Search Results
Future of Gait Analysis
A Podiatric Medical Perspective
Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine. (J Am Podiatr Med Assoc 95(2): 130–142, 2005)
Talonavicular coalitions, a rarely reported fusion between the talus and navicular, are often an incidental radiographic finding that may be asymptomatic or associated with peroneal spasm. The authors present a review of literature and case report based on clinical evaluation and instrumented gait analysis. Specifically, a patient presenting with a bilateral talonavicular coalition was objectively evaluated with kinetic, kinematic, muscle dynamometry, and pedobarographic testing to understand the biomechanical limitations related to this pathology. An excessive passive component of ankle torque, a high first metatarsophangeal joint plantar pressure, and a diminished time in the midstance portion of stance phase were measured and compared to those of healthy individuals.
There is little knowledge of the functional performance of patients with talocalcaneal coalition because of the marginal quantitative information accessible using current motion-analysis and plantar pressure–measurement techniques. A novel system was developed for comprehensively measuring foot–floor interaction during the stance phase of gait that integrates instrumentation for simultaneously measuring bony segment position, ground reaction force, and plantar pressure with synchronization of spatial and temporal variables. An advanced anatomically based analysis of foot joint rotations was also applied. Tracking of numerous anatomical landmarks allowed accurate selection of three footprint subareas and reliable estimation of relevant local forces and moments. Eight patients (11 feet) with talocalcaneal coalition were analyzed. Major impairment of the rearfoot was found in nonsurgical patients, with an everted attitude, limited plantarflexion, and overloading in all three components of ground reaction force. Surgical patients showed more normal loading patterns in each footprint subarea. This measuring system allowed for accurate inspection of the effects of surgical treatment in the entire foot and at several footprint subareas. Surgical treatment of talocalcaneal coalition seems to be effective in restoring more physiologic subtalar and forefoot motion and loading patterns. (J Am Podiatr Med Assoc 96(2): 107–115, 2006)
The Electrodynogram (EDG) system of foot-fall measurement has been in clinical use for more than 15 years. Recently the EDG was acquired by Tekscan, which manufactures the F-Scan system of foot-pressure analysis. The new F-Scan system with EDG module retains all of the benefits of the F-Scan system while incorporating the valuable temporal and pressure data comparisons offered by the EDG. This merging of technologies has resulted in a system that is more suitable for application in the pediatric patient than either system alone.
Dynamic Splinting for Runner’s Toe
A Case Report with Gait Analysis
We present a case report of runner’s hallux limitus and the effect of dynamic splinting in reducing contracture as measured by gait analysis. After 4 months of treatment with dynamic splinting, the patient regained 45° in active range of motion, and the gait analysis showed significant and beneficial changes. (J Am Podiatr Med Assoc 99(4): 367–370, 2009)
BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of treatment and adverse effects on gait function. The aim of the study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January 2015 and January 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria, ankle functional scores with the Teeny-Wiss score, and ankle arthrosis with the Takakura classification. In the last follow-up of the patients, foot loading analysis was performed and the results of the patients were evaluated for their relation with postoperative reduction quality, ankle functions and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range 19-78). The mean follow-up was 34.3 months (range 24 - 58). The mean Ovadia-Beals score was 12.35 {plus minus} 4.6 in the postoperative plain radiographs of the patients; the mean Teeny-Wiss score in the last follow-up was 76.82 {plus minus} 17.69, and the Takakura score was 1.47 {plus minus} 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior and 52.42% on the posterior of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial of the ankle and 57.85% loaded on the lateral of the foot. CONCLUSION: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.
Functional Outcome of Meniscal-Bearing Total Ankle Replacement
A Gait Analysis Study
Background: Most clinical studies on total ankle replacement (TAR) report assessments based on traditional clinical scores or radiographic analysis. Only a few studies have used modern instrumentation for quantitative functional analysis during the execution of activities of daily living. The aim of this study was to use gait analysis to compare the functional performance of patients who underwent TAR versus a control population.
Methods: A retrospective analysis was performed of ten consecutive patients who had undergone meniscal-bearing TAR. Clinical and functional assessments were performed at a mean follow-up of 34 months with a modified Mazur scoring system and state-of-the-art gait analysis.
Results: Gait analysis assessment of TAR at medium-term follow-up showed satisfactory results for all patients, with adequate recovery of range of motion. Because the literature reports unsatisfying long-term results, it is important to evaluate these patients over a longer follow-up period.
Conclusions: This study showed that TAR yields satisfactory, but not outstanding, general functional results at nearly 3 years’ follow-up. These gait analysis results highlight the importance of integrating in vivo measurements with the standard clinical assessments of patients who underwent TAR while they perform activities of daily living. These results also emphasize the importance of evaluating the functional outcome of TAR over time. (J Am Podiatr Med Assoc 98(1): 19–26, 2008)
Gait Changes with the Use of Heelys
A Case Study
Heelys shoes are a novel athletic shoe with a concealed wheel. They have been popular among youths since their introduction in 2000. This case study serves as a first look into the biomechanical implications of Heelys shoes on gait. Pressure readings of the forefoot, midfoot, and rearfoot during ambulation in regular athletic-shoe walking, Heelys without the wheel walking, Heelys with the wheel walking, and Heelys skating with the wheel were recorded on a single subject using the Pedar X System. A visual gait analysis was also performed on the subject. The resulting data show increased forefoot and rearfoot pressure while walking with the Heelys with the wheel. The visual gait analysis showed a diminished heel strike and a more rapid forefoot loading. These results demonstrate that Heelys do in fact affect the biomechanics of gait. (J Am Podiatr Med Assoc 99(3): 247–250, 2009)
