#pedographs

Accuracy of gait analysis programs and software. This is not meant, by any means, to be an exhaustive or comprehensive review of gait analysis programs or software. To be truthful, we here at TGG have abandoned all of the software programs well over a decade ago, programs that we initially used to help us slow the gait down, measure joint angles and other seemingly valuable parameters. As time ticked on, we realized that we had trained our eyes to see most of what the software was telling us, and we also began to value the third visual dimension that these types of programs were thin on. Then came ipads and iphones and the ability with a mere finger to slow down someones gait, reverse it and play forward again. This was all we needed, and this next statement is key, for what we do for our clients.

We were pleased to see the repeatability and consistency in the data and results as outlined in these 2 selected studies. If someones gait problem is repeating, and the software is consistent, the data should be repeatable. But, here it comes, what you see in someones gait is not their problem, it is their habitual pattern of possible dysfunction. There, we said it again, for the 1000th time. Software has limited value in fixing someones problems, it merely presents data points to quantify the gait they present with. And if the client has pain, the software consistently shows the gait pattern that presents with their problem. Changing their gait does not mean you have remedied their problem, you may have, but you are more likely to have asked them to generate a new compensation around a problematic gait. A compensation around a compensation if you will.

Force plates, pedographs, and the like also fall into this data capture category. These are all tools, tools for gathering information that must be folded into hands-on clinical examination information. One needs all of the pieces if they are to play this game right, using just some of them and negating others is abusing the value of each piece data. And, the result of implementing corrective change without all the pieces is gambling that you have enough data to do it right. So, when did this become a game of gambling ?

Gait Posture. 2016 Jul;48:194-201. doi: 10.1016/j.gaitpost.2016.05.014. Epub 2016 May 25. Accuracy and repeatability of two methods of gait analysis - GaitRite™ und Mobility Lab™ - in subjects with cerebellar ataxia. Schmitz-Hübsch T1, Brandt AU2, Pfueller C3, Zange L3, Seidel A3, Kühn AA4, Paul F4, Minnerop M5, Doss S3.

Time for a pedograph, folks. What do we have here?

To review :

Let’s divide the foot into 3 sections: the rear foot, the mid foot and the fore foot.

First of all, are they symmetrical? Look carefully at the fore foot on each side. NO! the right foot looks different than the left, so we are looking at asymmetrical pathology.

Let’s start at the rear foot: The heel teardrop is elongated on both sides, slightly more on the right; this means incraesed calcaneal eversion (or rearfoot pronation) bilaterally, R > L. The right heel shows increased pressure (more ink = more pressure).

Next up, the mid foot. Similar shapes, more pressure and printing on the left. Did you notice the “tail” of the 5th metatarsal printing, giving it a wider print? This person is staying on the outside of their foot longer than normal, right (more ink) more than left.

How about the fore foot? Lots going on there.

Lets start on the left

Notice the mild increased printing of the 5th and 4th metatarsal heads. Force should be traveling from lateral to medial here, as the foot goes into supination. A relatively normal amount of pressure on the head of the 1st metatarsal.

Now look at the toes. Notice that space between the 2nd and 3rd? This gal had an old fracture and has an increased space between them.

Now how about the right?

Increased pressure on most of the heads with a concentration on the 1st metatarsal. Hmmm…what would cause that? this is typical of someone who has a 1st ray (cunieform and metatarsal) that is hypomobile, such as with someone with a forefoot valgus (as this person does) or a dropped 1st metatarsal head (which is usually rigid, as is NOT the case here).

Did you see that rpinting at the medial aspect of the proximal phalanyx of the hallux (ie. big toe)? This gal externally rotates the lower extremity to push off the big toe to propel herself forward. This is because the 1st metatarsal head hits the ground BEFORE the 5th (as we would normally expect to see, like in the left foot), and because the weight is now on the outside of the foot, she need to push off SOMETHING.

Getting better at this? We hope so. Keep reading the blog and look at some of our past pedograph posts here.

Nothing like a little brain stretching and a little Pedograph action.

This person had 2nd metatarsal head pain on the left. Can you figure out why?

Let’s start at the rear foot:

limited calcaneal eversion (pronation) L > R. The teardrop shape is more rounded on the left. This indicates some rigidity here.

note the increased pressure at the  medial calcaneal facets on each side with the increased printing

very little fat pad displacement overall

Now let’s look at the mid foot:

decreased mid foot pronation on the L. See how thin the line is going from the rear foot to the forefoot along the lateral column? This indicates a high lateral longitudinal arch

Now how about the fore foot?

increased printing under the met heads bilaterally; L >> R

increased printing of 1st met head L >> R

increased printing at medial proximal phalynx of hallux  L >> R

increased printing of distal phalanges of all toes L >> R

 Figure it out?

What would cause increased supination on the L?

short leg on L

more rigid foot on L

increased pronation on the R

Did you notice the elongated 2nd metatarsals (ie: Morton’s toe) on each foot?

Here is what is going on:

there is no appreciable leg length deformity, functional or anatomical

The Left foot is more rigid than the Right, thus less rear, mid and fore foot pronation, thus it is in relative supination compared to the right foot

do this: stand and make your L foot more rigid than the right; take a step forward with your right foot, what do you notice?

Can you feel how when your foot is supinated

can you see how difficult it is to have ankle rocker at this point? remember: supination is plantar flexion, inversion and adduction

Can you feel the weight of the body shift to the outside of the foot and your toes curl to make the foot more stable, so you do not tip to the left?

now, how are you going to get your center of mass forward from here? You need to press off from your big toe (hallux)

Wow, does that make sense now?

What’s the fix?

create a more supple foot with manipulation, massage, muscle work

increase ankle rocker by training the anterior compartment (shuffle walks, lift/spread/reach exercise, heel walking, Texas walk exercise, etc)

have them walk with their toes slightly elevated

we are sure you can think of more ways as well!