A Closer Look At Case Studies In Gait Analysis

Author(s): 
David Levine, DPM, CPed

   When assessing patients, obtaining information via video and computer-assisted gait analysis may assist clinicians in more ways than they even realize. It is information that one may not otherwise obtain during a typical podiatric biomechanical examination. Watching patients ambulate can be very helpful in picking up key details that can inform the diagnosis and subsequent treatment plan.

   One needs to consider other contributing factors as well. These factors include the patient’s occupation as well as the shoes he or she typically wears. For example, a woman wearing dress shoes and a man with steel toe work boots may have different complaints but both are likely related to how their shoes affect their feet. Therefore, it is important to look at the entire person both from a static and dynamic point of view.

   Certainly, typical podiatric biomechanical intervention can address many problems that people encounter on a daily basis. However, there are many situations that present to us on a daily basis that need more detailed attention. Additional attention means understanding the way patients function. Simply having two feet does not mean that symmetry is something patients should take for granted. It is often asymmetry that causes the underlying presenting complaints.

   For example, consider a patient who presents with plantar fasciitis one year, tendonitis another year and hallux limitus at another time. There must be other biomechanical forces that are causing these repeated injuries. Overuse may be one factor but overuse in combination with biomechanical asymmetry is even more important to assess.

Pertinent Pointers On Ensuring An Effective Gait Analysis

   Gait analysis can take on many forms. During podiatry school, we learned how to perform biomechanical exams. These exams often include watching a person walk up and down the hallway. However, subtle movements can occur in each foot and these are difficult, if not impossible, to pick up at normal speed with just your eyes. Subtle differences can also occur between feet that one may not see when the patient is walking in the hallway.

   In addition, patients are often ill prepared for a proper gait analysis at the typical podiatric visit. When they try to bunch up their pants around the knees with the pants frequently falling to the ankles, it obscures the view of what we need to see. When you combine this with a waiting room full of patients, these biomechanical exams may be more rushed than you intended.

   Indeed, it is important to schedule a time and place to perform a thorough analysis of their gait. One way to do this is by using a gait lab. A room with dimensions of approximately 15 feet wide and 30 feet long is sufficient to watch a person walk with the aid of video cameras located in different positions around the patient walking area. The patient should come prepared for this visit by bringing shorts, a T-shirt, typical shoes and orthotic devices if he or she already wears them.

   Scheduling an appropriate amount of time for this exam is important. Even more advantageous is having an assistant or a technician run this test. That way, you will not be forced into making on the spot determinations of what you see. This permits the luxury of taking time to analyze the patient’s gait at your own pace and schedule. This is analogous to a patient undergoing a MRI or any other diagnostic test. Even thought the test is complete, it is expected that you will need time to read it. The same is true for gait analysis.

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