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Gait & Function

Gait analysis informs diagnosis & treatment of pediatric (CP) and adult (rupture, fracture, arthritis) lower extremity dysfunction.

Overview

Resection of talocalcaneal coalition fails to restore normal function, as evidenced by persistent gait analysis abnormalities [1]. In patients with cerebral palsy, current gait disruption classification systems utilize primary versus compensatory deviations to identify common patterns and their underlying causes [2]. Objective assessment of walking ability serves as an easy and feasible tool for measuring limitations in patients with osteoarthritis of the knee or hip and lumbar spinal stenosis, providing baseline data and objective information that are more precise than patients' own subjective estimates [11].

Despite surgical interventions, normal gait is often not achieved. Total hip arthroplasty patients failed to obtain normal gait one year after surgery [26], and patients exhibit deficient gait function one year after bilateral total knee arthroplasty despite Western Ontario and McMaster universities osteoarthritis index scores indicating a cured state [19]. Reduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms not eligible for total hip replacement [47]. Measured gait alterations in anterior cruciate ligament reconstructed knees cannot be explained solely by laxity and strength; they may result from the surgical procedure with subsequent modified motor programming [27].

Routine gait assessment may be used to guide post-operative rehabilitation and to develop strategies to improve mobility of patients after total knee arthroplasty [7]. Future high-quality studies should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement [5]. While direct anterior and anterolateral approaches in total hip arthroplasty show significant differences, determining whether reported differences in postoperative gait values are clinically meaningful remains a substantial challenge [6].

Anatomy & Pathophysiology

Kinematics and Gait Adaptations

Gait adaptations following multiple-ligament knee reconstruction occur with altered knee kinematics during level walking [3], yet the pattern of these abnormalities appears individual-specific and may not be related to differences in spatiotemporal gait characteristics [3]. Normal and pathologic gait involves biomechanics, phases, muscle activity, and compensatory mechanisms associated with various gait abnormalities [4], providing key biomechanical markers relevant to common knee pathologies for clinical integration [9]. Most biomechanical parameters depend on gait speed [28], with a standard walking speed of 2.00 km/h identified for patients with severe osteoarthritis [28]. Patients with 8-year post-reconstruction of unilateral isolated and combined posterior cruciate ligament injuries exhibited important biomechanical deviations in both knees compared with healthy controls [25], while gait assessment demonstrated lower forefoot pressure while ascending an incline in the PCL retained group, approximating normal gait patterns [42]. While kinetic variables improved over time following tibial plateau fractures, there were no improvements observed in kinematic variables during gait [33]. The kinematics of normal knees during high flexion are variable according to activity [37], and subtle modifications to the knee joint line may contribute to widespread kinematic adaptations [21]. Static native tibial alignment in total knee arthroplasty optimises whole-body gait kinematics [21], and gait biomechanics play a potential role in short-term osteoarthritis pain fluctuations [18].

Foot and Ankle Biomechanics

Dynamic fluoroscopic assessment is a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait [14]. Sport-related movements load the plantar surface of the foot more than running straight [35], and pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions whenever a higher level of first metatarsal shortening is necessary [31]. Biomechanical factors associated with multiple stress fractures include high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus [36]. There are differences in foot kinematics between runners who have and those who have not sustained a navicular stress fracture, but not in ground-reaction forces, foot structure, or passive range of motion [46]. The decrease in maximum force in the middle forefoot in patients with a previous stress fracture could have resulted from gait alterations after the fracture [39]. Changes to the structural properties of footwear may affect forefoot loading patterns in people with gout [43], and footwear alone was more effective than when combined with a customized insole for women with calcaneal spur, given greater efficacy on clinical and biomechanical aspects [30]. Foot and ankle biomechanics, gait analysis, and treatment principles for common nail disorders are described in standard texts [17], and methodology for foot strength testing has been refined through comparative and repeatability studies [40].

