Use of Video Gait Analysis in Running Shoe Stores

Here's a couple more:
http://ajs.sagepub.com/content/38/3/486.abstract
http://bjsportmed.com/content/43/12/943.abstract

I like this book chapter by Martyn Shorten:
http://www.biomechanica.com/docs/publications/docs/Shorten - Running Shoe.pdf

 

Here's the interesting thing about kinetics of the foot, James: increased pronation of the rearfoot will lead to "increased force medially"; you suggest that trainers with a higher density midsole on the medial side will also lead to "increased force medially", so how do we know whether the increased medial force is an increase in external supination moment without kinematic change or just an increase in rearfoot pronation?


Back to the thread: lets say I'm a shop assistant, I video someone running in neutral shoes and I then video them running in "structured" shoes. Structured shoe number 1) I see a kinematic change= less rearfoot eversion than in the neutral shoe. I think that I have increased the external supination moment via the use of the structured shoes to the point that motion has been altered. Structured shoe number 2) No kinematic change- rearfoot eversion is the same as in the neutral shoe. I know that I've altered external rearfoot supination moment because I understand physics, despite the lack of change in the kinematics. Yet, I don't know what has happened to the internal supination moment moments- has it increased (possible) or decreased (possible) or stayed the same (possible)?

Lets assume our patient has symptoms related to excessive internal pronation moments, for arguments sake lets say it's a tibialis posterior tendonitis. Tissue stress theory would have us reduce the moments that tibialis posterior is providing to bring about rotational equilibrium. Now this is where it gets interesting- which shoe is more likely to reduce the moment contribution of tibialis posterior and hopefully resolve the patients symptoms? Where would you put your money?

 

More research that may be of interest on the subject of running shoes:

 

Right, having given me a headache for the last hour (you click thanks for the heaache can you - admin?) I feel more confused than when I started....but in a nice way as it's god the old grey cells working.

So I would go with the structured shoe....with reservation, as

 

Hi again,
10-30 minutes max.
You have to look at it through a retailer's eyes. This is a promotional tool to give the customer a service value to the cost of shoes.
The retailer would have a shoe in mind when you see the customer ambulates, grabs the two closest competitor rivals(whom may be having an instore promotion at the time) and does a quick comparison to make sure that
a: Didn't make a mistake in the initial shoe selection
b: letting the patient have a slightly different fit and feel selection to choose the one that 'feels right'

IT IS NOT A PODIATRY CONSULT


I would feel that if this process was followed you would have very few people whom would walk out without shoes, so 20 mins to gaurantee a sale isn't too bad in the retailers mind

 

All that in 10 - 30 min WOW!

But lets not get bogged down in all that for the moment, l see your Melbourne, do you know where l could go and see all of this done please?

 

Am I not mistaken that this is the premise of such stores as active feet etc. It certainly is the anecdotal evidence of my patients that go there for their shoes

 

Graig,
you cant'be serious; Just look at the foot, and you know if it's a supinator, neutral or pronator. ou are a magician or so?
I know people with varus-feet who pronate to much, and I know people with normal feet who overpronate or supinate, and there are a lot of flat feet, which run neutral.

I have a sport-shoes specialist shop in the Netherlands, and I know, that ONLY dynamic evaluation of the athlete will give you the right information. The use of a treadmill is not the way(it's NOT the same as running on a firm surface), and the use of a footscan is just a INDIRECT evaluation of a movement. Footscanning is just to impress the customers. A lot of injuries are not pressure-related, but movement-related. For a good shoe-advice you need to know a lot of things: e.g.: weight of the runner/sportsman/-woman, surface they do their sport on, injuryhistory, flexibility of the ankle- and footjoints, foot-type, barefoot running and/or walking gait. And than you have to know the characteristics of the shoes (and you cannot rely on what the factory says), and last but not least the evaluation of the running/walking gait on the new shoes. And when you have found the right shoe, you may sometimes have to use orthotics. I must say, that a lot of podiatrist think they can solve everything with an insole, or just do not know what is the right shoe. The just look at a shoe, and say if it's a good or no-good shoe. Impossible to do so.
I admit, that a lot of running shops just don't know what they are doing. They "cooperate" with a podiatrist just to get rid of people who they sold the wrong shoes to.

 

I was dead serious

I do not know of a single injury that is movement related.

