Technology in Practice: Video Gait Analysis

Technology is a wonderful thing, and bringing technology into an allied health environment has given better information and education to both practitioners and patients alike. In the last decade the use of video gait analysis has increased substantially within podiatry clinics. The burst of electronic recording devices has coincided with the release of the Apple iPad and SMART technologies which brought easy usability and portability to the medical profession.
The advancement of technologies which has brought these devices into an affordable market has also aided research in allowing better data to be collected about the motion and function of the foot. Notably is the addition of video gait analysis in conjunction with bone pin analysis and a multi-segmented foot structure as opposed to the solid block it was once pinned as.
Of course, the more expensive, laboratory placed, scientific research equipment which supplies quantitative data on three dimensional kinetics and kinematics is by far the Gold Standard. However, incorporating video gait analysis into a podiatry clinic which is capable of slowed content, frame by frame vision, measurement tools and comparative analysis is invaluable to the assessment process in identifying moments during gait which may be contributing to ailments or lack of performance.

A consistent message throughout the literature identifies the fact that video gait analysis cannot be completed in isolation. This is primarily due to three major concerns;
1) A misunderstanding or misinterpretation of what a normal gait may in fact look like. This is due to the teachings and interpretations of teaching through various allied health professions, with each physio, osteo, podiatrist and exercise physiologist having various belief of what constitutes this from a visual aspect.

2) Inter-rater reliability and repeatability was often identified as being questionable to poor, this was mostly dependent on the perceived establishment of the gait analyser and the theory of biomechanical function in which they follow.

3) Visualized movement coinciding with a contributing risk factor for a condition does not necessary correlate as there is not a measurable way to through pure video gait analysis to assess the of tissue stress which occurring.

To combat these identified factors (IV) proposed 6 areas which should be assessed when completing a visual gait analysis in practice;

• Pelvic Rotation
• Pelvic Obliquity
• Knee Flexion in Stance Phase
• Ankle Mechanism
• Foot Mechanism
• Lateral Displacement of the Body

Visual Gait Analysis as a tool for biomechanical assessment may not be able to be used in isolation, however as a contributing modality for an overall assessment is a much needed addition when comparing it to previous observational gait analysis. Additionally, the recording of material allows the practitioner to sit down with their client and discuss the movements which are taking place and how they may or may not be contributing to their complaint. The more a patient understands about their condition the more likely they are to be compliant to advice which is given.

The retail sector has also taken advantage of the increased affordability of assessment technology with shoe stores such as “The Athletes Foot” using force plates and motion analysis in store to identify areas of increase pressure and essentially the amount of pronation an individual goes through. This then apparently then correlates with one to three different shoes which you should be wearing. We will look further into my ideology of athletic footwear in another article however, in short my current belief is the addition of a slightly denser foam within a shoe is not going to stop the amount of pronatory motion you just witnessed while barefoot on they pretty screen. Podiatrist and other allied health professionals study how to analyse gait for years and continually review this information to keep it front of mind when assessing a patient. In many cases a retail assistant has completed a short online course or has been trained in store by a manager or store owner who has done short online course. The take away message is wear what’s comfortable! If you have issues, see a health professional and follow their advice.

The literature came across as quite negative when I read over it the first time, however the important thing to be aware of is the research was looking at the video gait analysis as an isolated modality for assessment and not part of a bigger picture. It is about using the available technology to add to the biomechanical assessment as an analysis and educational based tool.

Until Next Time,

Jackson McCosker
Director/Chief Editor

References

Bishop, C., Gunther, P., & Thewlis, D. (2012). Recommendations for the Reporting of Foot and Ankle Models. Journal of Biomechanics, 1 – 17.

Brunnekreef, J., VanUden, C., Moorsel, S., & Kooloos, J. (2005). Reliability of Video Taped Observational Gait Analysis in Patients with Orthopedic Impairments. BMC Musculoskeletal Disorders, 1 – 19.

Eastlack, M., Arvidson, J., Snyder-Mackler, L., Danoff, J., & McGarvey, C. (1991). Interrater Reliability if Videotaped Observational Gait Analysis Assessments. Physical Therapy, 465-472.

Here’s What Actually Matters When Shopping for Running Shoes. (2016, 07 25). Greatist.

Incorporating Video Gait Analysis into Your Practice. (2016, July 31). Australia: SiliconCoach.

Keenan, A.-M., & Back, T. M. (1996). Video Assessment of Rearfoot Movements During Walking: A Reliability Study. Archive of Physical and Medical Rehabilitation, 651-655.

Langer, P. (2011). Video Gait Analysis in Podiatric Sports Medicine. Current Topics in Sports Podiatry, 149-154.

Lee, L., & Grimson, W. (2002). Gait Analysis for Recognition and Classification. The Computer Society.

Toro, B., Nester, C., & Farren, P. (2003). A Review of Observatinal Gait Assessment in Clinical Practice. Physiotherapy Theory and Practice, 137-149.

Why Gait Analysis Doesn’t Work. (2016). Champions Everywhere.