Gait Evaluation, or the process of watching someone walk or run, is one of the most crucial components to the understanding lower extremity biomechanics. It is so vital to the understanding of the effect of various modalities on function, like the difference between a stability shoe and a motion control shoe for a patient. Whatever you put into someone's shoe, you should always make sure that it affects the gait in a positive manner. I remember my first biomechanics teacher, the famous Dr Harry Hlavac from Mill Valley, CA, inviting all the podiatry students to go out to the sidewalks and malls and just watch people walk. Some of the best advice I ever received. After watching literally thousands walk and run, I can see what is wrong better than laying the patient down and trying to measure something (at least initially).
Gait Evaluation begins the process in my mind of connecting the dots between the pain the patient presents with and the way they walk or run. Remember that the 4 most common mechanical gait abnormalities that can produce symptoms are limb length differences, poor shock absorption, excessive pronation, and excessive supination. This is made more complicated by the fact that patients can have combinations of problems, and these combinations can be different on the right vs. left sides. For example, one patient may overly pronate on the right side, but overly supinate with poor shock absorption on the left side, and this combination means there is at least a functional short leg problem. The human body never gets boring. I try to tell students to see if the gait changes make sense with the injury, and begin treatment. Slowly change that treatment based on the response of the patient. The longer you are doing this the better you become, but there are still many patients who become the teacher as we attempt to eradicate the mechanical sources of their pain syndrome.
Now, if I could ask you to look at the video of Liz walking one more time I will try to point out some of the motions I see. See what you see!! The following observations were made:
- Slight Head Tilt to the left
- Slight Right Shoulder Drop
- Slight Forward Position of the Left Arm/Shoulder
- Slight Increased Arm Swing Left
- Slight Drift to the Left (although sometimes she drifted to the right)
- Equal Hip Motion
- Equal Slightly Out Toed Gait
- Excessive Pronation both sides
- Left Lands Pronated, but solid
- Right Lands More Laterally/Inverted, and pronates more rapidly
- Excessive Pronation needing some correction (right side more than left)
- Functional or Structural Short Leg with left longer and more pronated, possibly needing lift therapy