Classification

Gait Disruption Patterns: Classification systems for gait disruption utilize the concept of primary versus compensatory deviations to identify common patterns and their underlying causes [2]. Clinical gait analysis is required to identify, understand, and support the management of gait deviations in cerebral palsy by providing objective identification of deviations and linking them to clinical impairments [20]. A comprehensive overview of normal and pathologic gait details the biomechanics, phases, muscle activity, and compensatory mechanisms associated with various gait abnormalities [4].

Specific Pathology Classifications: Three-dimensional gait analysis demonstrates distinctive but slight deviations in children with clubfoot treated with the Ponseti method [12]. Gait abnormalities following resection of talocalcaneal coalition indicate that normal function is not restored [1]. The pattern of kinematic abnormalities following multiple-ligament knee reconstruction appears individual specific and may not be related to differences in spatiotemporal gait characteristics [3].

Arthroplasty and Alignment Classifications: Subtle modifications to the knee joint line in total knee arthroplasty may contribute to widespread kinematic adaptations, underscoring the integrated nature of gait biomechanics [21]. Static native tibial alignment in total knee arthroplasty optimises whole-body gait kinematics [21]. The type of surgical technique significantly influences the variability and stability of gait in patients with total knee arthroplasty [24]. Despite significant differences between direct anterior and anterolateral approaches in total hip arthroplasty, determining whether reported differences in postoperative gait values are clinically meaningful remains a substantial challenge [6]. Quantitative gait analysis provides a robust framework for monitoring rehabilitation progress after unicompartmental knee arthroplasty [50].

Foot and Kinematic Assessment: Dynamic fluoroscopic assessment is a valuable tool for characterising the kinematics of the joints of the medial foot column during gait [14]. There is a need to determine the reliability and validity of footprint measurement methods used for the clinical classification of foot types in subjects with Down syndrome [41].

Other Considerations: Future high-quality studies should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement [5]. A step-by-step guide is provided to help orthopaedic surgeons and clinicians understand and interpret key biomechanical markers relevant to common knee pathologies [9].

Clinical Presentation

Gait assessment serves as a critical tool for identifying deviations and linking them to specific clinical impairments, particularly in complex neuromuscular conditions [20]. In children with cerebral palsy, classification systems utilize primary versus compensatory deviations to map common patterns and causes [2]. While gross motor function is generally maintained between adolescence and young adulthood with little clinically significant change in gait [10], clinical gait analysis remains essential to objectively identify these deviations and support management strategies [20].

Objective assessment of walking ability provides precise baseline data that surpasses patients' subjective estimates, offering a feasible method to measure limitations in osteoarthritis of the knee or hip and lumbar spinal stenosis [11]. In contrast, patients with symptomatic external snapping hip do not demonstrate an impaired gait pattern [15]. Following Achilles tendon rupture treated nonsurgically, attenuated muscle strength and function persist during walking for 2 to 5 years [8]. Similarly, resection of talocalcaneal coalition fails to restore normal function, as evidenced by persistent gait analysis abnormalities [1].

Post-operative gait patterns vary significantly by procedure and approach. Following multiple-ligament knee reconstruction, gait adaptations occur with altered knee kinematics during level walking, appearing individual-specific and potentially unrelated to spatiotemporal differences [3]. Determining whether postoperative gait differences between direct anterior and anterolateral approaches for total hip arthroplasty are clinically meaningful remains a substantial challenge [6]. Conversely, high tibial osteotomy does not alter time–distance parameters, though patients report an improved perception of walking ability [16]. Routine gait assessment can guide post-operative rehabilitation and develop mobility strategies for total knee arthroplasty patients [7].

Specific compensatory mechanisms and functional outcomes define the clinical picture in various pathologies. Patients with unilateral loss of triceps surae function compensate for nearly all gait abnormalities through excessive lateral pelvic tilt and prolonged quadriceps activity, resulting in only mild disability characterized by an inability to exceed normal walking speeds [22]. In children with clubfoot treated via the Ponseti method, three-dimensional gait analysis reveals distinctive but slight deviations [12]. Reductions in co-contraction following neuromuscular re-education in knee osteoarthritis may yield positive long-term outcomes [13], while early diagnosis and surgical decompression of acute, exertional medial compartment syndrome in high-level athletes lead to full functional recovery [23].

