A deficient anterior cruciate ligament does not lead to quadriceps avoidance gait

Without an intact anterior cruciate ligament (ACL) to resist anterior tibial translation, it is commonly believed that ACL-deficient patients employ alterations in walking. Although there is no consensus in the literature about the specific kinematic and kinetic adaptations in these patients with ACL tears, the gait adaptation of quadriceps avoidance is perhaps the one most popularized. The purpose of our study was to determine whether quadriceps avoidance is common in patients with ACL-deficiency. We used a video-based motion analysis system and surface electromyography (EMG) to study 18 patients with ACL-deficiency. All patients demonstrated an internal knee extension moment during early mid-stance (similar to normal subjects). Quadriceps EMG activity was noted throughout most of stance. No patients demonstrated an internal knee flexion moment, a decreased internal knee extension moment or a decreased duration of quadriceps EMG activity during stance. The findings of this study would suggest that quadriceps avoidance as a gait adaptation in ACL-deficient patients may be less common than previously reported.     

Lower back kinetic demands during induced lower limb gait asymmetries

BackgroundGait asymmetries are common in many clinical populations (e.g., amputation, injury, or deformities) and are associated with a high incidence of lower back pain. Despite this high incidence, the impact of gait asymmetries on lower back kinetic demands are not well characterized due to experimental limitations in these clinical populations. Therefore, we artificially and safely induced gait asymmetry during walking in healthy able-bodied participants to examine lower back kinetic demands compared to their normal gait.Research questionAre lower back kinetic demands different during artificially induced asymmetries than those during normal gait?MethodsL5/S1 vertebral joint kinetics and trunk muscle forces were estimated during gait in twelve healthy men and women with a musculoskeletal lower back model that uniquely incorporated participant-specific responses using an EMG optimization approach. Five walking conditions were conducted on a force-measuring treadmill, including normal unperturbed “symmetrical” gait, and asymmetrical gait induced by unilaterally altering leg mass, leg length, and ankle joint motion in various combinations. Gait symmetry index and lower back kinetics were compared with repeated-measures ANOVAs and post hoc tests (α = .05).ResultsThe perturbations were successful in producing different degrees of step length and stance time gait asymmetries (p < .01). However, lower back kinetic demands associated with asymmetrical gait were similar to, or only moderately different from normal walking for most conditions despite the observed asymmetries.SignificanceOur findings indicate that the high incidence of lower back pain often associated with gait asymmetries may not be a direct effect of increased lower back demands. If biomechanical demands are responsible for the high incidence of lower back pain in such populations, daily tasks besides walking may be responsible and warrant further investigation.     

Gait patterns after anterior cruciate ligament reconstruction

The aim of this study is to analyse the changes in select gait parameters following anterior cruciate ligament (ACL) reconstruction. The study was performed on 15 subjects who underwent ACL reconstruction by the bone-patellar tendon-bone technique. Gait analysis was performed using the Elite three-dimensional (3D) optoelectronic system (BTS), a Kistler force platform and the Telemg telemetric electromyograph (BTS). Kinematic data were recorded for the principal lower limb joints (hip, knee and ankle). The examined muscles include vastus lateralis, rectus femoris, biceps femoris and semitendinosus. The results obtained from the operated subjects were compared with those of 10 untreated subjects and 5 subjects without ACL damage. In the operated subjects the knee joint angular values regained a normal flexion pattern for the injured limb during the stance phase. The analysis of joint moments shows: (a) sagittal plane: recovery of the knee flexion moment at loading response and during preswing; (b) frontal plane: recovery of the normal patterns for both hip and knee adduction-abduction moments during the entire stance phase. The examination of ground reaction forces reveals the recovery of frontal component features. The EMG traces show the normal biphasic pattern for the operated subjects as compared to the untreated subjects. The results suggest that the gait parameters shift towards normal value patterns.     

