Gait analysis is a necessary and important part of the overall lower
limb patient evaluation. If done properly, gait analysis can reveal nuances of
patient ambulation otherwise unseen to the naked eye, according to Seamus
Kennedy, CPed, owner of Hersco Ortho Labs. Kennedy has seen a variety of
systems used from simple static ink pedigraphs for those amid budgetary
constraints to dynamic video and digital pressure mapping systems. Despite the
overwhelming capabilities of computer processing and graphic design, it is not
necessarily essential to spend a fortune on
gait analysis in order to yield quality and reliable results.
“The simplest and least expensive step is education,” Kennedy
told
O&P Business News. “Read up on how to perform a
thorough visual examination of the patient while both standing and walking. Ask
more experienced practitioners for help if it is necessary. Find out what they
look for and how they conduct their exams.”
Kennedy also recommended another inexpensive and effective way to
analyze a patient’s gait without breaking the bank — shoe
examination.
“You can learn a significant amount just by examining the wear
patterns and condition of a patient’s shoes,” Kennedy said.
“Even before the advent of digital pressure systems and video gait
analysis, practitioners knew what the normal foot strike pattern was from the
lateral heel through the midfoot and finally toe-off from the medial forefoot.
This was from the wear pattern visible on the sole of almost every shoe. Check
each patient’s shoes to verify this.”
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| Seamus Kennedy |
Kennedy also recommended comparing the patient’s left foot with the
right foot to see if there are any differences. He said overwear on a single
side indicates a possible leg-length discrepancy, excessive unilateral motion
or some other general compensation.
“Localized compression of the midsole material highlights where
weight is loaded during ambulation,” he explained.
Some business owners may spring for a gait analysis lab on a budget. An
inexpensive gait analysis lab involves few items. According to Kennedy, an
inexpensive lab includes a second-hand treadmill and a video camera with a
tripod. He recommended drawing a colored line down the center of the
treadmill’s running surface. Then, set the camera up so it can shoot video
from behind the patient and from the side of the treadmill. The images can be
recorded, saved, watched and replayed on a regular laptop.
“Although this is a basic set-up, you will be surprised at the
depth of information it reveals,” Kennedy said. “Playback in slow
motion will clearly show details about the extent of eversion or inversion and
foot position at heel-strike and toe-off. It can help in the assessment and
design of orthotics and shoes as well. Viewing the dynamic video in a
‘before and after’ fashion is also a valuable patient education tool.
If seeing is believing, this tool will help patients understand what you are
attempting to do for them.”
Pedorthists beginning their careers should upgrade to better equipment
and software when they feel as though they are financially comfortable to do
so, Kennedy recommended.
“Make the investment when you can,” he said. “These
systems are a good start, but they are not as sophisticated as the full digital
dynamic pressure mapping and video units.”
While quality equipment can help greatly in patient evaluations, good
observation skills, patience and deductive thinking are also essential to
successful examinations, according to Kennedy. — by Anthony Calabro
Regardless of the gait analysis equipment a pedorthist uses to examine a
patient, the best tools are always going to be their eyes and knowledge. It is
extremely important to view all aspects of the patient’s body and footwear
collection, while also listening to the patient and the particular complaint he
or she presents with.
Certainly there can be a combination of conditions present that may show
up on walking, standing, patient’s footwear, foot exam, joint manipulation
and a plethora of other tools that only a pedorthist is going to take the time
to search out. Having the expensive equipment can make things easier at times,
but one can sometimes miss things when relying on the analysis seen.
It is my finding that most pedorthists truly like looking at the
biomechanics of the person and the wear of the footwear, etc. than solely
looking at a readout from a gait analysis. It is certainly helpful having the
equipment as an additional tool but a pedorthist can get just as much
information looking at a dynamic test using a Harris Mat.
— Art Smuckler, CPed
Owner, General
Orthopedic Inc.
There are a few evaluations that can be done by a pedorthist that
involve training as opposed to capital equipment. One of the more valuable
methods is shoe evaluation. If the patient is coming in with shoes that are
used or often worn, there is a great deal of information in both the upper and
the sole of the shoe. The sole wear pattern can give you information regarding
heel strike along with the line of progression or the movement of weight across
the bottom of the shoe from heel strike to the lateral side of the foot and
then transfer at the metatarsal heads and the big toe.
There is a visual observation of the gait that can be done, such as
simply watching the way they walk. You can observe their hip level, their
ability to elevate and lift their knee and throw their foot forward to get heel
strike. You can observe their alignment. If the patient has a bad back, you may
notice that they shift their weight in a particular way from one side to the
other and that will impact their gait. You should visually be able to see this
in the way that they walk. You do not necessarily need a gait lab to make that
kind of an assessment.
In my personal experience, gait analysis is barely covered in pedorthic
school. Conducting assessments of anything beyond the foot is not generally
within their scope of practice. If you are starting to assess the knee, hip and
spine involvement, you are outside of your scope of practice. Therefore, it is
not taught. On the other hand, the impact of gait affects the foot
significantly. The best thing a pedorthist can do is look at his or her scope
of practice, which means look at the shoes. The shoes will tell you a great
deal of information and that is the area that you will be able to treat.
— Jon Fogg, CPed
National sales manager,
Acor Orthopaedic
At this point, gait analysis labs are a luxury for pedorthists. They are
not currently charging clients for their services, only the products they
dispense. It would require a complete change in their business model. The cost
of equipment and time has to be calculated and “sold” to consumers
and other health care professionals as an added value benefit deserving an
additional fee.
Gait analysis labs are definitely an opportunity for pedorthists to
further solidify their position as a provider of more than just footwear and
related products. I believe we can always learn more. Gait analysis technology
can always help, but it has to be affordable and produce a return on investment
to the pedorthist utilizing it.
— Robert Schwartz, CPed
President and chief
executive officer of Eneslow Pedorthic Enterprises Inc.
