running deep to the gastrocnemius from the lateral condyle of the femur to the calcaneus. It
Soleus arises from the posterior surface of the tibia, fibula and the deep calf muscles. Its tendon joins with that of the gastrocnemius to
Flexor hallucis longus, flexor digitorum longus, tibialis posterior, peroneus longus and peroneus brevis are the deep calf muscles, and all
The plantar interossei and the lumbricals lie in the deepest layer of the sole of the foot. These signals include the positions of the joints and the tension in the muscles and ligaments.
Upper body: The trunk is about half a stride length behind the level of the foot at the time of heel contact. It is at its lowest vertical
The direction of the ground reaction force changes from upwards and forwards during the heel strike transition (Fig. 2.7), to upwards and backwards immediately afterwards (Fig. 2.9). Hip: The position of the legs at the time of heel contact is shown in Fig.
Upper body: The shoulder and arms, having reached their most advanced position on the contralateral side, are now moving back again
Upper body: The shoulder and arms, having reached their most advanced position on the contralateral side, now move backward again.
Knee: The knee flexes following heel contact, and in doing so it acts as a spring, preventing the vertical force from building up too
Ankle and foot: The stage of the gait cycle from heel contact to foot flat, sometimes called the initial rocker or 'heel pivot', involves a
General: The term 'mid stance' may be used either to describe the period of time between foot flat and heel off, or to define a particular
Upper body: The period from foot flat to mid stance sees the trunk climbing to its highest point, about 25 mm above the mean level, and
Hip: At mid stance, the hip is more than half way through its movement into extension, with a typical angle close to zero (see
Ankle and foot: The period from foot flat to heel off, sometimes called the 'mid-stance rocker', is characterized by forward rotation of the
The descriptions that follow are based on a typical heel drop at 40 percent of the gait cycle, although in the normal specimen shown in Figures 2.4 to 2.7 and 2.9 to 2.14, the heel dropped slightly later, at 45 percent. The heel usually occurs before the other foot touches the heel, which happens about 50 percent of the time.
Upper body: Once mid stance has passed, the trunk begins to lose vertical height, on its way down to its lowest point in the double support
Torso: Once center stance is passed, the trunk begins to lose vertical height, heading down to its lowest point in the double support.
Knee: The knee has an extension peak close to the time of heel off, the angle at this time being between zero and a few degrees of flexion
The role of the soleus in opposing the external flexion moment around midstance has been described previously. As soon as the direction of the external moment changes, so that it tries to extend the knee, the gastrocnemius comes into play.
Ankle and foot: The peak of ankle dorsiflexion is reached around the time of heel off. The ankle angle at this time is usually between 15 and 20
This muscle strengthens the action of the soleus at the ankle joint, but also acts as a flexor at the knee, preventing hyperextension. Upper body: The upper body position is roughly a mirror image of the position described around the foot flat, which takes place on the.
Upper body: The position of the upper body is roughly a mirror image of that described around foot flat, which is taking place on the
The period between heel off and toe off is sometimes called terminal rocker, which is appropriate as the leg now rotates forward about the forefoot instead of about the ankle joint. Both the ground reaction force and the moment of force around the ankle joint are similar between these two groups.
Hip: The peak extension of the hip, which is between 10 and 20 degrees, is reached before toe off, by which time the hip is flexing again
The swing phase occupies about 40 percent of the gait cycle, and mid-swing usually occurs near the middle of this period. Walking speed is largely dependent on the efficiency of the swing phase, as stride length is the amount by which the foot can be moved forward in that time.
Upper body: At mid swing, as at mid stance, the trunk is at its highest position, and is maximally displaced over the stance phase leg
The force transmitted through the leg flexes the knee and helps initiate hip flexion. The most obvious exchange between potential and kinetic energy occurs in the movement of the torso.
The whole leg is externally rotated during the swing phase 6. There is an absence of reciprocal arm swinging
The bending of the knee during the swing phase is also somewhat reduced at one year of age. Some of the differences between the gait of the young and the elderly are evident in fig.
The swinging leg must be able to advance to a position where it can take over the supporting role
Although there is some variation in normal walking, especially in muscle use, there is a clearly recognizable 'normal gait pattern' and a 'normal range' can be defined for most measurable parameters. The swing leg must be able to move to a position where it can take over the supporting role.
Sufficient power must be provided to make the necessary limb movements and to advance the trunk
The first part of the chapter describes in some detail the most common abnormal gait patterns. This is followed by a description of the use of walking aids and the amputee's gait.
- The whole of the weight of the trunk is now supported by the left hip joint, instead of being shared between the two hips
- The weight of the right leg is now taken by the left hip, instead of by the ground
- The left hip abductors (primarily gluteus médius) contract, producing an anticlockwise moment to keep the pelvis from dipping
- Trunk weight not shared
- Weight of right leg
- Contraction of abductors
- The absence of significant pain on loading 2. Adequate power in the hip abductors
- A sufficiently long lever arm for the hip abductors 4. A solid and stable fulcrum in or around the hip joint
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- Painful hip: If the hip joint is painful, as in osteoarthritis and rheumatoid arthritis, the amount of pain experienced usually depends to
- Hip abductor weakness: If the hip abductors are weak, they may be unable to contract with sufficient force to stabilize the pelvis during
- Abnormal hip joint: Three conditions around the hip will lead to difficulties in stabilizing the pelvis using the abductors: congenital
The weight of the right leg is now taken by the left hip instead of the ground. The figures also assume that the bending of the trunk brings its center of gravity exactly over the hip joint.
