A Closer Look At Gait Analysis In Patients With Diabetes

Start Page: 44
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Author(s): 
Michael DeBrule, DPM

2. Ask your patient to change into shorts and a T-shirt to help visualize arm, leg and knee motion.

3. Perform observational gait analysis in a systematic fashion using a checklist.25-27

4. Use a stopwatch with a measured walking distance to record basic temporal-spatial gait parameters like walking speed, cadence and stride length.

5. Use simple video with a camcorder, handheld device or cell phone.

6. Perform video analysis with multiple camera views, gait analysis specific software and key angle measurements.

7. Use a plantar pressure mat system or force platform.

8. Use a plantar pressure in-shoe recording system.

   Once you have performed gait analysis, next comes the hard part. You have to come up with a treatment plan by considering all the significant deviations you observed and their most likely causes (some will not be podiatric). You may then choose to perform additional assessments like checking for knee or hip range of motion, ordering magnetic resonance imaging (MRI), performing a timed get up and go test for fall risk, or whatever you feel is indicated.

   Without sounding too preachy, please do not underestimate the contribution of limb length difference to asymmetry and remember that a custom foot orthotic will not cure everything. Consider discussing the gait changes you observed in your patient with other specialists and get their opinions. Orthopedists, physical therapists, endocrinologists, rheumatologists, vascular specialists and primary care doctors may all help improve the gait in your patient with diabetes and prevent limb loss.

In Conclusion

Patients with diabetic peripheral neuropathy tend to walk slower with an increased base of gait. Gait analysis may improve your diagnosis and provide additional information for preventing foot ulcers, limb loss and morbidity. Gait analysis may also help when planning conservative or surgical treatments for diabetic foot offloading, or identifying an unsteady patient at risk of falling.

   Dr. DeBrule is in private practice with Midwest Podiatry Centers in Richfield, Minnesota. He is board certified in wound care.

References

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