Kinematic and kinetic characteristics of Masai Barefoot Technology footwear

The Masai Barefoot Technology (MBT) shoe was developed as a walking device to improve gait stability and reduce the joint load. Kinematic changes with MBT shoes have been reported; however, kinetic characteristics with MBT shoes have not been adequately assessed. The purpose of this study was to investigate the immediate effects of using MBT footwear on the kinetic and kinematic changes in the lower extremity in healthy males. Fourteen healthy male subjects (mean age: 25.6 ± 5.1 years) underwent three-dimensional gait analysis. Ground reaction forces (GRF) during the shock absorption phase were significantly decreased with MBT shoes compared with stable shoes. Gait with the MBT shoes showed significantly decreased knee extension angle in the early stance phase, a decreased hip extension angle, and an increased ankle dorsiflexion angle in the late stance phase. The peak value of the ankle planter moment, ankle negative power, and vertical component of the GRF significantly decreased with MBT shoes in the late stance phase compared with stable shoes. Therefore, MBT shoes could assist with shock absorption in the early stance phase and maintain the progression force while reducing joint moment and power. The results of this study suggest that MBT shoes might be effective to improve shock absorption, increase knee extensor muscle activity, and assist ankle push-off.     

Effect of genu recurvatum on the anterior cruciate ligament-deficient knee during gait

Purpose

This study aimed to investigate the effects of genu recurvatum, which is considered to carry a high risk for anterior cruciate ligament (ACL) injury, on healthy and post-ACL injury gait and lower extremity muscle strength.

Methods

Subjects were 36 patients with ACL-deficient knee and 40 healthy controls without pain or restricted range of motion of the lower extremity during gait. The knee joints of all subjects were examined; those with over 10° hyperextension of both knees were defined as exhibiting genu recurvatum. On this basis, the subjects were further subdivided into two groups: with or without genu recurvatum. A three-dimensional motion analysis system and force plates were used for gait analysis. Isokinetic dynamometers were used to measure knee muscle strength.

Results

There were no differences in joint angles, joint moments, or components of ground reaction force during gait or in knee strength for the healthy control subjects with and without genu recurvatum. ACL-deficient subjects without genu recurvatum showed a decrease in knee angles during the stance phase and a decrease in extension moments during the early stance phase compared with ACL-deficient subjects with genu recurvatum and controls. In contrast, neither knee angles nor extension moments during the stance phase differed significantly between ACL-deficient subjects with genu recurvatum and controls.

Conclusions

This study provides clinically relevant information regarding the effects of genu recurvatum on gait parameters. The results suggest that in ACL injuries, the presence of genu recurvatum alters gait pattern. Consideration of the presence of genu recurvatum would be useful during rehabilitation following ACL injuries or ACL reconstruction.

Level of evidence

II. Prospective comparative study.     

Comparison of muscle activity during walking in subjects with and without diabetic neuropathy

The purpose of this study was to compare muscle activity and joint moments in the lower extremities during walking between subjects with diabetic neuropathy (DN) and control subjects. Tests were performed on nine subjects with DN, and nine age, gender, and weight-matched controls. Onset and cessation times of lower extremity electromyographic (EMG) activity and joint moments were determined. Results demonstrated that subjects with DN had less ankle mobility, slower walking speeds, longer stance phases, and lower peak ankle dorsiflexion, ankle plantar flexion, and knee extension moments than control subjects. Onset times with respect to heel-strike (HS) for the soleus, medial gastrocnemius, and medial hamstring muscles were significantly earlier during the gait cycle (GC) in subjects with DN than in control subjects. The cessation times of soleus, tibialis anterior, vastus medialis, and medial hamstring muscles were significantly prolonged in subjects with DN. Subjects with DN showed more co-contractions of agonist and antagonist muscles at the ankle and knee joints during stance phase compared with control subjects. These gait changes and co-contractions may allow subjects with DN to adopt a safer, more stable gait pattern to compensate for diminished sensory information from the ankle and the foot. The premature activation of soleus and medial gastrocnemius muscles in subjects with DN could be contributing to abnormal forefoot plantar pressure distribution. Additional research is needed to clarify the relationship between the premature activation of triceps surae muscles and the forefoot plantar pressure parameters in subjects with DN.     

Gait patterns before and after anterior cruciate ligament reconstruction

The aim of this study is to determine how selected gait parameters may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was performed on 25 ACL-deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months after ACL reconstructive surgery by the bone-patellar tendon-bone technique. Gait analysis was performed using the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris Medizintechnik GmbH, Germany). Kinematic data were recorded for the lower limb. The muscles examined include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without ACL damage. The acute ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks after surgery. The quadriceps avoidance phenomenon does not develop in chronic ACL-deficient patients. In the individuals operated on, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient limb during gait 4 months after surgery. However, the relative ACL movement parameter-which describes the tibial translation into the direction of ACL-and the EMG traces show no significant statistical difference compared with the values of healthy control group just 8 months after surgery. The results suggest that: (1) development of a quadriceps avoidance pattern is less common than previously reported, (2) anterior cruciate ligament deficiency and reconstruction significantly alter the lower extremity gait pattern, (3) the gait parameters shift towards the normal value pattern, and (4) the re-establishment of pre-injury gait patterns--including the normal biphase of muscles--takes at least 8 months to occur.     

