Gait Analysis
Persistent foot pain, i.e. distal to the ankle joint, is extremely common, although usually under-reported and/or under-diagnosed. Persistent foot pain, although commonly not life-threatening, may become extremely annoying, to the point of having a negative effect on the patient’s quality of life. For the correct and timely diagnosis, a clinical examination by an experienced physician, ideally an Orthopedic Surgeon with special interest for foot disorders, is required. Too often, patients seek imaging tests (X-ray, CT, MRI) bypassing the most important component of diagnosis, the clinical examination.
Several patients seek Physical Therapy – PT right away, addressing physical therapists, who are happy to take on the new patient even without a diagnosis and without a doctor’s referral. Bypassing a proper physical assessment and an MD referral for PT is extremely common nowadays. However, it is still required for proper and full reimbursement by their insurance provider, whether public or private. Why is that?
If the problem subsides and the foot pain goes away, the patient-physiotherapist relationship is strengthened. On the other hand, if symptoms persist, problems ensue and proper medical advice is sought in retrospect, usually together with a referral for PT (still in retrospect, despite proven ineffective) and a likely suggestion for an MRI scan, a positive confession for the lack of diagnosis, sometimes even the inability for clinical thinking.
Correct treatment requires correct diagnosis. Without a proper diagnosis it is highly unlikely that the treatment will be efficient, whether “physical” or not. Most important component for a correct diagnosis is the clinical examination. The imaging tests merely confirm the already established clinical diagnosis. However, in case of likely operative treatment, the detailed imaging control is mandatory, in order to avoid surprises in the form of “random findings”. One of them is the increasingly common “bone marrow oedema”.
Gait analysis is a functional examination, recording the forces exerted on the sole of the foot either during standing (static analysis) or while walking (dynamic analysis) and it requires the use of a dynamic plate or in extreme cases even more sophisticated equipment. The results are visualized in two and/or three dimensions and with the use of a thermographic scale the pressure distribution on the sole is perceived and the points of pathologically increased pressure are identified. These are usually responsible for the corresponding pathology, which may be relieved with the use of orthotic insoles.
However, it should be made clear that the information given by the Gait Analysis per se, without the clinical examination by an experienced MD and auxiliary imaging tests, is inadequate for a complete diagnosis and an effective treatment. Orthotic insoles or, in extreme cases prescription shoes address only the mechanical component of the disorder.
The importance of gait analysis also extends to more distant disorders, such as degenerative osteoarthritis – OA of the knees, possibly even hip and spine OA. There, the restoration of a normal gait pattern and the normalization of the pressures exerted on the sole of the foot and transmitted to the knee, hip and spine, will lead to spectacular relief of symptoms, especially when combined with other approaches, in a comprehensive, holistic approach of the patient’s condition.