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Gait Analysis

Is the study of a persons style of walking. This includes descriptive and quantitive analysis of measurable parameters and clinical interpretation. For forensic gait analysis, please also reference the Medico-Legal & Forensics page.

Gait Analysis - Simplified!




Basic anatomical terms

The anatomical terms describing the relationships between different parts of the body are based on the anatomical position in which a person is standing upright, with the feet together and the arms by the sides of the body, with the palms forward. This position, together with the reference planes are the terms describing relationships between different parts of the body.

Six terms are used to describe directions, with relations to the centre of the body. These are:

  • anterior
  • posterior
  • superior
  • inferior
  • left
  • right

Within a single part of the body additional terms are used to describe relationships:

  • Medial means towards the midline of the body: the big toe is on the medial side of the foot.
  • Lateral means away from the midline of the body: the little toe is on the lateral side of the foot.
  • Proximal means towards the rest of the body: the hip is the proximal part of the lower limb.
  • Distal means away from the rest of the body: the toes are the distal part of the foot.
  • Superficial structures are close to the surface.
  • Deep structures are far from the surface.

The motion of the limbs is described using reference planes:

  1. A sagittal plane is any plane which divides part of the body into right and left portions; the median plane is the midline sagittal plane, which divides the whole body into right and left halves.
  2. A frontal or coronal plane longitudinally divides a body part.
  3. A transverse plane divides a body part into upper and lower portions.

Most joints can only move in one or two of these three planes. The possible movements are:

  1. Flexion and extension take place in the sagittal plane; in the ankle these movements are called dorsiflexion and plantarflexion, respectively.
  2. Abduction and adduction take place in the transverse plane.
  3. Inversion and Eversion take place in the frontal plane.

Other terms which are also used to describe the motions of the joints or body segments;

  1. Varus and valgus, which describe and angulation of a joint towards and away from the midline, respectively; knock knees are in valgus, bow legs are in varus.
  2. Inversion of the feet brings the soles together; eversion causes the soles to point away from the midline.
  3. Pronation and supination, are triplaner rotations.

Terminology in the foot can be confusing. The term pronation is used for a combined movement, which consists primarily of eversion but also includes some dorsiflexion and forefoot abduction. Similarly, supination is primarily inversion, but also includes some plantarflexion and forefoot, adduction relative to the hindfoot.

Bones

Almost every bone in the body takes part in walking and running.

The pelvis is formed from the sacrum, the coccyx and the two innominate bones. The sacrum consists of the five sacral vertebrae, fused together. The coccyx is the vestigial 'tail', made of three to five rudimentary vertebrae.

The innominate bone on each side is formed by the fusion of three bones - the ilium, ischium and pubis. The only real movement between the bones of the pelvis occurs at the sacroiliac joint, and this movement is generally very small. It is thus reasonable, for the purpose of gait analysis, to regard the pelvis as being a single rigid structure. The superior surface of the sacrum articulates with the fifth lumbar vertebra of the spine. On each side of the lower part of the pelvis is the acetabulum, which is the proximal part of the hip joint.

The femur is the longest bone in the body. The spherical femoral head articulates with the pelvic acetabulum to form the hip joint. The neck of the femur runs downwards and laterally from the femoral head to meet the shaft of the bone, which continues downwards to the knee joint. At the junction of the neck and the shaft are two bony protuberances, where a number of muscles are inserted - the greater trochanter laterally, which can be felt beneath the skin, and the lesser torchanter medially. The bone widens at its lower end to form the medial and lateral condyles. These form the proximal part of the knee joint and have a groove between them anteriorly which articulates with the patella.

The patella or kneecap is a sesamoid bone. That is to say, it is embedded within a tendon - in this case the massive quadriceps tendon, which beyond the patella is known as the patella tendon. The anterior surface of the patella is subcutaneous (immediately below the skin); its posterior surface articulates with the anterior surface of the lower end of the femur to form the patellofemoral joint. It has an important mechanical function which is to displace the quadriceps tendon forwards and thereby to improve its leverage.

The tibia extends from the knee joint to the ankle joint. Its upper end is broadened into medial and lateral condyles with an almost flat upper surface which articulates with the femur. The tibial tubercle is a small bony prominence on the front of the tibia, when the patella tendon is inserted. The anterior surface of the tibia is subcutaneous. The lower end of the tibia forms the upper and medial surfaces of the ankle joint with a subcutaneous medial projection called the medial malleolus.

The fibula is next to the tibia on its lateral side. For most of its length it is a fairly slim bone although it is broadened at both ends, the upper end being known as the head. The broadened lower end forms the lateral part of the ankle joint with a subcutaneous lateral projection known as the lateral malleolus. The tibia and fibula are in contact with each other at their upper and lower ends, as the tibiofibula joints. Movements at these joints are very small. A layer of fibrous tissue known as the interosseous membrane is between the bones.

The foot is a very complicated structure which is best thought of as being in three parts:

  1. The rearfoot or hindfoot, which consists of two bones, one on tope of the other.
  2. The midfoot, which consists of five bones, packed closely together.
  3. The forefoot, which consists of the five metatarsals and the toes.

The talus (or astragalus) is the upper of the two bones in the rearfoot. Its superior surface forms the ankle joint, articulating above and medially with the tibia, and laterally with the fibula. Below, the talus articulates with the calcaneus through the subtalar joint. It articulates anteriorly with the most medial and superior of the midfoot bones - the navicular.

The calcaneus or os calcis lies below the talus and articulates with it through the subtalar joint. Its lower surface transmits the body weight to the ground through a thick layer of fat, fibrous tissue and skin. The anterior surface articulates with the most lateral and inferior of the midfoot bones - the cuboid.

The midfoot consists on five bones:

  1. The navicular, which is medial and superior.
  2. The cuboid, which is lateral and inferior.
  3. Three cuneiform bones (medial, intermediate and lateral), which are in a row distal to the navicular.

The forefoot consists of the following:

The five metatarsals lie roughly parallel to each other, the lateral two articulating with the cuboid, and the medial three with the three cuneiform bones. The phalanges are the bones of the toes; there are two in the big toe and three in each of the other toes. The big toe is also called the great toe or hallux.