Gait pattern in Duchenne muscular dystrophy

We investigated the gait pattern of 21 patients with Duchenne muscular dystrophy (DMD), compared to 10 healthy controls through 3D Gait Analysis. An overall observation of gait pattern in our DMD patients when compared to controls confirmed the data previously reported for small dystrophic groups. An excessive anterior tilt of pelvis and abnormal knee pattern in loading response phase were found. Since during the swing phase the DMD foot is too plantarflexed, patients adopt a higher flexion and abduction of the hip in order to advance the swinging limb. Velocity and cadence of DMD patients resulted similar to those calculated for healthy subjects, whereas stride length was reduced and step width was increased. We then divided the DMD patients in to two subgroups (treated with steroids and untreated), and we observed that the only statistically significant differences between the two groups in Gait Analysis parameters were found for the maximum of ankle power. 3D Gait Analysis gives objective and quantitative information about the gait pattern and the deviations due to muscular situation of DMD subjects; being our study a single moment evaluation, it is otherwise unable to unravel changes only detectable through serial analysis during the time course of the disease and, if any, due to the treatment.     

Immediate effect of walking with talus-stabilizing taping on ankle kinematics in subjects with limited ankle dorsiflexion

ObjectiveTo determine the effects of walking with talus-stabilizing taping (TST) on ankle dorsiflexion (DF) and heel-off time in the stance phase of gait and ankle DF passive range of motion (PROM).DesignPre- and post-intervention study.SettingUniversity motion analysis laboratory.ParticipantsTen subjects participated in this study. Sixteen ankles with limited ankle DF PROM were tested.Main outcome measuresAnkle DF PROM was measured using a goniometer, and maximum ankle DF before heel-off and time to heel-off in the stance phase of gait were measured using a 3D motion analysis system before and after walking with TST. Data were analyzed using a paired t-test.ResultsAnkle maximum DF before heel-off (p = 0.001), time to heel-off during the stance phase of gait (p = 0.005), and ankle DF PROM (p < 0.001) were significantly increased post-intervention compared with pre-intervention.ConclusionsWalking with TST is an effective self-exercise for improving ankle kinematics during gait and increasing ankle DF PROM in individuals with limited ankle DF PROM.     

Knee muscle activity during gait in patients with anterior cruciate ligament injury: a systematic review of electromyographic studies

Purpose

This review compared knee muscle activity between ACL-deficient (ACLD) patients and healthy controls during gait, to find out whether the available electromyography (EMG) studies support Quadriceps (Q-ceps) inhibition or hamstring facilitation during gait in ACLD patients.

Method

A systematic review was conducted to retrieve the EMG studies of knee muscles during gait in ACLD patients. Cochrane library, PubMed, Medline, Ovid, CINAHL and Science Direct databases were searched entries from 1995 through October 2014 using the terms “anterior cruciate ligament” OR “ACL”, “electromyography” Or “EMG” “gait” Or “walking”. Articles that assessed subjects with ACL rupture that used surface EMG to assess the knee muscle activity were included. The quality of the included papers was assessed using the Critical Appraisal Skills Programme tool for observational studies.

Result

In total, 13 studies met the inclusion criteria. Seven studies consistently found no significant difference in magnitude of activity or timing of Q-ceps muscle between the chronic ACLD patients and control subjects. Two studies on acute ACLD patients and three studies on ACLD patients with unstable knee found the significantly reduced Q-ceps activity compared to control subjects. Six studies showed the significantly greater hamstring activity, and three studies found prolonged duration of activity in ACLD patients compared to the control subjects.

Conclusion

This review highlighted that the results of the studies are in favour of increased hamstring muscular activity. However, decreased Q-ceps activation exists in the acute stage and in ACLD patients that experience knee instability (non-copers).

Level of evidence

III.