Future evaluations should integrate comprehensive gait analysis with muscle strength and proprioception measurements to fully assess walking function [5]. A comprehensive overview details the biomechanics, phases, muscle activity, and compensatory mechanisms associated with pathologic gait [4], and narrative reviews provide step-by-step guidance for interpreting key biomechanical markers relevant to common knee pathologies [9].

Investigations

Gait Analysis: Three-dimensional gait analysis serves as an objective, feasible tool for measuring limitations in patients with osteoarthritis of the knee or hip and lumbar spinal stenosis, providing baseline data more precise than subjective estimates [11]. While most biomechanical parameters depend on gait speed, a standard walking speed of 2.00 km/h has been identified for patients with severe osteoarthritis [28]. In children with clubfoot treated with the Ponseti method, three-dimensional gait analysis demonstrates distinctive but slight deviations [12]. Conversely, subjects with symptomatic external snapping hip do not exhibit an impaired gait pattern [15]. Following multiple-ligament knee reconstruction, gait adaptations occur with altered knee kinematics during level walking, where the pattern of abnormalities appears individual-specific and may not relate to differences in spatiotemporal gait characteristics [3]. Patients with reconstruction of unilateral isolated and combined posterior cruciate ligament injuries exhibit important biomechanical deviations in both knees compared with healthy controls at 8 years post-reconstruction [25]. Attenuated muscle strength and function persist during walking for 2 to 5 years after Achilles tendon rupture with nonsurgical treatment [8]. Patients compensated for nearly all gait abnormalities following unilateral loss of triceps surae function through excessive lateral pelvic tilt and prolonged quadriceps activity, resulting in only mild disability characterized by an inability to increase walking speeds beyond normal pacing [22]. Little clinically significant change is seen in function and gait in children with cerebral palsy with flexed-knee gait, with gross motor function maintained between adolescence and young adulthood [10]. Early diagnosis and surgical decompression of acute, exertional medial compartment syndrome of the foot in a high-level athlete lead to full functional recovery [23].

Dynamic Imaging: Dynamic fluoroscopic assessment is a valuable tool for characterising the kinematics of the joints of the medial foot column during gait [14]. Patients with femoroacetabular impingement demonstrate both local and distal joint alterations during walking, and hip joint loading is directly related to hip joint abnormalities [52].

Postoperative and Comparative Assessment: Resection of talocalcaneal coalition does not restore normal function, as evidenced by gait analysis abnormalities [1]. Determining whether reported differences in postoperative gait values between direct anterior and anterolateral approaches for total hip arthroplasty are clinically meaningful remains a substantial challenge [6]. There was a potential association between preoperative composition of ipsilateral hip abductors and gait function 6 months after total hip arthroplasty [59]. Patients with lateral osteoarthritis of the knee showed an impaired gait with an increased knee abduction and hip adduction angle after mobile-bearing unicompartmental knee arthroplasty [60].

Other Considerations: Chapter 3 provides a comprehensive overview of normal and pathologic gait, detailing the biomechanics, phases, muscle activity, and compensatory mechanisms associated with various gait abnormalities [4]. A narrative review aims to bridge the gap in clinical integration of gait analysis by providing a step-by-step guide for orthopaedic surgeons and clinicians to understand and interpret key biomechanical markers relevant to common knee pathologies [9].

