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Ian Linane started the thread on Stable or unstable or ? . I have split of one of his points into this thread, so we can have a seperate discussion:
Quote:
At the society conerence I was pleased to get a couple of minutes of Craig's time (thanks) out of which arose some discussion on a couple of things. Thought it might be useful to open them up here if people want. They are in fact related issues:
1. Craig outlined that at one point he could see little value in gait analysis but that his view had altered slightly. He might want to expand on this but it had altered because he valued seeing the effect of force upon foot function ( is that right Craig?)
Personally I value gait analysis for other reasons than observing the effect of forces upon the foot. Do others value gait analysis and why?
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Gait analysis, ie. the analysis of the kinetics, kinematics, and physiologic functions during gait are quintessential to our understanding of locomotion. Is this really questionable?
__________________ Science is the antidote to the poison of enthusiasm and superstition
Gait analysis, ie. the analysis of the kinetics, kinematics, and physiologic functions during gait are quintessential to our understanding of locomotion. Is this really questionable?
I have to agree with Simon here. Is it cold in here or just me?!
Seeing the potential changes in digital video analysis is beneficial. It depends on what you are looking for and how you measure the changes. 2D kinematics is questionable in it's repeatibility and measurability. 3D is better but expensive and very time consuming.
In-shoe pressure analysis is great for tracking changes in the orthotic prescriptions, ie Force vs Time curves. You can also track the Center of Pressure as it moves along, comparing each foot side by side to compare accelerations.
There is so much you can do both clinically and for research. If you really want to understand what your foot orthoses do, nothing is better than utilizing some regular type of gait analysis to track those changes for better or worse.
Bruce
The point I tried to make at conference and where Kevin and I disagree is based on just why do we do a gait analysis for? .... there can only be two reasons:
1. Is there any evidence of pathomechanical dysfunction that could be causing the patients symptoms
2. Derive an orthotic prescription. Maybe: 3. Evaluate effects of interventions
For (2) most of what I see in a gait analysis is not useful information for an orthotic prescription (what I see may be useful for other things, but then again is it?)
For every clinical test we do, we need to ask, what useful information am I gaining from this test? What am I going to potentially change as a result of this clinical test (eg gait analysis)
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
The point I tried to make at conference and where Kevin and I disagree is based on just why do we do a gait analysis for? .... there can only be two reasons:
1. Is there any evidence of pathomechanical dysfunction that could be causing the patients symptoms
2. Derive an orthotic prescription. Maybe: 3. Evaluate effects of interventions
For (2) most of what I see in a gait analysis is not useful information for an orthotic prescription (what I see may be useful for other things, but then again is it?)
For every clinical test we do, we need to ask, what useful information am I gaining from this test? What am I going to potentially change as a result of this clinical test (eg gait analysis)
Craig;
were you referring to only visual gait analysis or computerized gait analysis or both?
I do see some useful things with a visual gait analysis that will help me in devising a prescription for an orthosis. It is much more difficult to see if the inprovements worked visually after orthotic modification. that is why I prefer computerized gait analysis for step by step testing and evaluation. That helps to eliminate my subjectivity and provide much more objectivity.
Bruce
The point I tried to make at conference and where Kevin and I disagree is based on just why do we do a gait analysis for? .... there can only be two reasons:
1. Is there any evidence of pathomechanical dysfunction that could be causing the patients symptoms
2. Derive an orthotic prescription. Maybe: 3. Evaluate effects of interventions
For (2) most of what I see in a gait analysis is not useful information for an orthotic prescription (what I see may be useful for other things, but then again is it?)
For every clinical test we do, we need to ask, what useful information am I gaining from this test? What am I going to potentially change as a result of this clinical test (eg gait analysis)
Craig:
There are more than just two or three reasons to do a gait examination. Here are some other reasons to add to your short list:
1. Find evidence of muscle weakness.
2. Find evidence of central nervous dysfunction.
3. Determine biomechanical effects of gait in different shoegear vs barefoot.
4. Determine mechanical efficiency of gait.
It must be remembered, that without analyzing the dynamics of gait, the clinician is trying to determine dynamic gait function from static measures only....an impossible task!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
were you referring to only visual gait analysis or computerized gait analysis or both?
