Understanding The Impact Of Gait Analysis

Start Page: 62

Continuing Education Course #107 — April 2003

I am very pleased to introduce the seventh article, “Understanding the Impact of Gait Analysis,” in our CE series. This series, brought to you by HMP Communications, consists of regular CE activities that qualify for one continuing education contact hour (.1 CEU). Readers will not be required to pay a processing fee for this course.

As David Levine, DPM, CPed, points out in his article, the short walk in the hallway of an office may not be enough to provide a true gait assessment of patients who have more “involved biomechanical situations.”

Offering several clinical examples, Dr. Levine explains the benefits of multiple camera views and pressure mapping, and how combining these diagnostic tools can reinvent the way you look at gait analysis.

At the end of this article, you’ll find a 10-question exam. Please mark your responses on the postage-paid postcard and return it to HMP Communications. This course will be posted on Podiatry Today’s Web site (www.podiatrytoday.com) roughly one month after the publication date. I hope this CE series contributes to your clinical skills.

Sincerely,

Jeff A. Hall
Editor-In-Chief
Podiatry Today

INSTRUCTIONS: Physicians may receive one continuing education contact hour (.1 CEU) by reading the article on pg. 63 and successfully answering the questions on pg. 68. Use the postage-paid card provided to submit your answers or log on to www.podiatrytoday.com and respond electronically.
ACCREDITATION: HMP Communications, LLC is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
DESIGNATION: This activity is approved for 1 continuing education contact hour or .1 CEU.
DISCLOSURE POLICY: All faculty participating in Continuing Education programs sponsored by HMP Communications, LLC are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentation.
DISCLOSURE STATEMENTS: Dr. Levine has disclosed that he has no significant financial relationship with any organization that could be perceived as a real or apparent conflict of interest in the context of the subject of his presentation.
GRADING: Answers to the CE exam will be graded by HMP Communications, LLC. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the exam.
TARGET AUDIENCE: Podiatrists.
RELEASE DATE: April 2003.
EXPIRATION DATE: April 30, 2004.
LEARNING OBJECTIVES: At the conclusion of this activity, participants should be able to:
• discuss how gait analysis can aid in improving the diagnosis of certain conditions;
• assess multiple camera views of a patient’s gait;
• describe the diagnostic benefits of pressure mapping; and
• discuss how the combination of pressure mapping and video gait analysis can affect treatment decisions.

Sponsored by HMP Communications, LLC.

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68
Author(s): 
By David Levine, DPM, CPed

There is a large untapped population of patients who need our biomechanical expertise and guidance. These are the patients who are currently seeing physical therapists, chiropractors, orthopedic surgeons and their family physicians for ongoing aches and pains that are sometimes in their feet, but often in other locations too. These are patients looking for answers to their foot, leg, knee, hip and back pain.
Even though we do not directly treat ailments affecting other regions, we do understand the impact the foot has on the rest of the body. Certainly a static exam is an integral part of any exam we do, but it is the dynamic examination that will yield important clues.
With these clues, we will be better at diagnosing and treating a variety of mechanical conditions that are affected by the foot. Just like taking an X-ray, assessing gait is a diagnostic exam that will provide important information. The more attention you give it in your practice, the more you will learn and the wider your eyes will open in learning how people function during gait.
You can perform gait analysis in several different settings. The easiest technique is the simple hallway assessment. Having the patient walk back and forth in the hallway allows a view of both the front and back of the person. This is a quick and easy way to gain insight into function and is routinely done by most podiatric practitioners. It serves as a way to confirm the nonweightbearing examination performed in the exam chair.
However, walking barefoot in a hallway with the pant legs bunched up around the knees can sometimes alter a person’s normal gait pattern. Sometimes the pant legs will fall, obscuring the very thing you want to see or patients will hunch over holding their pant legs up. Then in an effort to save time, the patient will be ushered back into the exam room, making for an incomplete assessment of what was originally intended. Unfortunately, this short walk may not be sufficient in the more involved biomechanical situations.

How Multiple Camera Views Can Be Helpful In Analyzing Gait
There are other options for assessing gait. By recording the hallway walking of a patient with a video camera, you will be able to at least save what you have for viewing at a later time. You can even play it back on the computer frame by frame in slow motion. This can become part of the medical record.
Improving technology with digital cameras is making this even easier.
Using video allows you to assess dynamic function. For instance, in a foot type that pronates a lot, you will see the first ray elevate, the longitudinal arch disappear and how this affects propulsion. You will also observe transverse plane rotational characteristics that contribute to foot motion. This will help you determine the plane from which the pathomechanics emanate. This, in turn, will help you judge the effectiveness of the proposed treatment.
Multiple camera views are ideal. For instance, a side view of gait is one that we don’t often get to evaluate unless there is the ability to film it. This will let you see the function of the first ray and whether the hallux participates in propulsion. It will also allow you to see how much motion actually occurs in the first ray during gait. You can see overall posture from the side view.
Other camera views that are helpful are those that zero in on the foot from the front and back. A camera view at head or shoulder height is also helpful. This will help you determine whether there is a leg length discrepancy, a pelvic tilt or even shoulder tilt. It is not uncommon to see hallux limitus occur asymmetrically in a patient who has scoliosis.
Consider the situation in which the source of the asymmetry was the curvature in the back which, in turn, lead to a functional leg length discrepancy. If this goes undetected, then the surgical solution you plan for the foot may not be effective over the long term. However, if you have a more comprehensive picture of a person’s function, your surgical results may be even better if you integrate a biomechanical approach as well.
These positional variations may be helpful in determining how the pathology has affected other parts of the body.

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