     

Muscle, ligament, and joint-contact forces at the knee during walking

PURPOSE: In vivo measurement of the forces and strains in human tissues is currently impracticable. Computer modeling and simulation allows estimates of these quantities to be obtained noninvasively. This paper reviews our recent work on muscle, ligament, and joint loading at the knee during gait. METHODS: Muscle and ground-reaction forces obtained from a sophisticated computer simulation of walking were input into a detailed model of the lower limb to obtain ligament and joint-contact loading at the knee for one full cycle of gait. RESULTS: Peak anterior cruciate ligament (ACL) force occurred in early stance and was mainly determined by the anterior pull of the patellar tendon on the tibia. The medial collateral ligament was the primary restraint to anterior tibial translation (ATT) in the ACL-deficient knee. ATT in the ACL-deficient knee can be reduced to the level calculated for the intact knee by increasing hamstrings muscle force. Reducing quadriceps force was insufficient to restore ATT to the level calculated for the intact knee. For both normal and ACL-deficient walking, the resultant force acting between the femur and tibia remained mainly on the medial side of the knee. The knee adductor moment was resisted by a combination of muscle and ligament forces. CONCLUSION: Knee-ligament loading during the stance phase of gait is explained by the pattern of anterior shear force applied to the leg. The distribution of force at the tibiofemoral joint is determined by the variation in the external adductor moment applied at the knee. The forces acting at the tibiofemoral and patellofemoral joints are similar during normal and ACL-deficient gait. Hamstrings facilitation is more effective than quadriceps avoidance in reducing ATT during ACL-deficient gait.     

Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis

The greatest population of amputees in developed nations are elderly dysvascular transtibial amputees. Conventional prostheses, e.g. the solid ankle cushioned heel (SACH) foot, create difficulties in walking on inclines. The aim of this study was to analyse the gait characteristics of elderly amputees walking on an incline, through quantitative three-dimensional biomechanical analysis, by comparing them to age-matched controls. Participants walked up and down an inclined (5 degrees) instrumented walkway at a self-selected pace. A Vicon System 370 was used to acquire gait data, including temporo-spatial characteristics, ground reaction forces (GRF), electromyography (EMG), kinematics, and kinetics of the lower limb. Compared to the age-matched controls, the amputees demonstrated reduced speed, knee and hip range of motion, hip moments, vertical GRF, along with increased amplitude and periods of muscle activation. The residual limb also had shorter single support stance phase, small stance phase knee moments, and the smallest moments and powers. These differences demonstrate instability in stance of the residual limb. The sources of this instability include the prosthesis' limited range of ankle motion and ankle power generation, coupled with the residual limb's limited proprioception and tolerance of force. For these amputees to regain a gait pattern equivalent to their able-bodied counterparts on inclined walkways, they must be equipped with a prosthesis that has a full range of ankle motion and active power generation at the ankle. Prosthesis design and rehabilitation training should also improve the proprioception of their residual limb and increase their tolerance of force through the residual limb.     

Secondary gait compensations in individuals without neuromuscular involvement following a unilateral imposed equinus constraint

Ankle equinus is the most commonly identified impairment of individuals with spastic hemiplegia (SH). However, it is not clear how equinus at the ankle may contribute to gait deviations at other joints. The purpose of this study was to determine what compensatory gait deviations may occur as a result of an imposed, unilateral equinus constraint. Gait data were collected on 12 adult subjects with and without one ankle constrained in equinus using a unique taping method. Knee extension at initial contact, knee extension in mid stance, and hip extension at terminal stance were all found to be significantly reduced on the ipsilateral side as a result of the ankle constraint. On the unconstrained or contralateral side, subjects tended to adopt a foot-flat or toe-first initial contact pattern. This study suggests that stance phase limitations in both hip and knee extension in the gait of persons with hemiplegia are not necessarily caused by limited length of the involved side hamstrings and/or hip flexors, but rather that they can occur as the result of an ankle plantarflexor contracture alone. Deviations in the contralateral foot contact pattern can also occur secondary to unilateral equinus and should not be assumed to represent bilateral involvement.     

