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Hi guys,

I was always taught to ask a patient to march on the spot before taking biomechanical measurements (e.g. calcaneal inversion, etc), as this will achieve a normal standing position. I've always wondered if there is any clinical evidence, or at least some anecdotal evidence to show that marching on the spot will give a more "normal" standing position than compared to not doing anything. Anyone out there who can enlighten me? Thanks :)

Matt.

 

What you are describing is theoretically getting the patient into their 'angle and base' of gait for clinical measurements and also for weightbearing x-rays. The idea being that the position should be repeatable, so the next time the measurement is taken the foot is in the same position. eg the calc angle in the frontal plane may be different if the foot is internally or externally rotated in the transverse plane - so if the foot is in its 'angle and base' of gait for both times the measurement is taken, then theoretically we controlled for that variable.

As for evidence, thats another story. ... its just make intuitive sense.

 

When I was teaching, I taught doing the bioeval and gait analysis. The "base" of gait, the distance of the feet are from the line of progression, sometimes was negative and usually smaller than the marching in place "base" of gait. Didn't record the numbers, but I actually looked. I should have looked at how repeatable the "stand comfortably" base of gait is.

The measurement does matter for assessing available range of motion. Decreasing the base of gait will increase tibial varum and thus decrease available range of motion in the direction of eversion. This matters as you usually don't want your orthotic to attempt to evert the foot farther than it can go.

Eric

 

when you ask someone to stand still while you take some measurements, without fail, they will automatically 'stand to attention', or similarly alter their posture thus affecting their apparent base and angle of gait (BOG).

Marching on the spot has the advantage of eliminating any of that subconscious posture/BOG change, people without thinking sink into their natural posture/BOG.

So scientific measurement aside, common sense would suggest that despite whatever faults there may be in marching on the spot, it's far closer to their BOG than not doing it (and more reproducible).