Gait and stance help

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Hi

Looking for a bit of help here.

I tend to take the view that it is not possble to ascertain a persons dynamic movements (heel strike, leg swing etc) by observation of them in stance. Has anyone got any studies that may support or disagree with this view. Indeed any comments would be valued.

There is a significant reason for the enquiry.

Thanks

Ian

CRAIG:CONGRATULATIONS ON THE 2000 MARK!! THANKS FOR THE HARD WORK

 

Ian

I would say there are many things that one can make assumptions about regarding the persons gait when observing them in resting stance and also many things one can't.
For instance if the person stands with a toe out and max pronated posture then it is unlikely that they will become toe in and supinated in gait.
If one assesses the STJ position/ orientation then it is a good indication of how plantar pressure will progress especially if you examine plantar lesions, or shoe wear, as well. On the other hand if one does not ascertain the STJ orientation it may not be possible to make assumptions, by observation of the dynamic gait alone, about how the plantar pressure progresses.
People who have a large exostsis causing hallux rigidus are unlikely to have a flexible 1st MPJ in gait and will probably toe out in compensation in gait.
One might say about someone who has a pronated left and supinated right foot and a low right hip that it is quite likely they will have early heel lift on the right foot especially if other observations like plantar callus lesions patterns, pathology and pain location are taken into account.
The examples could go on and on but at the end of the day static observations are only one part of the total analysis which for some may include sophisticated technology to back up dynamic and static observations.


Cheers Dave Smith

 

Hi David

Thanks for the reply. I would concur with much of what you say there with the rider that it is essentially an educated guess and at the end of the day the variables are huge. I probably phrased my query badly because I was meaning to address the question of can we determin what a persons "running action" will be like based upon stance position alone, indeed can we tell what it would be like even based upon walking lone? That is, we have no access to observations of:

plantar lesions
levels of shoe wear
muscle imbalance
pelvic levels.
And they are fully cloathed

Just an ordinary person stood in the street. At best we might have seen them walk a little.

Thanks
Ian

 

The problem with any gait analysis is that it is only telling you the foot and limb motions (and most motion happen so fast that the eyes can not pick it up). Slow motion video (and there are some good computer based digital ones now for routine clinical practice) can allow you to see more....but the big problem is that its looking at MOTION. Motion does not damage tissues (forces do). Static stance evaluation only tells you POSITION - not motion and not forces.

We also now know that foot orthoses changing foot motion and position is not associated with outcomes (we still do not know what is, but its most likely changes in forces are associated with outcomes) ... so any sort if gait analysis and static stance eval is close to useless for providing valuable information for clinical decision making, but is a good teaching tool for students and patients. Being able to measure the forces provides more information for clinical decision making....fortunalty some forces CAN be made during static stance eval, but just more work is needed on them.

 

Hi Craig

Thanks and I understand what you are saying.

Not wishing to be a nusiance but:

Essentially I am after opinions (or papers) as to whether it is possible to determin a persons (ordinary in the street as described above) running action based upon their stance position.

If not then why not?
If so then how and to what degree of accuracy?

Personally I do not think it is reliably possible but other opinions would be welcome.
Thanks Ian

Althougha lot can be gained from observati

 

There are a number of studies that show that static measures (ie most of what we do) do not predict dynamic function. Will have to dig reference list up later as just on way out door to do something healthy

 

Hi Craig

What's that? have a BBQ, sink a few tinnies?

Those papers would be great.
Perhaps when I complete a degree I will at least be able to ask questions better!

Cheers
Ian

 

Does the dorsiflexion lunge test and/or 1st MPJ ROM fall into the catergory of a static measure? If so, I am sure most of us could extrapolate what range of pathomechanical compensation could result in the subsequent dynamic function testing.

 

Ian:

I do not know of any method or studies relating to the correlation of the position of the foot in relaxed bipedal stance relative to the kinematics of gait of the foot and lower extremity. In looking at tens of thousands of feet over the past 20+ years, I would say that there is some correlation of position to function, but there is no way currently to accurately predict function by only taking relaxed bipedal stance measurements.

Dynamic function of gait will always be difficult to predict from static measurements since dynamic function is determined by absolute muscle strength, muscle moment arms to joint axes, neurological function, passive stiffnesses of the foot and lower extremity joints and gait speed, to name a few. I imagine you would just as well try to predict how a car would perform during driving by looking at it, parked on the street.

This is the main reason why I always stress the importance of gait examination of patients when assessing the etiology of a patient's injury when I give lectures on the treatment of musculoskeletal pathology of the foot and lower extremity. There is absolutely no substitute for doing a "test drive" of the patient up and down the office hallway, just as there is no substitute for taking a car for a spin before making an assessment of its driving function parameters.

 

Yes. The lunge, first MPJ ROM, functional hallux limitus and supination resistance tests have the only ones that have been documented as being predictive of dynamic function .... will get the ref list later...

 

Thanks Kevin, also Craig and others.

Although all were put more intelligently than I could they reaffiirmed my own views.

Ian

 

Donatelli R, Wooden M, Ekedahl SR, Wilkes JS, Cooper J, Bush AJ: Relationship between static and dynamic foot postures in professional baseball players. Journal of Orthopaedic ad Sports Physical Therapy 1999 29:316-330

Hamill J, Bates BT, Knutzen KM, Kirkpatrick GM: Relationship between selected static and dynamic lower extremity measures. Clinical Biomechanics 1989 4:217-225

Hunt AE, Fahey AJ, Smith RM: Static measures of calcaneal deviation and arch angle as predictors of rearfoot motion during walking. Australian Journal of Physiotherapy 2000 46:9-16

Knutzen KM, Price A: Lower extremity static and dynamic relationships with rearfoot motion in gait. Journal of the American Podiatric Medical Association 1994 84:171-180

McPoil TG, Cornwall MW: Relationship between three static angles of the rearfoot and the pattern of rearfoot motion during walking. Journal of Orthopaedic and Sports Physical Therapy 1996, 23:370-375

McPoil TG, Cornwall MW: The relationship between static lower extremity measurements and rearfoot motion during walking. Journal of Orthopaedic and Sports Physical Therapy 1996 24:309-314

Tis, LT & Higbie EL: Static forefoot varus lacks dynamic correlate. Biomechanics March 1999 pg 51-58

 

Thanks Craig. Appreciate your time.

Ian