Lower limb joint motion during a cross cutting movement differs in individuals with and without chronic ankle instability

ObjectiveTo compare the kinematics of lower limb joints between individuals with and without chronic ankle instability (CAI) during cross-turn and -cutting movements.DesignCross-sectional study.SettingMotion analysis laboratory.ParticipantsTwelve subjects with CAI and twelve healthy controls.Main outcome measuresHip flexion, adduction, and internal rotation, knee flexion, and ankle dorsiflexion and inversion angles were calculated in the 200 ms before initial ground contact and from initial ground contact to toe-off (stance phase) in a cross-turn movement during gait and a cross-cutting movement from a forward jump, and compared across the two groups.ResultsIn the cross-cutting movement, the CAI group exhibited greater hip and knee flexion than the control group during the stance phase, and more hip abduction during the period before initial contact and the stance phase. In the cross-turn movement the joint kinematics were similar in the two groups.ConclusionsCAI subjects exhibited an altered pattern of the proximal joint kinematics during a cross-cutting movement. It is important for clinicians to assess the function of the hip and knee as well as the ankle, and to incorporate coordination training for the entire lower limb into rehabilitation after lateral ankle sprains.     

A comprehensive evaluation of the variation in ankle function during gait in children and youth with Charcot–Marie–Tooth disease

A better understanding of gait dysfunction for children and youth with Charcot–Marie–Tooth (CMT) will assist in developing appropriate treatments and understanding prognosis for ambulation. The purpose of this retrospective study was to document the typical gait patterns in children and youth (12 ± 4 years) with CMT using motion analysis and relate these findings back to the clinical assessment at the ankle. All patients underwent a motion analysis as a component of treatment decision-making.Lower extremity kinematics and kinetics were evaluated in comparison to a typically developing age-matched reference control group collected in the same gait laboratory. Three patient subgroups were defined based on peak ankle dorsiflexion in terminal stance: greater than typical (n = 23), within typical range (n = 30) and less than typical (n = 13). The three subgroups showed statistically significant differences (p < 0.004) in degree of impairment for ankle plantar flexor and dorsiflexor weakness and ankle plantar flexor contracture. Patients with excessive dorsiflexion in terminal stance had the greatest ankle plantar flexor weakness (median 2) and the greatest dorsiflexor weakness (median 4). Patients with less than typical dorsiflexion in terminal stance were the only patients with a plantar flexor contracture (?2 ± 9°). Delayed peak dorsiflexion in stance was the most common kinematic finding and consistent with ankle plantar flexor weakness. All patients showed significantly less (p < 0.001) peak ankle moments and power generation in terminal stance than the typically developing controls. We concluded that children and youth with CMT present differently in terms of impairment and associated gait issues which therefore require patient specific treatment strategies.     

Kinematic changes in patients with severe knee osteoarthritis are a result of reduced walking speed rather than disease severity

BackgroundKinematic changes in patients with knee osteoarthritis (OA) have been extensively studied. Concerns have been raised whether the measured spatiotemporal and kinematic alterations are associated with disease progression or merely a result of reduced walking speed.Research question: The purpose of this study was to investigate the effect of walking speed on kinematic parameters in patients with knee OA using statistical parametric mapping (SPM).MethodsTwenty-three patients with unilateral knee OA scheduled for a total knee replacement and 28 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal plane kinematics were measured in the hip, knee, and ankle using the inertial sensors system RehaGait® while walking at a self-selected normal (patients and controls) and slow walking speed (controls) for a distance of 20 m. Gait parameters were compared between groups for self-selected walking speed and for matched walking speed using SPM with independent sample t tests.ResultsAt self-selected walking speed, patients had significantly lower knee flexion during stance (maximum difference, -6.8°) and during swing (-11.0°), as well as higher ankle dorsiflexion during stance phase (+12.5°) and lower peak hip extension at the end of stance compared to controls (+4.2°). At matched speed, there were no significant differences in joint kinematics between groups.SignificanceDifferences in sagittal plane gait kinematics between patients with knee OA and asymptomatic controls appear to be mainly a result of reduced walking speed. These results emphasize the importance of considering walking speed in research on gait kinematics in patients with knee OA and in clinical trials using gait parameters as outcome measures.     