 

This can't be serous to... Overpronation, or to fast pronation, or too much rearfootpronation, or supination (etc, etc) are all movements, and yes on bare feet you will see different pressure patterns, but these are still 2 dimensional, indirect pictures from what is happening.
Forefoot problems are much more related to too much pressure, and than a scan would make that clear. But I don't need a scan for that, just some ink and paper.
A scan is useless in advising which type of shoe is the best for you.

 

Craig maybe sleeping as it´s quite late in the land of OZ but if I put money on it, he may say something like this. Motion does not cause injury to tissue -----> Force cause injury to tissue. So the motion of pronation does not cause injury to tissue the forces required to stop or reduce the pronation moment is the cause of injury.

ps I tried to get a few more ----> in but could not

pps Craig if I have represented what you would had not said, I´m sorry.

ppps are you talking about ink and paper ie the wet foot test CorneHaast, cause thats got about as much to do with fitting the correct shoe as sitting on a horse with your eyes closed. -----> these are my thoughts.

 

Thanks Michael!

Of the ~30 prospective studies that have looked at foot pronation and injury, 29 of them have shown no relationship between foot pronation and injury and the 1 that did find a relationship reported a very weak relationship. Foot pronation is not a problem.

 

Could you list the studies please?

 

Here is a start (It will take a while to dig them all out) (I am working on updating that part of the Boot Camp lectures):
Cowan et al, 1992; Cowan et al, 1996; Brusseuil et al, 1998; Wen et al, 1998; Twellaar et al, 1997; Kaufmann, Brodine & Shaffer, 1999; Michelson, Durant & McFarland, 2002; Giladi et al, 1985; Burns et al, 2005; Hetrsroni et al, 2006

 

Simon,

I've got most of the articles on this list as pdfs (I sourced them all after the last boot camp). Can email through if you like? From memory the one study which showed a weak relationship was the Yates and White article in AJSM which looked at MTSS in the military

IG

 

You were next on my list Griff, you know the address.

 

A wetfloortest is not the same as ink and paper, because on a ink and paper-test you can see the variations in pressure. But I use this only, if one has pain/numbness in the forefoot, and from that I make small adaptations in the sockliners. Only if necessary there will be made custom made orthotics.

 

We are getting off topic. The question was if the video-analysis is useful or just a gimmick/salesman talk. And I say, no it isn't, if that salesman knows what he's talking about, and regretfully there are not many of them. And a footscan is much more a gimmick (in a sportsshop, because they can't interprete any of the data), and just to impress the customer.

Craig,

I've read about those studies, but you should be critical about them. E.g. when they find that on neutral shoes the injury-rates are the same as on stability shoes say absolutely nothing. A neutral runner, put on a stability shoes is at injury risk, and a overpronating runner on a neutral shoe idem.
I hate the term neutral anyway, because some neutral shoes can alter one's running pattern dramatically, so they act not neutral. Neutral is for me, when the shoe changes nothing compared with barefoot running.
As soon as they use in a study for all the subjects the same shoes I disqualify that study. No shoe is the same, and the best shoe for one runner is the worse for the other.

And you are able, by just looking at a foot, what shoes someone need? Than come work for 2 weeks in my shop, and pay me 100 dollar for every customer which returns with problems.

 

OK, I'll jump in here and give this one a shot for my first post.

I'm in the final throes of finishing up my PhD in biomech, looking at 3D motion analysis of OA in the knee following APM surgery, and particularly looking at kinetics and kinematics during gait.

Craig, I believe we may have sat together on the bus out to the Footwear Biomech. Group's symposium in Stellenbosch after ISB last year?

I have also spent the last couple of years working for a running shoe store who work closely with referring pods/physios, and have always prided themselves on offering a specialist fitting service - and who arent TAF.

Until last year, that fitting service would go something along the lines of havign a chat to the customer, finding out what they are doing in their shoes, what their injury history is, what they are using shoe-wise currently (and looking at the wear of those shoes if they have brought them in), and getting them to walk (and then run if they are going to be running) barefoot, to give us a general idea of what sort of shoe we need to be aiming for. Once we're in the ballpark, ideally there'd be a couple of shoes across the brands (let's say Brooks Adrenaline, Mizuno Nirvana, Adidas Salvation) that we would throw on and have a look at, until we found one that looks good on the foot, and feels good for the customer. If they are wearing orthotics with their shoes, we would generally start with a neutral shoe, and very rarely deviate into any medial support unless specified by the pod.