Primarily visual, but the same principle applies to the comuterized systems, or any sort of clinical testing .... I guess it comes from teaching students .... I simply keep saying what are you going to do with the information from that test/observation? If the information gained does not have the potential to change your intervention, then why are you doing it?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
There are more than just two or three reasons to do a gait examination. Here are some other reasons to add to your short list:
1. Find evidence of muscle weakness.
2. Find evidence of central nervous dysfunction.
3. Determine biomechanical effects of gait in different shoegear vs barefoot.
4. Determine mechanical efficiency of gait.
It must be remembered, that without analyzing the dynamics of gait, the clinician is trying to determine dynamic gait function from static measures only....an impossible task!
Kevin, I am not disagreeing. The point I am trying to make is that what do you do with the information? How does it change your treatment?
For eg; what if you observe an asymmetrical arm swing during a visual gait analysis. What are you going to do differently to the orthotic because of that observation? The asymmetry in the arm swing may be due to a leg length difference. The decision re adding a heel lift (ie the intervention) is not based on observing the asymmetry in the arm swing, but on some clinical test of leg length. It does not mean the gait analysis is not important; its does not mean the asymmetrical arm swing is not important; I just want peple to think about what of our tests/observations are used to make the clinical decisions with.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
You could look at many components of a biomechanical examination on their own and question their value. However these components all add small pieces of information to the big picture.
I have had many instances where a NWB examination and static examination showed very little until the subject walked for me. On occasions walking showed little of interest, but running revealed something.
On the flip side, I don't think you can do a true assessment of someone simply by viewing their gait. You must also examine the subject to get a true representation of the mechanics.
I am preaching to the converted in this forum, however I have seen many instances where more value is given to what is seen on video, without actually assessing the patient.
Example- I recently assessed an elite middle distance runner who has had chronic achilles issues. I performed my standard assessment of lower limb posture, ROM, strength etc. There was a limb length difference (symptomatic side long). He was mildy pronated, but nothing of glaring significance. Walking was also pretty unremarkable.
I was then handed a report from a lab in Germany who had video taped him running- with the report that there was significant unilateral pronation (on the asymptomatic side).
When I observed him running, he did actually appear to do just as the report said- there was significant medial upper deviation as we all have seen in heavy pronators.
This was actually a case of what I call a 'false pronator' where the subjects heel sits medially in the shoe due to having a varus rearfoot. I have seen this many times in people who have cavus feet yet distort the medial upper of the shoe because the heel does not sit in the middle of the shoe.
This type of case would be completely missed (and was in this case) if you live only by the video analysis.
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
This was actually a case of what I call a 'false pronator' where the subjects heel sits medially in the shoe due to having a varus rearfoot. I have seen this many times in people who have cavus feet yet distort the medial upper of the shoe because the heel does not sit in the middle of the shoe.
This type of case would be completely missed (and was in this case) if you live only by the video analysis.
Craig;
great example! I will file that for future reference!
Kevin, I am not disagreeing. The point I am trying to make is that what do you do with the information? How does it change your treatment?
For eg; what if you observe an asymmetrical arm swing during a visual gait analysis. What are you going to do differently to the orthotic because of that observation? The asymmetry in the arm swing may be due to a leg length difference. The decision re adding a heel lift (ie the intervention) is not based on observing the asymmetry in the arm swing, but on some clinical test of leg length. It does not mean the gait analysis is not important; its does not mean the asymmetrical arm swing is not important; I just want peple to think about what of our tests/observations are used to make the clinical decisions with.
I understand your point better now, Craig. In all of medicine, not all tests that clinicians perform result in a change in treatment. However, if the clinician hasn't performed the test, how are they to know that the test results are normal so that they can move their attention elsewhere in search of a proper diagnosis/treatment plan? In much the same way, the visual gait analysis is simply another medical test that may or may not give us valuable information to help us better understand the medical condition of a patient. I don't see why a podiatrist, who is hopefully better trained at visual gait analysis than any other health professional, would not perform a gait analysis (i.e. watch a person walk) for the benefit of every new patient to give them information on whether one of the patient's most important locomotor activities are occurring normally or not.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Value of gait analysis
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