Stance and swing phase ankle phenotypes in youth with Charcot-Marie-Tooth type 1: An evaluation using comprehensive gait analysis techniques

BackgroundCharcot-Marie-Tooth disease (CMT) results in muscle weakness and contracture leading to a wide variety of gait issues including atypical ankle kinematics in both stance and swing. Knowledge of the stance and swing phase kinematic patterns for CMT type 1 (CMT1), the most common CMT type, will improve our understanding of expected gait outcomes and treatment needs to improve gait function.Research questionWhat are the stance/swing phase ankle phenotypes in CMT1?MethodsA prospective convenience sample of 25 participants with CMT1, ages 7–19 years, underwent comprehensive gait analysis following standard procedures. Ankle phenotypes based on peak ankle dorsiflexion in terminal stance and mid-swing were defined and compared using linear mixed models.ResultsPatients with CMT1 presented with three stance phase ankle phenotypes: 21 limbs (42 %) with reduced (mean 5°, SD 2°), 19 limbs (38 %) with typical (mean 11°, SD 1°) and 10 limbs (20 %) with excessive (mean 15°, SD 2°) peak dorsiflexion in terminal stance (p < 0.05). There were two swing phase phenotypes: 19 limbs (38 %) with typical (mean −1.7°, SD 1.5°) and 31 limbs (62 %) with excessive (mean −5.6°, SD 1.4°) plantarflexion in mid-swing (p < 0.002). Eleven patients (44 %) had ankles that were classified into different stance groups, and 9 patients (36 %) had ankles that were classified into different swing groups. The most common combination of stance/swing ankle phenotypes was decreased dorsiflexion in terminal stance with increased plantarflexion in mid-swing (16 sides, 32 %).SignificanceThis study shows that youth with CMT1 have multiple combinations of combined ankle kinematics for stance and swing. The ankle phenotypes identified in this study reflect contributions of both dorsi/plantarflexor weakness and plantarflexor contracture, which require different treatment approaches. Comprehensive gait analysis can distinguish between multiple ankle phenotypes to assist in determining the most appropriate treatment to improve gait for individual patients.     

Lower extremity joint moments throughout gait at two speeds more than 4 years after ACL reconstruction

BackgroundLong-term gait adaptations after anterior cruciate ligament reconstruction (ACLR) have been reported. However, it is still unclear if they persist more than 4 years after surgery and if they are affected by gait speed.Research question: To investigate differences between groups, legs and walking speeds for ankle, knee and hip joint moments in three planes throughout the stance phase of gait.MethodsReconstructed participants (n = 20 males, 32.5 years, 5.5 years post-ACLR) and healthy controls (n = 20 males, 30.6 years) took part in the study. Gait analysis was performed in two different speeds (self-selected and 30% faster). Sagittal, frontal and transverse plane external moments were measured for ankle, knee and hip and compared throughout the stance phase using 95% confidence intervals. Significant differences were established as a consecutive 5% of gait cycle in which 95% confidence interval did not overlap.ResultsThe reconstructed leg did not demonstrate higher joint moments; there were largely no differences while there was lower knee external rotation moment compared to the non-preferred leg of the control group. Higher joint moments were observed during fast speed walking on sagittal plane for knee and hip moments in both groups, and in the frontal and transverse plane for ankle moments.SignificanceGait kinetics appear to be largely normalized at a minimum of 4 years after ACLR. Faster walking speed increase lower extremity joint moments.     

Basic gait and symmetry measures for primary school-aged children and young adults whilst walking barefoot and with shoes

This study investigated the basic spatio-temporal gait measures of 898 primary school-aged children (5–13 years) and 82 young adults (18–27 years). Participants completed 6–8 walks at preferred speed along a GAITRite walkway whilst barefoot and whilst wearing athletic shoes or runners. Outcome measures (non-normalized and normalized) were gait speed, cadence, step and stride length, support base, single and double support, stance duration, foot angle and associated symmetry measures. Non-normalized measures of speed, step and stride length, support base and foot angle increased with age whereas cadence reduced. Normalized measures remained unchanged with age in children whereas the young adults (both conditions) exhibited a 2.3% reduction in single support, a 5.1% increase in double support and a 2.6% increase in stance duration (p < 0.0001). For the entire sample, shoes increased walking speed by 8 cm s⁻¹, step length by 5.5 cm, stride length by 11.1 cm and base of support by 0.5 cm. In contrast, foot angle and cadence reduced by 0.1° and 3.9 steps min⁻¹ respectively. Shoes increased both double support (1.6%) and stance time (0.8%), whereas single support reduced by 0.8%. Symmetry remained unaffected by age. On average, measures of step and stride symmetry (combining both conditions) fell around 0.7 cm, whereas measures of symmetry for step and stance time, single and double support fell around 0.6%. Footwear significantly affected gait (p < 0.0001). Gait may not be mature by age 13. Gait is symmetrical in healthy children and young adults but may change with pathology.