Now, what constitutes "looking good on the foot", I can already hear you ask - yes, it is back to the old rearfoot position...with some points of difference. By getting someone to run back towards you, and observing the front of the foot, it also gives you a chance to see if they are pronating over late, or slapping down. We also try and have a look at the hips, and try to accomodate for people who might be either heavy heelstrikers or midfoot strikers.

Up until late last year, the analysis basically came down to eyeballing them as they run, and relying on staff training to try and keep things consistent across the stores. However, after some discussions with some of our referring pods, we ended up buying some cameras and treadmills, and offering a video analysis service, with me running it as the "biomechanist". It's not pure science by any means, but I do believe the video analysis does offer a couple of benefits that are worthwhile:
- It gives the chance to offer some sort of dynamic analysis. It's not perfect, no, I'm aware of potential differences in gait as compared to overground, but for a runner, I still believe it's better than a pressure plate approach where you do't even get up to a similar pace as you would when using the shoes.

- It gives the patient the opportunity to try and understand what it is we're looking for, and to see the way the different shoes can change things. Gives them a bit more confidence we have actually been looking for something, and not just thrown them whichever shoe gives us the best profit margin in their size.

- The MAIN advantage of the service, as I see it, is that it allows us to give some feedback back to the referring pod/physio. We can email them a video clip of the shoe the patient has ended up in; should they want to try something different, they can ring us back and we will change the shoe over no worries. Rather than the referral to us, we fit the shoe, patient goes off and then the pod doesnt see them for a month or so, by which time if the shoe hasnt been what they wanted, it's tough to do something about it. We are also happy to take footage of a selection of shoes, email them off, and let the referrer make the final call based on the footage.

- For physios, it also allowed us to capture the patients hips if requested, to let them have a look at their running gait at pace for things like TFL weakness, hamstring tightness, quad avoidance, etc.

I will stress that I am not a qualified physio/pod, so all I have ever presented myself as is a biomechanist, and the service is just a video capture service. Beyond assessing the rearfoot position and fitting a shoe, I am not making any other diagnoses/recommendations/assessments of orthotics - I am just capturing and sending back to the referrer.

Analysis is only in the frontal plane - at anything above a brisk walk, without high-speed cameras, the sagittal view of the feet, and even the knees, just got too blurry.

Ideally I wanted to step up to an in-shoe pressure analysis as well, and do it properly - compare different shoes on the treadmill capturing both video and in-shoe pressure data - but for a retail company the cost was prohibitive.

Now, we can all debate the merits of assessing rearfoot postition as means of injury reduction (although I tend to refer to it now as "gait stability", taking itno account the knees and hips, not just the foot) but from an end-user, customer perspective, if they are back to being able to exercise with reduced pain, thats all they care about.

Sorry for the essay, but I hope this gives those who were wanting to know an idea of what the thinking is behind the process.

 

Very true to an extent Craig. It is just another tool used in the big bag of analysis that we can use. At Complete Feet we use it often and find it useful for diagnosis of foot/ankle problems, but also higher up the kinetic chain for footwear Px and diagnosis of other probs.
It is useful as a patient education tool also as they can see for themselves what is occurring for them.:dizzy:

 

Football boots for football maybe a specific squash tennis shoe if pitch on running shoe a little high, nothing for surfing and yoga and leave him in whatever he already has for running if he is getting no symptoms and isnt planning to increase his running significantly (marthons etc)

 

In shops that I know - the treadmill and videoanalysis are used to see how the foot behaves in a new shoe - the goal is to totally (or at least as much as possible) eliminate rearfoot pronation.

 

Nice work... because pronation is bad, he must be the enemy :bash:, I prefer to call pronation "beelzebub" (nice bloke, if a little bit misunderstood and a tad buzzy)......:bang:

 

I've got most of the articles on this list as pdfs (I sourced them all after the last boot camp). Can email through if you like? From memory the one study which showed a weak relationship was the Yates and White article in AJSM which looked at MTSS in the military

Hiya Ian,
any chance you would be able to furnish some of the plebs like myself with a couple of chosen articles from the list? no worries if you cant.
cheers
JB

 

JB,

No problem, get your email address to me and I'll send some your way. Either PM me with it or mail it to me (ian@sportspodiatryinfo.co.uk)

Ian

 

P.S. I'm a huge fan of the all you can eat burger offer in Ghent, that I'm currently getting with this thread.

