Updated: 10/6/2016

Gait Cycle

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Questions
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Evidence
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https://upload.orthobullets.com/topic/7001/images/gait cycle.jpg
Overview
  • One gait cycle is measured from heel-strike to heel-strike 
    • consists of 
      • stance phase
        • period of time that the foot is on the ground
        • ~60% of one gait cycle is spent in stance
        • during stance, the leg accepts body weight and provides single limb support
      • swing phase
        • period of time that the foot is off the ground moving forward
        • ~40% of one gait cycle is spent in swing
        • the limb advances
  • Stride
    • is the distance between consecutive inital contacts of the same foot with the ground
  • Step
    • is the distance between initial contacts of the alternating feet
Stance Phase
  • Initial contact (heel strike)  
    • definition
      • occurs when foot contacts the ground
    • muscular contractions
      • hip extensors contract to stabilize the hip 
      • quadriceps contract eccentrically
      • tibialis anterior contracts eccentrically 
  • Loading response (initial double limb support)
    • marks the beginning of the initial double limb stance
    • definition
      • occurs after initial contact until elevation of opposite limb
      • bodyweight is transferred on to the supporting limb
    • muscular contractions
      • ankle dorsiflexors (tibialis anterior) contract eccentrically to control plantar flexion moment
      • quads contract to stabilize knee and counteract the flexion moment (about the knee)
  • Mid-stance (single limb support)
    • initial period of single leg support
    • definition
      • from elevation of opposite limb until both ankles are aligned in coronal plane
    • muscular contractions
      • hip extensors and quads undergo concentric contraction 
  • Terminal stance (single limb support)
    • definition
      • begins when the supporting heel rises from the ground and continues until the opposite heel touches the ground
    • muscular contractions
      • toe flexors and tibialis posterior contract and are the most active during this phase   
  • Pre-swing (second double limb support)
    • is the start of the second double limb stance in the gait cycle
    • definition
      • from initial contact of opposite limb to just prior to elevation of ipsilateral limb
    • muscular contractions
      • hip flexors contract to propel advancing limb
Swing Phase
  • Initial swing (toe off)  
    • start of single limb support for opposite limb
    • definition
      • from elevation of limb to point of maximal knee flexion
    • muscular contractions
      • hip flexors concentrically contract to advance the swinging leg
  • Mid-swing (foot clearance)
    • definition
      • following knee flexion to point where tibia is vertical
    • muscular contractions
      • ankle dorsiflexors contract to ensure foot clearance
  • Terminal swing (tibia vertical)
    • definition
      • from point where tibia is vertical to just prior to initial contact
    • muscular contractions
      • hamstring muscles decelerate forward motion of thigh
Variables Affected During Gait Cycle
  • Pelvic rotation
    • pelvis rotates 4 degrees medially (anteriorly) on swing side
      • lengthens the limb as it prepares to accept weight
  • Pelvic tilt
    • pelvis drops 4 degrees on swing side
      • lowers COG at midstance
  • Knee flexion in stance
    • early knee flexion (15 degrees) at heel strike 
      • lowers COG, decreasing energy expenditure
      • also absorbs shock of heel strike
  • Foot mechanisms
    • ankle plantar flexion at heel strike and first part of stance
  • Knee mechanisms
    • at midstance, the knee extends as the ankle plantar flexes and foot supinates
    • restores leg to original length
    • reduces fall of pelvis at opposite heel strike
  • Lateral displacement of pelvis
    • pelvis shifts over stance limb 
      • COG must lie over base of support (stance limb)
  • Center of gravity (COG)
    • in standing position is 5cm anterior to S2 vertebral body
    • vertical displacement
      • during gait cycle COG displaces vertically in a rhythmic pattern
        • the highest point is during midstance phase
        • lowest point occurs at the time of double limb support
    • horizontal displacement
      • COG displaces 5cm horizontally during adult male step
Muscle Activity
  • Figure showing muscle activity through different phases of gait cycle  
 

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Questions (7)
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(SAE07PE.54) During the early swing phase of the normal gait cycle, what lower extremity muscle is primarily contracting? Review Topic

QID: 6114
1

Tibialis posterior

2%

(14/659)

2

Tibialis anterior

83%

(547/659)

3

Vastus medialis

8%

(52/659)

4

Adductor longus

1%

(9/659)

5

Gastrocnemius

5%

(33/659)

ML 2

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PREFERRED RESPONSE 2

(OBQ13.110) During which period of gait does the tibialis anterior contract eccentrically? Review Topic

QID: 4745
1

Mid-stance

10%

(273/2730)

2

Heel strike

75%

(2055/2730)

3

Pre-swing

6%

(169/2730)

4

Initial swing

4%

(115/2730)

5

Mid-swing

4%

(104/2730)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ12.237) Which phase of gait is affected most in a patient with quadriceps atrophy? Review Topic

QID: 4597
1

Terminal swing

20%

(760/3827)

2

Preswing

5%

(179/3827)

3

Initial swing

19%

(714/3827)

4

Midstance

46%

(1772/3827)

5

Midswing

10%

(372/3827)

ML 4

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PREFERRED RESPONSE 4

(OBQ06.222) The primary antagonist of the anterior tibial tendon is innervated by which of the following nerves? Review Topic

QID: 233
1

Superficial peroneal nerve

57%

(1407/2457)

2

Deep peroneal nerve

9%

(231/2457)

3

Tibial nerve

24%

(587/2457)

4

Posterior tibial nerve

8%

(207/2457)

5

Sural nerve

1%

(17/2457)

ML 3

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PREFERRED RESPONSE 1

(OBQ10.123) Which of the following descriptions of muscle activity during normal gait is correct? Review Topic

QID: 3217
1

Gastrocnemius-soleus contracts eccentrically during heel strike

24%

(627/2667)

2

Gastrocnemius-soleus contracts concentrically during heel strike

7%

(177/2667)

3

Gastrocnemius-soleus contracts concentrically during swing phase

3%

(73/2667)

4

Tibialis anterior contracts concentrically during toe-off

3%

(88/2667)

5

Tibialis anterior contracts eccentrically at heel strike

63%

(1686/2667)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
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