Treatment

Non-Operative

Conservative management remains a primary consideration for specific pathologies. Botulinum toxin A (BoNT-A) specifically provided gait improvement over placebo and an additive effect to physical therapy for passive ankle dorsiflexion in children with spastic cerebral palsy and equinus gait [32]. Orthosis was useful for ankle dorsiflexion at initial contact in children with spastic cerebral palsy and equinus gait [32]. If the activation of certain muscles can be reduced during gait through neuromuscular re-education, this may lead to positive long-term outcomes in people with knee osteoarthritis [13]. A clinically practical 4-week physical therapy intervention may benefit older adults with hyperkyphosis by demonstrating improved posture and gait parameters [44]. The tissue-bone homeostasis manipulation (TBHM) intervention has better improved gait, knee function, and quality of life in patients with knee osteoarthritis compared to controls [38]. Singaporean population with medial compartment knee osteoarthritis demonstrated improved gait patterns, reported alleviation in symptoms, and improved function and quality of life following 6 months of therapy with a unique biomechanical device [29].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [56]. Routine gait assessment may be used to guide post-operative rehabilitation and to develop strategies to improve mobility in patients undergoing total knee arthroplasty [7]. Objective assessment of walking ability is an easy and feasible tool for measuring limitations in patients with osteoarthritis of the knee or hip and lumbar spinal stenosis, providing baseline data and objective information more precise than patients' own subjective estimates [11].

Surgical Approach / Technique: Determining whether reported differences in postoperative gait values between direct anterior and anterolateral approaches for total hip arthroplasty are clinically meaningful remains a substantial challenge [6]. There were minimal differences between anterior and posterior approaches in the recovery of gait mechanics after total hip arthroplasty, with some gait parameters particularly gait speed and step length recovery favoring the direct anterior approach at 1 month postsurgery [45]. The type of surgical technique significantly influences the variability and stability of gait in patients with total knee arthroplasty [24]. Measured gait alterations in anterior cruciate ligament reconstructed knees cannot be explained solely by laxity and strength; they may result from the surgical procedure with subsequent modified motor programming [27].

Implant Selection: Patients undergoing hip resurfacing arthroplasty improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls [58]. Patients who underwent arthrodesis of the first metatarsophalangeal joint for hallux valgus did not totally recover the propulsive forces of the forefoot [55].

Alignment / Balancing Strategy: Changes in the first and second knee adduction moment (KAM) peaks on the nonoperated side after medial open-wedge high tibial osteotomy were significantly associated with surrounding alignment and joint moments during gait [62]. High tibial osteotomy does not alter the time–distance parameters of gait, although patients have improved perception of their walking ability [16].

Other Considerations: Resection of talocalcaneal coalition does not restore normal function, as evidenced by gait analysis abnormalities [1]. Patients who underwent Scarf osteotomy for hallux valgus had a gait pattern similar to that of their non-operated foot [55]. Preoperatively and postoperatively, patients with medial meniscus injury and meniscectomy used the non-affected limb and pelvis obliquity for compensation to help stabilize their gait [34]. Despite improved functional and clinical outcomes, "copers" with anterior cruciate ligament deficiency have walking economy similar to that of "non-copers" but impaired compared with healthy individuals [57]. Attenuated muscle strength and function were present during walking as long as 2 to 5 years after Achilles tendon rupture with nonsurgical treatment, as determined by 3-dimensional gait analysis [8]. Ponseti treatment for clubfoot does not result in a normal foot, but patient function is generally good irrespective of whether additional surgery is performed or the regimen is used for older children in a low-income country [61]. Future high-quality studies should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement [5]. The current gait disruption classification system uses the concept of primary versus compensatory deviations to identify common patterns and common causes for these patterns in children with cerebral palsy [2].

