Wednesday, September 28, 2011

A Look at The Gait Cycle & its Importance

The gait cycle can be defined as the interval of time from heel strike of a foot, to heel strike of that same foot, on the next step. In example, the gait cycle consists of a single footstep of say, the left foot that would take place during normal walking. To accomplish that single footstep made by the left lower extremity, the entire gait cycle must be executed. This is in addition to a great deal of other things that must take place for an individual to walk, but for simplification purposes we will only focus on the pedal aspects of the gait cycle. In essence, anytime an individual is walking they are repetitively carrying out the full gait cycle with each step that the individual takes.
The gait cycle is comprised of two major components; stance phase which is also known properly as closed kinetic chain, and the swing phase which is also known as open kinetic chain motion. To be precise, 62% of the gait cycle is occupied by the stance phase, or when the foot is in contact with the ground (weight bearing portion). The other 38% of the gait cycle is naturally comprised of swing phase, or when the foot is not in contact with the ground.

In podiatry it is imperative to dissect, and analyze these two major components of the gait cycle, and the gait cycle in whole. This allows a doctor to understand, diagnose, and treat all of the lower extremity pathologies that exist due to irregularities in an individual’s gait cycle.

To further review these components of the gait cycle, stance phase, or the weight bearing portion of the gait cycle can be sub-divided into three phases. Those are the contact period (when the foot initially strikes the ground), mid-stance, and toe-off (also known as propulsion). During contact period, the heel of the foot being observed is striking the ground, and almost simultaneously the forefoot of the same foot, is loaded with the force that is being transferred from the hind-foot to forefoot (this is when the majority of pronation* occurs). Next, mid-stance is immediately taking place. This is a transitional period that takes place after the contact period, but before the same heel lifts off the ground, and toe-off (propulsion) occurs. Supination** of the foot starts during mid-stance period, and does not end until immediately after toe-off. Lastly, propulsion or toe-off occurs. This is the third portion of the stance, or weight bearing phase of the gait cycle. Throughout toe-off the foot is being supinated, and the momentum of the lower extremity and the upper body is being directed forward to make forward progress (walking or running).

After these three sub-phases of the stance phase have occurred, the foot is immediately carried into swing phase. During swing phase the foot is elevated from the ground, and is being carried forward by a variety of the lower extremity musculature. This non-weight bearing portion of the gait cycle is where the most visually evident portion of forward progress is made.

To summarize, the complete gait cycle consists of stance phase and swing phase. Stance phase is further divided into contact, mid-stance and toe-off periods. Again, immediately after toe-off, swing phase takes place, and ends once the heel of this same foot strikes the ground again, to start the whole process over, hence the term gait cycle. Walking or running simply consists of the complete gait cycle alternating between the two limbs of an individual. In essence, the gait cycle of each foot has a converse relationship. For example, while the left foot is in stance phase, the right foot is in swing phase. This succinct process occurs throughout every step that is taken and most people have no idea it even exists. To clarify any potential confusion, there are certainly short periods in most gait cycles where both feet may be contacting the ground, or especially in running, both feet are not in contact with the ground. Yet, in general, the cycle occurring at each foot is alternating in a conducive manner for walking or running.

With a vast majority of the pathologies that podiatrists like Dr. Michael Garvin see, certain portions of a patients gait cycle have abnormalities that cause improper force transfer, and eventually translate to some type of disease manifestation-“something has to give”. These abnormalities of the gait cycle can occur for a great variety of reasons. These causes are all hugely important in the overall treatment, and prevention of further injuries to the patient’s foot, and their overall health. Dr. Garvin recognizes this, and does his best as a Podiatric physician to observe, listen, address, and heal his patients. 

If you feel you have an abnormal gait, or you have any kind of pain while walking, do not wait until you injure yourself to see a doctor. Call Dr. Garvin’s office and make an appointment at the East office- 772-335-7171, or the West office-772-871-6020, in Port St. Lucie Florida. Or e-mail him at info@doctorgarvin.com .

Below is a schematic of the gait cycle.

 
Below is a list of pathologies commonly seen in the lower extremity that often times manifest due to poor biomechanics (abnormalities in the gait cycle):

*pronation consists of tri-plane motion of the foot; dorsiflexion, eversion & abduction of the foot.
**Supination consists of tri-plane motion of the foot; plantarflexion, inversion & adduction of the foot.

Monday, September 12, 2011

All About Those Bunions


Is your big toe crowding the rest of your toes?  Is there a firm lump on the side of your big toe?  Do you have pain from the pressure of your shoes causing you to flinch while walking? Is finding a shoe that fits comfortably difficult? If you are experiencing any of these symptoms then you may have a bunion.
Bunions, also called hallux valgus or hallux abducto valgus (HAV), form a firm bump on the inside edge of the foot at the base of the big toe.  This causes the big toe to move out of place.  When a bunion forms on the big toe, the toe moves toward the other toes and causes the lump to become bigger and can create pain.  Pain occurs because pressure from the shoe on the bunion or from pressure inside the joint.

A main factor for bunion growth is wearing footwear that is too tight.  When you wear tight footwear your toes are squeezed together and create unnecessary pressure.  Not only footwear, but faulty foot mechanics and a combination of the way you walk can cause bunions.  And of course foot injuries, people with neuromuscular problems and activities such as ballet dancing can also be linked to the formation of bunions.     
There are non-surgical and surgical treatments for bunions, but your options would depend on the severity of your feet.  Changing your shoes to provide more room, taping and padding your foot into a normal position, and having shoe inserts or orthotics can help reduce symptoms and prevent bunions from becoming worse.  
However, discussing your options and having your feet looked at can help in making the right decision for treatment.  It’s important to get bunions looked at immediately as other issues can develop such as hammer toes, corns, calluses and ingrown toenails.  
If you are experiencing bunion symptoms and pain call our office to set up an appointment with Dr. Garvin at www.doctorgarvin.com