Describe Gait — Normal Cycle & Pathological Gaits in detail.

The Normal Gait Cycle

Gait is the manner of walking. The gait cycle is the sequence of events between one heel-strike and the next heel-strike of the same foot, and is divided into two phases: the stance phase (~60%), when the foot is on the ground (heel-strike → foot-flat → mid-stance → heel-off → toe-off), and the swing phase (~40%), when the foot is off the ground and advancing. Normal gait requires intact bones and joints, muscle power, neurological control, balance and sensation.

The gait cycle: stance phase (foot on the ground, ~60%) and swing phase (foot advancing, ~40%).

Pathological Gaits

Disorders of any component produce characteristic gaits. An antalgic (painful) gait shortens the stance phase on the painful limb to reduce time bearing weight. A Trendelenburg gait (weak hip abductors — gluteus medius/minimus) drops the pelvis on the opposite (swing) side, and a bilateral/compensated form gives a waddling gait. A high-stepping (steppage) gait (foot drop) lifts the knee high to clear the toes. Other patterns include the short-limb (dipping) gait, the stiff-hip/knee gait, the spastic scissoring gait (cerebral palsy), the ataxic broad-based gait (cerebellar), and the shuffling festinant gait of Parkinsonism.

Clinical Assessment

Gait is examined by watching the patient walk (and, where possible, run), looking at each phase from the front, side and behind. Observation of the abnormal pattern localises the problem (pain, weakness, deformity, stiffness, shortening or neurological cause) and guides further examination (e.g. Trendelenburg test for the hip). Instrumented gait analysis is used to plan surgery in complex cases such as cerebral palsy.

Clinical Relevance

Recognising the gait pattern is a powerful diagnostic short-cut: an antalgic gait signals a painful lower limb, a Trendelenburg/waddling gait points to hip abductor pathology, and a steppage gait to foot drop. Correcting the underlying cause — and providing walking aids or orthoses — restores efficient, safe walking.

• Gait cycle: stance phase (~60%, foot on ground) + swing phase (~40%, foot advancing).
• Antalgic = pain (short stance); Trendelenburg = weak abductors (opposite pelvis drops).
• Steppage = foot drop; scissoring = spasticity; broad-based = cerebellar.
• Watch gait from front/side/behind to localise pain, weakness, deformity or neurological cause.
• Trendelenburg sign: ‘the sound side sags’ with abductor weakness/hip instability.