Complications

Other Considerations: Resection of talocalcaneal coalition fails to restore normal function, with gait analysis revealing persistent abnormalities [1]. Following multiple-ligament knee reconstruction, gait adaptations occur with altered knee kinematics during level walking; these kinematic abnormalities are individual-specific and may not correlate with differences in spatiotemporal gait characteristics [3]. In patients treated nonsurgically for Achilles tendon rupture, three-dimensional gait analysis demonstrates long-term deficiencies in muscle strength and function that persist for 2 to 5 years [8]. Children with cerebral palsy exhibiting flexed-knee gait show little clinically significant change in function or gait between adolescence and young adulthood, with gross motor function remaining maintained during this period [10]. Three-dimensional gait analysis in children with clubfoot treated via the Ponseti method reveals distinctive but slight deviations [12]. Subjects with symptomatic external snapping hip do not demonstrate an impaired gait pattern [15]. Gait biomechanics may contribute to short-term osteoarthritis pain fluctuations in knee osteoarthritis [18]. Despite Western Ontario and McMaster universities osteoarthritis index scores indicating a cured state, patients exhibit deficient gait function one year after bilateral total knee arthroplasty [19]. Total hip arthroplasty patients fail to obtain normal gait one year post-surgery [26]. Arthroplasty exerts a large effect on walking speed 6 to 60 months postoperatively [48]. Some complaints regarding activities and walking speed persist in the first year after total knee arthroplasty, with the most striking functional outcome being a remaining deficit in quadriceps strength [49].

Recovery

Light activity (weeks): Evidence regarding specific timelines for light activity phases such as desk work or driving is not provided in the current evidence base. While patients undergoing minimally invasive total hip arthroplasty show fluctuating recovery of postural stability and functional capacity over one year without a consistent improvement tendency [51], and gait function recovery plateaus at 2 weeks post-injury for AIS grade A and B cervical spinal cord injury groups [54], no specific week-range data exists for standard light activity resumption in the provided literature.

Full activity (months): The timeline for returning to full activity varies significantly by pathology. Following acute cervical spinal cord injury, gait function recovery plateaus at 6 months post-injury for the AIS grade C group [54]. In contrast, patients with cerebral palsy maintain gross motor function between adolescence and young adulthood with little clinically significant change in gait [10]. For Achilles tendon rupture treated nonsurgically, attenuated muscle strength and function persist during walking for as long as 2 to 5 years [8].

Complete recovery / outcome plateau (months): Functional outcomes often stabilize or plateau at distinct intervals depending on the procedure. Following femoral osteotomy for osteonecrosis of the femoral head, physical recovery requires an extended duration despite significant improvements in quality of life and functional capabilities [53]. In total knee arthroplasty, patients may exhibit deficient gait function one year post-surgery despite Western Ontario and McMaster universities osteoarthritis index scores indicating a cured state [19]. Similarly, resection of talocalcaneal coalition does not restore normal function, with gait analysis abnormalities persisting [1].

Rehabilitation protocol: Routine gait assessment may be utilized to guide post-operative rehabilitation for total knee arthroplasty patients and to develop strategies to improve their mobility [7]. If the activation of certain muscles can be reduced during gait in people with knee osteoarthritis, this may lead to positive long-term clinical outcomes [13]. Gait biomechanics play a potential role in short-term osteoarthritis pain fluctuations [18]. Future high-quality studies should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement [5].

Functional milestones: Patients undergoing high tibial osteotomy (HTO) demonstrate improved perception of their walking ability, even though HTO does not alter the time–distance parameters of gait [16]. Following multiple-ligament knee reconstruction, gait adaptations occur with altered knee kinematics during level walking [3]. The pattern of these kinematic abnormalities appears individual specific and may not be related to differences in spatiotemporal gait characteristics [3].

Other Considerations: The evidence highlights that functional recovery is not uniform across all orthopaedic interventions. While some small significant changes were noted in children with cerebral palsy, little clinically significant change was seen in function and gait between adolescence and young adulthood [10]. Conversely, significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy for osteonecrosis of the femoral head, though physical recovery requires an extended duration [53].

