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Best Equipment for Gait Analysis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by EstebanP, Oct 4, 2014.

  1. EstebanP

    EstebanP Welcome New Poster

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    Hi, I am a GP setting up a multidisciplinary private practice. I am looking to create a specialist gait analysis lab for a podiatrist but am unsure about what equipment is needed.

    I have spoken to a few podiatrists who have said video gait analysis is the best option so all I need is a treadmill and video camera. Others have mentioned pressure plates, force plates and 3D scanners as essential, while another stated all I need is a long corridor and a good podiatrist!

    Any advice from people currently using any form of gait analysis equipment would be greatly appreciated.


  2. Craig Payne

    Craig Payne Moderator

    Everyone is going to have their preferences and biases!

    There is no data on linking the nature of the gait analysis to better outcomes, nor are there any standards for 'best practice'

    As I keep challenging people to think: Does the information you are deriving from doing this have the potential to change the intervention that you choose to use. A good gait analysis "method" or "system" has to have the potential to change the intervention, otherwise it was a waste of your time, patient $'s and probably unethical. This means that whatever system you use, it has to give a good return on that potential to change the intervention.

    The range could be (from less to more sophisticated):
    1. No gait analysis (=epic fail)
    2. Visual gait analysis in longer corridor (or outdoor area if running)
    3. Visual gait analysis in longer corridor with video (esp iPad with Coaches Eye)
    4. Treadmill
    5. Treadmill with video and software for analysis (eg Silicon Coach; Dartfish; Contemplus; Kinovea; etc)
    6. Multi-camera set up for (5)
    7. Pressure platform (harder to do before and after intervention
    8. In-shoe pressure system (can do before and after intervention)
    9. 6 + 8
    10. Marker based tracking system on treadmill
    11. 6 + 8 + 10
    12. 3d system with force plate
    (please do not quote me on this list as its basic and i just did it off the top of my head)

    The further down the list, the more sophisticated and the more expensive....and each has their fan boys

    The question then has to be, how far down the list to go before the "return on investment" in terms of better patient outcomes is not worth it?
    The answer will vary depending on personal preferences and biases in the absence of data - there are a few clinics around doing (12) and when I ask them how things are going, they rave about it!

    My personal preference for a new clinic that is not doing high volume of biomechanical assessments would be (3) - you can video them on the iPad and freeze frame it using Coaches Eye.
    If the clinic was busier and doing a lot of biomech assessments, then I would go for (5)

    IMHO, I would only go further down the list if the clinician was more "expert" and more complex patients with intractable problems are going to be seen more often.

    A really neat study would be to assess the incremental improvements (if any) in patient outcomes if more expensive systems further down the list was added.

    There are some other threads on equipment etc here.

    Estaban, as you in the UK, check in with Jonathon at Mar Systems.
  3. Craig's list is a good start but picking up on the point above, a good podiatrist without any equipment other than their eyes may provide a better gait analysis than someone with "all the gear, but no idea". Having the technoogy is one thing, correctly interpreting the data it can provide is another.
  4. Jose Pérez

    Jose Pérez Active Member

    What is your opinion about optogait or bioval systems?. They are not so much expensive.
  5. Craig Payne

    Craig Payne Moderator

    They are both good systems, but in my list above I would put them around 8 to 10.

    The only question I have about them (and other systems that are above 5 in my list) is what is the cost benefit in terms of improved patient outcomes using them above using a system that is 5 to 6 in my list?

    I not convinced that the cost/benefit is worth it unless you are managing a lot of the more complex problems.

    BTW, when i say cost/benefit, I mean:
    Cost = $ and time involved in setup and anaylsis
    Benefit = improvement in patient outcomes better than if you had not used the system

    For eg - you decide that foot orthotics are indicated and do an assessment to come up with the prescription variables and design features needed for that patient. My question is that if you do a gait analysis with one of the systems further down the list, has the outcome of that gait analysis changed that orthotic prescription? If not, then there was no cost/benefit as you still going to do the same as what you would have done without it ..... and charged the patient money for it!

    Same for a video gait analysis in a running shoe store - did the decision as to the running shoe recommendation change as a result of the gait analysis?
  6. Dr. Steven King

    Dr. Steven King Well-Known Member

    I did see any emg references.?

    It may be beyond this lab but one good way to determine the functional outcomes of your modalities and interventions would be to see what the muscles are up to too.

    I really wish someone could come up with a good system that measures in shoe and external shoe characteristics at the same time. What is happening on both sides of your shoe/Orthotic??

    A hui hou,

    ASTM F13 and E54 committees
    Co-PI. SBIR A11-109 US DoD

    HUGHESA1 Member

    Thats a very easy one to answer, you would be better off paying more to an appropriately educated and experienced Podiatrist using the Mk 1 eyeball. Bells and whistles are fine and can be impressive but all they really dop is genertae data which still needs the above to be interpreted and acted upon appropriately.
  8. EstebanP

    EstebanP Welcome New Poster

    Thank you for all the information, it has been very useful. Due to limited space in the clinic we have decided on the treadmill option with 2 cameras. My last question is in regards to the type of software for viewing the video, does anyone know of any free or low cost good software that is compatible with an iPad or MacBook? Craig you mentioned Coaches Eye, I will have a look at this.


  9. EstebanP

    EstebanP Welcome New Poster

    Ah I missed the other softwares you mentioned Craig, Dartfish seems like a good option.


  10. Craig Payne

    Craig Payne Moderator

    Its a app for iPhone/iPad that only costs a few $ - more than adequate. I use it a lot as I can carry it with me! - great for workshops as I can video someone and then connect iPad to projector for discussion.
    I left that out as I do not know anyone using that in clinical practice, and if they were exactly, what they do with the data to potentially change the intervention/prescription above what they might have done anyway without the testing.
  11. Griff

    Griff Moderator

    Top three apps which are either free or very cheap (and allow quick and dirty analyses) are definitely Coaches Eye, Dartfish and Ubersense.
  12. Ballantyne_23

    Ballantyne_23 Member

    I have found instead of using 2 cameras, two tripods and expensive computer software with annual license Fee's, buying one Ipad with the free Ubersense app is much more cost effective. You can build two wooden 'slot's' to fit the ipad, 2 meters away from the treadmill both in the saggital plane and coronal plane.
  13. Andrew Clarke

    Andrew Clarke Member

    Thanks for this Craig. As a Dartfish "struggler" aka techno-peasant, I am going to download Coaches eye for android onto my Samsung, to see if it make a difference to my patient interactions.
  14. Hi all!
    I also agree with Craig's list; in my humble opinion, I'd add to the cost-benefit ratio the importance of explaining and showing the patient their outcomes in a visual way, and I think video analysis and pressure platform are the most intuitive and easy ways for them to understand.
    And about specific systems, we use the Kinovea free software to record and play video, with two HD webcams (about 70€ each), and a High speed photo camera [http://www.casio-europe.com/euro/exilim/exilimhighspeed/] (about 250€) for runners, in a treadmill.
    And I've found recently a cheaper option, consisting in a Playstation 3 camera [http://www.amazon.es/Sony-Eye-Camer...500524&sr=8-10&keywords=playstation 4 camara] you can get in Amazon for about 13€ with nice resolution and speed.
    I hope it helps... And good luck with your new adventure!
  15. Petcu Daniel

    Petcu Daniel Active Member

    There is a point where the eyes are not enough for a good podiatrist ?

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