Have you ever considered that the niggling back pain that’s been bothering you may have nothing whatsoever to do with a back problem? Or wondered why your knees are hurting when you can’t remember injuring them? Turns out that all sorts of aches and pains further north in the body are actually caused by your gait.
We asked podiatrist Mr Mark Foster, a top expert in gait analysis, how he assesses and treats patients with gait problems.
Over to you Mark…
What is gait?
Gait is the way you walk or run. Correcting an abnormal gait early on can help prevent all sorts of musculoskeletal problems later in life.
Gait analysis
Having idly pocketed a piece of chalk from the classroom one Friday afternoon when we were about 13 or 14, my friends and I walked back into town to the bus stop. As we did so, I ran the chalk along various walls and fences. The line it produced was a fairly regular sine wave with the second curve slightly higher and narrower than the first.
Move forward a few years and essentially that is what I am looking for when examining a patient’s gait as they move over the force plate during a Biomechanical Examination. This piece of equipment allows me to see where pressure falls through the feet when a patient is standing still, but more importantly to see where force falls over time, otherwise known as a gait cycle.
Symptoms of an incorrect or abnormal gait
What is fascinating is the range of different symptoms that people present with and to which gait may be either a contributor or entirely responsible. Everything from foot pain to knee, hip and lower back pain are presenting symptoms that I get to see on a daily basis, with the root problem being incorrect or abnormal gait. There are of course many other factors to consider as well, including previous injuries, operations, training regimes and footwear. The challenge for a podiatrist is to tease these apart and work out exactly where the problem stems from.
To get really technical, the foot may be thought of as a 3 point rocker, pivoting over 3 fulcrum points: the rounded underside of the heel, the ankle joint allowing sufficient dorsiflexion/upward bend of the foot so that the body may pass over the foot like an inverted pendulum and the Hallux/big toe is sufficiently dorsiflexed to engage the plantar fascia and act as a timing mechanism to unlock the knee so that gravity can take the leg and swing through to the next step. If that “Uneven M” shaped curve is not occurring then it is possible to see roughly where dysfunction is occurring.
Gait treatments
Treatment is usually with orthotics (in-shoe devices). These are made bespoke for each patient – a bit like a pair of spectacles!
Joint mobilisation: technique used to release a joint that has become partially restricted or immobile.
Dry needling of trigger points: a dry needle is one that does not inject any substance. I use acupuncture needles that have a rounded tip so it can push its way between tissue planes, unlike a hypodermic that has a chisel ended tip and so cuts through.
Trigger points are hyperirritable spots or nodes in muscle tissue, easily overstimulated that can cause localised pain or pain and dysfunction at secondary satellite sites seemingly remote.
Taping: application of tape to support injured areas, muscles, soft tissue etc.
Exercise prescription: exercises given to strengthen or stretch dysfunctional muscles either as a treatment in itself or in support of a treatment regimen.
Steroid Injection: an injection of steroid. The primary effect being as a direct anti-inflammation measure.
To this end, it is sometimes necessary to refer to and work alongside other health professionals such as physiotherapists, osteopaths, chiropractors, and consultant orthopaedic surgeons to bring about full resolution of the gait abnormality. I am very lucky to have a full range of excellent colleagues in these fields to work alongside, whom I regularly refer patients to and from whom I receive referrals. Like most of healthcare, the best outcomes are a result of good teamwork.
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