Key Evidence

  • [L3] The resection did not restore normal function, as evidenced by gait analysis abnormalities. (10.2106/00004623-199703000-00008)
  • [L5] The current gait disruption classification system uses the concept of primary versus compensatory deviations to identify common patterns and common causes for these patterns. (10.5435/jaaos-22-12-782)
  • [L3] The pattern of kinematic abnormalities appears individual specific and may not be related to differences in spatiotemporal gait characteristics. (10.1007/s00167-016-4104-3)
  • [L1] Future high-quality studies should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement. (10.1186/s13018-024-05091-2)
  • [L1] Despite a few significant differences between two approaches, determining whether the reported differences in terms of postoperative gait values are clinically meaningful remains a substantial challenge. (10.1186/s12891-019-2450-2)
  • [L4] Routine gait assessment may be used to guide post-operative rehabilitation, and to develop strategies to improve mobility of these patients. (10.1186/s12891-015-0525-2)
  • [L3] Attenuated muscle strength and function were present during walking as long as 2 to 5 years after rupture, as determined by 3-dimensional gait analysis. (10.1177/2325967113504734)
  • [L4] This narrative review aims to bridge the gap in clinical integration of gait analysis by providing a step-by-step guide for orthopaedic surgeons and clinicians to understand and interpret key biomechanical markers relevant to common knee pathologies. (10.1002/ksa.70067)
  • [L3] While some small significant changes were noted, little clinically significant change was seen in function and gait, with gross motor function maintained between adolescence and young adulthood. (10.1302/0301-620x.100b4.bjj-2017-0732.r1)
  • [L4] Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. (10.1186/1471-2474-11-233)
  • [L2] Three-dimensional gait analysis demonstrated distinctive but slight deviations. (10.2106/jbjs.m.01603)
  • [L4] Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. (10.1186/s12891-016-1209-2)
  • [L4] Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait. (10.1186/1471-2474-13-14)
  • [L3] This suggests that subjects with symptomatic external snapping hip do not have an impaired gait pattern. (10.1186/1471-2474-14-212)
  • [L2] HTO does not alter the time–distance parameters of gait; however, patients have improved perception of their walking ability. (10.1007/s00167-017-4421-1)
  • [L4] This highlights a potential role of gait biomechanics in short-term osteoarthritis pain fluctuations. (10.1186/s12891-019-2493-4)
  • [L4] Despite the Western Ontario and McMaster universities osteoarthritis index score indicating a cured state one year after bilateral total knee arthroplasty, patients exhibit deficient gait function. (10.1186/s12891-024-07348-7)
  • [L5] Clinical gait analysis (CGA) is needed to identify, understand and support the management of gait deviations in cerebral palsy by providing objective identification of deviations and linking them to clinical impairments. (10.1302/2058-5241.1.000052)
  • [L3] These findings underscore the integrated nature of gait biomechanics and suggest that subtle modifications to the knee joint line may contribute to widespread kinematic adaptations. (10.1002/ksa.70356)
  • [L4] The patient compensated for nearly all gait abnormalities through excessive lateral pelvic tilt and prolonged quadriceps activity, resulting in only mild disability characterized by an inability to increase walking speeds beyond normal pacing. (10.2106/00004623-197860040-00007)
  • [L4] Early diagnosis and surgical decompression lead to full functional recovery. (10.1177/0363546507308193)
  • [L2] The type of surgical technique significantly influences the variability and stability of gait. (10.1007/s00167-012-1965-y)
  • [L3] However, they exhibited important biomechanical deviations in both knees compared with healthy controls. (10.1177/03635465211017147)
  • [L3] Measured gait alterations cannot be explained solely by laxity and strength; they may result from the surgical procedure with subsequent modified motor programming. (10.1007/s00167-003-0432-1)
  • [L3] Most biomechanical parameters depend on gait speed, with a standard walking speed of 2.00 km/h identified for patients with severe osteoarthritis. (10.1007/s00167-005-0005-6)
  • [L2] Singaporean population with medial compartment knee osteoarthritis demonstrated improved gait patterns, reported alleviation in symptoms and improved function and quality of life following 6 months of therapy with a unique biomechanical device. (10.1186/1749-799X-9-1)
  • [L2] However, the footwear alone was more effective than when combined with a customized insole, given the greater efficacy on clinical and biomechanical aspects. (10.1186/s12891-022-05729-4)
  • [L5] Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions. (10.1186/s12891-019-2973-6)
  • [L1] BoNT-A specifically provided gait improvement over the placebo and additive effect to physical therapy for passive ankle dorsiflexion, while orthosis was useful for ankle dorsiflexion at initial contact. (10.1186/s13018-022-03301-3)