A Right
Unequal leg length: When walking with an unequal leg length, the pelvis tips downwards on the side of the shortened limb, as the body
It may also include exaggeration of the first determinant (rotation of the pelvis around the vertical axis). Knee flexion and extension are best seen from the subject's side.
Reduce limb loading: When using a cane to remove some of the load from the leg, it is usually held in the same hand as the affected leg and
For this mechanism to work, the cane must be held in the opposite hand to the painful hip. Reduce limb load: When a cane is used to take some of the load off the leg, it is usually held in the same hand as the affected leg and.
Gait with a single aid: If only a single cane or crutch is used, the subject uses the walking aid either to increase stability, or to reduce the
Walking with a single aid: When only a single cane or crutch is used, the subject uses the walking aid to increase stability or to decrease stability.
Three-point swing-through gait: This gait pattern is used when it is impossible to support the body weight first on one leg and then on the
Three-point swing-to gait: This gait pattern is similar to three-point swing-through gait, except that the feet are advanced by a much shorter
It is therefore only suitable if both legs can support part of the body weight. The gait is very similar to the frame, except that it is easier to move forward because tilting the walker lifts the back feet off the ground.
The lever arm between the hip joint and the socket is relatively small, which reduces the moment which the hip muscles can apply to the
The handle between the hip joint and the bowl is relatively small, which reduces the torque that the hip muscles can apply.
There is always some relative motion between the stump of the femur and the socket, due to the compression of soft tissues, which is
If the socket is uncomfortable, the subject may be reluctant to apply large forces to the prosthetic limb
During the swing phase of the prosthetic leg, there was a tendency to jump onto the normal leg. One of the most important current applications of gait analysis is the assessment of patients with cerebral palsy (CP).
Overall, the results of this study of young people are consistent with other publications on the gait of elderly subjects who have had a cerebrovascular accident.
Stride length and velocity were very much reduced, although cadence was usually normal
The walking base was slightly increased
The range of motion at the hip, knee and ankle were all decreased, mainly by a reduction in the amount of joint extension
The swinging of the arms was much reduced
The majority of patients rotated the trunk in phase with the pelvis, instead of twisting it in the opposite direction
The vertical trajectories of the head, heel and toe were all reduced, although other workers have commented on a distinct 'bobbing'
Visual gait analysis is entirely subjective and the quality of the analysis depends on the skill of the person performing it. However, with careful wire routing, interference with the gait pattern can be minimized.
The electrogoniometer is fixed to cuffs around the soft tissues, not to the bones, so that the output of the potentiometer does not exactly
The position of the potentiometer is adjusted to be as close as possible to the locking axis. The electrogoniometer is clamped around the soft tissue, not the bone, so the output of the potentiometer is not exact.
Some designs of electrogoniometer will only give a true measurement of joint motion if the potentiometer axis is aligned to the anatomical
Methods of Gait Analysis 143 can be used to measure the angle of a joint if it is fixed so that the body of the potentiometer is attached to one limb segment and the pivot to the other. A single potentiometer can only take measurements in one axis of the joint, but two or three can be mounted in different planes to make multi-axial measurements.
A joint may, in theory, move with up to six degrees of freedom - that is, it may have angular motion about three mutually perpendicular
The electrical output thus depends on the position of the joint, and the device can be calibrated to measure the angle of the joint in degrees. The output of the device gives a relative angle, instead of an absolute one, and it may be difficult to decide at what angle the limb should be taken.
The output of the device gives a relative angle, rather than an absolute one, and it may be difficult to decide what limb angle should be taken
Methods of Gait Analysis 145 defense of the use of potentiometer-based electrogoniometers in gait analysis. The electrical output from the platform can be provided as either six or eight channels.
Two side-to-side signals from the front and back of the platform
Where recording from both legs is required, the relative positioning of the two force platforms can be a significant problem. For subjects who have a very short stride length, such as children, better results can be achieved if the platforms are mounted with their shortest dimensions in the walking direction.
The center of pressure (see Figs 2.21 and 2.22)
The use of force platforms for measuring postural sway has already been mentioned. Methods of Gait Analysis 173 require knowledge of the mass of the limb segments and the location of their centers of gravity.
Hypothesis formation: The next stage is the development of a hypothesis regarding the cause or causes of the observed abnormali-
Hypothesis testing: The hypothesis about the cause of the gait abnormality can be tested in two different ways - either by using a
Analysis of the results of the gait analysis may indicate the need for fine-wire EMG recordings of other muscles (Fig. 5.1). An example of the use of gait analysis to distinguish between pathological gait and habitual patterns is in the diagnosis of toe walking.
Cerebral palsy 2. Parkinsonism
It is appropriate to divide it into the study of diseases and research into treatment methods. Many diseases affect the neuromuscular and musculoskeletal system, which can lead to gait disturbances.
Joint diseases of many types 5. Lower limb amputation
Head injury 8. Spinal injury
One of the most common uses of gait analysis in clinical research is to perform a direct comparison between two or more treatment methods. Monitoring the performance of such a device and comparing it to mechanical orthoses would be difficult to implement without the use of some type of gait analysis.
A purely mechanical approach, using an orthosis 2. The use of FES to stimulate all the necessary muscles
Gait analysis can be used to examine energy storage and recovery by prosthetic foot mechanisms and to determine how well certain types of feet fit different categories of patients. Electrical stimulation has been used in cerebral palsy to increase strength in paretic muscles, and gait analysis has been used to monitor the resulting improvements.
