Clinical assessment of walking and running gait
- Stephen M Simons, MD, FACSM
Stephen M Simons, MD, FACSM
- South Bend-Notre Dame Sports Medicine Fellowship
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Obtaining a history and performing a standard physical examination of a stationary patient in an examination room is often sufficient to develop a working differential diagnosis for a particular musculoskeletal injury. However, such an assessment may fail to uncover important underlying causes that stem from abnormal gait mechanics. A focused dynamic assessment of gait can be performed in a clinic hallway or using a treadmill. In addition, high-quality video capability is available on many smart phones or handheld devices, enabling more careful review of a patient's gait. Such gait analysis can provide important insights into the cause of a patient's symptoms.
The term "gait analysis" encompasses a broad spectrum of potential assessment strategies used to evaluate normal and abnormal gait, both walking and running. Such assessments range from simple observation to sophisticated computer analysis of biomechanics. This topic is intended to help general clinicians and primary care sports medicine physicians understand how to perform a basic analysis of a patient's normal walking and running gait and to recognize some common gait abnormalities. Such techniques as computer-assisted gait analysis, force platforms, pressure sensors, and other sophisticated modes of analysis are beyond the scope of this topic, as is the assessment of complex pathologic conditions, including cerebral palsy, other pediatric neuropathic gait patterns, and gait involving use of a prosthetic limb . Specific injuries that may stem from abnormal gait patterns are reviewed in greater detail separately. (See "Overview of running injuries of the lower extremity" and "Evaluation and diagnosis of common causes of foot pain in adults" and "Overview of stress fractures" and "Stress fractures of the tibia and fibula" and "Hamstring muscle and tendon injuries" and "Patellofemoral pain" and "Iliotibial band syndrome".)
GAIT CYCLE BASICS
The gait cycle is the repetitive pattern of walking or running movement (figure 1). Each complete gait cycle, or stride, begins when one foot makes initial contact with the ground, progressing through each phase of gait (see below), and ending when the same foot again makes contact. For walking, each stride is subdivided into a stance phase and swing phase for each foot. For running, a float phase is added. Each phase and its subdivisions are briefly described below:
●Stance phase: Period during gait when the foot is on the ground.
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- GAIT CYCLE BASICS
- PREPARATION FOR GAIT ASSESSMENT
- PRELIMINARY PHYSICAL EXAMINATION BEFORE GAIT ASSESSMENT
- Joint motion
- Muscle strength
- GENERAL APPROACH TO GAIT ASSESSMENT
- Gait observation checklist
- ASSESSMENT OF WALKING AND RUNNING GAIT
- Upper body including head
- - Walking
- - Running
- - Walking
- - Running
- - Walking
- - Running
- Knee and leg
- - Walking
- - Running
- Foot and ankle
- - Walking
- - Running
- SUMMARY AND RECOMMENDATIONS