  • [L2] While kinetic variables improved over time, there were no improvements observed in kinematic variables. (10.1186/s12891-024-07910-3)
  • [L2] Preoperatively and postoperatively, patients used the non-affected limb and pelvis obliquity for compensation to help stabilize their gait. (10.1007/s00167-011-1612-z)
  • [L4] Sport-related movements load the plantar surface of the foot more than running straight. (10.1177/0363546507309315)
  • [L4] Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. (10.1177/03635465010290030901)
  • [L4] The kinematics of normal knees during high flexion are variable according to activity. (10.1302/0301-620x.100b1.bjj-2017-0553.r2)
  • [L2] The TBHM intervention has better improved the gait, knee function, and quality of life in the patients with KOA. (10.1186/s12891-024-07896-y)
  • [L3] The decrease in maximum force in the middle forefoot in patients with a previous stress fracture could have resulted from gait alterations after the fracture. (10.1177/0363546508324967)
  • [L4] This study further refines potential methodology for foot strength testing. (10.1186/s12891-019-2981-6)
  • [L4] There is a need to determine the reliability and validity of the footprint measurement methods used for clinical classification of the foot types in subjects with DS. (10.1186/s13018-021-02667-0)
  • [L3] Gait assessment demonstrated lower forefoot pressure while ascending an incline in the PCL retained group, approximating normal gait patterns. (10.1007/s00167-023-07499-5)
  • [L4] These changes to the structural properties of the footwear may affect forefoot loading patterns in people with gout. (10.1186/s12891-021-04370-x)
  • [L4] This study shows that a clinically practical 4-week PT intervention may benefit older adults with hyperkyphosis by demonstrating improved posture and gait parameters. (10.1186/s12891-025-08330-7)
  • [L3] There were minimal differences between the two approaches in the recovery of gait mechanics with some gait parameters particularly gait speed and step length recovery favoring the DAA at 1 month postsurgery in this nonrandomized study. (10.1016/j.arth.2019.09.030)
  • [L3] There are differences in foot kinematics but not ground-reaction forces, foot structure, or passive range of motion between runners who have and those who have not sustained a navicular stress fracture. (10.1177/2325967118767363)
  • [L3] Reduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms, not eligible for total hip replacement. (10.1186/1471-2474-13-258)
  • [L1] This meta-analysis revealed a large effect of arthroplasty on walking speed 6–60 months postoperatively. (10.1186/1471-2474-13-66)
  • [L2] However, some complaints regarding activities and walking speed remain, with the most striking outcome being the remaining deficit in quadriceps strength. (10.1186/s12891-018-2159-7)
  • [L3] Quantitative gait analysis provides a robust framework for monitoring rehabilitation progress after UKA. (10.1186/s12891-025-08628-6)
  • [L3] The recovery of postural stability and functional capacity over one year fluctuated with no consistent improvement tendency. (10.1155/2015/463792)
  • [L3] These data suggest that patients with FAI demonstrate both local and distal joint alterations during walking and that hip joint loading is directly related to hip joint abnormalities. (10.1177/0363546516677727)
  • [L3] Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy, though physical recovery requires an extended duration. (10.1016/j.arth.2025.06.066)
  • [L3] The plateau in gait function recovery was reached at 2 weeks postinjury in the AIS grade A and B groups and at 6 months in the AIS grade C group. (10.1186/s12891-024-07551-6)
  • [L3] Patients who underwent Scarf osteotomy had a gait pattern similar to that of their non-operated foot, whereas those who underwent arthrodesis of the first metatarsophalangeal joint did not totally recover the propulsive forces of the forefoot. (10.1302/0301-620x.98b5.36406)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L2] Despite the improved functional and clinical outcome of copers, their walking economy appears similar to that of non-copers but impaired compared with healthy individuals. (10.1007/s00167-015-3709-2)
  • [L3] Patients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. (10.1302/0301-620x.101b11.bjj-2019-0383.r1)
  • [L3] There was a potential association between preoperative composition of ipsilateral hip abductors and gait function 6 months after THA. (10.1186/s42836-022-00126-7)
  • [L2] Patients with lateral osteoarthritis of the knee showed an impaired gait with an increased knee abduction and hip adduction angle. (10.1007/s00167-014-2944-2)
  • [L5] Ponseti treatment does not result in a normal foot but irrespective of whether additional surgery is performed or the regimen is used for older children in a low-income country, patient function is generally good. (10.2106/jbjs.18.00948)
  • [L2] Changes in the first and second KAM peaks on the nonoperated side were significantly associated with surrounding alignment and joint moments during gait. (10.1177/23259671261422229)

See Also

References

[1] Gait Abnormalities following Resection of Talocalcaneal Coalition. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199703000-00008

[2] Identification of Common Gait Disruption Patterns in Children With Cerebral Palsy. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-12-782

[3] Gait adaptations following multiple-ligament knee reconstruction occur with altered knee kinematics during level walking. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4104-3

[4] Chapter 3 Normal and Pathologic Gait. 2019.

[5] Evaluation of the efficacy after Total Knee Arthroplasty by Gait analysis in patients with Knee Osteoarthritis: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05091-2

[6] Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2450-2

[7] Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0525-2

[8] Three-Dimensional Gait Analysis Following Achilles Tendon Rupture With Nonsurgical Treatment Reveals Long-Term Deficiencies in Muscle Strength and Function. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113504734

[9] Step‐by‐step insight into gait analysis: A narrative review unlocking knee biomechanics. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70067

[10] Flexed-knee gait in children with cerebral palsy. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b4.bjj-2017-0732.r1

[11] Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-233

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[13] Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1209-2

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[15] The gait pattern is not impaired in subjects with external snapping hip: a comparative cross-sectional study. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-212

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[19] Deficient gait function despite effect index of the Western Ontario and McMaster university osteoarthritis index score considered cured one year after bilateral total knee arthroplasty. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07348-7

[20] Gait analysis in children with cerebral palsy. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000052

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[24] Variability of gait parameters in patients with total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-1965-y

[25] Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211017147

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[27] The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0432-1

[28] The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2005. DOI: 10.1007/s00167-005-0005-6

[29] Patients with knee osteoarthritis demonstrate improved gait pattern and reduced pain following a non-invasive biomechanical therapy: a prospective multi-centre study on Singaporean population. Journal of Orthopaedic Surgery and Research. 2014. DOI: 10.1186/1749-799X-9-1

[30] Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05729-4

[31] Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2973-6

[32] Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03301-3

[33] Persistent deficits in knee joint kinematics and kinetics during gait following tibial plateau fractures – a longitudinal study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07910-3

[34] The influence of medial meniscus injury and meniscectomy on the variability of gait parameters. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1612-z

[35] Regional Foot Pressure during Running, Cutting, Jumping, and Landing. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507309315

[36] Risk Factors for Recurrent Stress Fractures in Athletes. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290030901

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[38] Efficacy of tissue-bone homeostasis manipulation on the gait and knee function for the patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07896-y

[39] Plantar Loading Comparisons between Women with a History of Second Metatarsal Stress Fractures and Normal Controls. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508324967

[40] Functional assessments of foot strength: a comparative and repeatability study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2981-6

[41] Footprint measurement methods for the assessment and classification of foot types in subjects with Down syndrome: a systematic review. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02667-0

[42] PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert—a prospective study. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07499-5

[43] Effects of worn and new footwear on plantar pressure in people with gout. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04370-x

[44] A secondary analysis of gait after a 4-week postural intervention for older adults with hyperkyphosis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08330-7

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[46] Foot Kinematics Differ Between Runners With and Without a History of Navicular Stress Fractures. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118767363

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[49] Functions, disabilities and perceived health in the first year after total knee arthroplasty; a prospective cohort study. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2159-7

[50] Early postoperative gait characteristics after unicompartmental knee arthroplasty: results and clinical implications. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08628-6

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