 

During my student years, I worked in a specialised running shop. Assessments would last from 30 to 45 minutes including testing the shoes outside for a quick run.
In this shop in the south of England, it's a free service if customers buy the shoes, or £15 if they only want the assessment. A podiatrist comes to the shop every other week to provide training about many different issues such as why some tests are done ( STJN, tight calf muscles, 1st MTPJ ROM, etc) and some pathologies that a good shoe would help with. The video gait analysis is not performed to everyone and like has been said, it's a great marketing tool.

The problem starts when the shop assistants (let's not forget that's all they are) give forefoot or /and rearfoot correction to customers. Orthoses (2 degrees of rearfoot posting) are sold as corrective orthoses, but customers are not explaind the limitations of these devices. Heel lifts are sold daily for "tight calfs" but not stretches are adviced as some of the sales assistants are only interested in the bonus they'll get if the sell lots. It's a big conflict of interest for a podiatry student that needs the Saturday job to pay some bills, I tell you.

Craig, you are right, you pretty much make the decission of what level of support the person needs, as soon as you see them walking. You bring down 3 pairs of shoes of that level of support and let the customer decide which one is the most comfortable. The video analysis is another tool to sell and customers LOVE to see themselves running.

 

I discovered this forum a few weeks ago, and found really interesting articles. But I am disappointed about the way some people in this thread look at a good runningshoe advice. Very contradictionary above all: they look very precise at feet, scan here, scan there, marker here marker there, advanced computer-analysis, but than they say: just by looking at feet, I can say which shoes are good for someone. This goes with a flavour of arrogance. Not all neutral shoes are the same, not all stability shoes are the same, but that doesn't matter. (??) Just put a orthotic in the shoe, and it doesn't matter what kind of shoes you wear.
Podiatrists who don't sell shoes, don't know enough about the shoes, which are sold. They only theorize about shoes. Video is not just a tool to sell. In my opinion the foot-scan is a tool to make impression on customers, and a tool to advice as much as possible orthoses.

 

Nice rant CorneHaast. You don't come across as a shoe salesman/woman with an inferiority complex at all...

Wake up and smell the spEVA - none of us have a valid system in which we can accurately predict which shoe is most appropriate (or will prevent lower limb musculoskeletal overuse injury) for a given individual. Fact.

Perhaps as you know more about shoes than most of us (and we only theorise about shoes) you could share some of your knowledge and maybe enlighten us. What do you base your decisions regarding shoe recommendations on? Can you accurately predict the alterations in kinematic and kinetic variables for a given individual in a given shoe?

Look forward to your thoughts

Ian

 

$15 (sorry dont have a pound key) for 30 -45 min! and l thought l was cheap at $85 for an fscan inshoe assessment for my diabetic clients.

Amortization of the equipment and cost of floor space leaves very little for a pay packet @ $15, plus the possible damage to the product as the "possible" client takes the shoe for an "..outside for a quick run..", l guess it must work for them if they are still in business?

 

No, you're not cheap. In the example above, the people carrying out these assessments are untrained shop assistants who earn about £6 per hour, so £15 for 30 mins is good. And what do you tell your diabetic clients following your "in-shoe f-scan assessments" to justify your $85?

 

l only use the system for my at risk diabetic clients, that is my only focus for buying this equipment.

The Fscan inshoe is used (for me anyway) to asses pressure points and trajectory of the current orthosis and footwear, so that l can show improvements/changes that need to be made to my orthosis and rocker soles trajectory to help these at risk client's.

It is then used as a reporting system back to the hospital of current outcomes.

 

Dear Ian, I cannot find the word "rant" in my dictionary, but I suspect it's not a compliment. There is no inferiority complex at all (again I taste a little bit of arrogance), but I'm getting tired of the so-called expertise of some people, but at the same time not being able to give a better advice while using highly advanced equipment. Here in The Netherlands they have tried to give proper running-shoe advice based on the use of this kind equipment. It took hours per customer, and nevertheless the advice didn't make sense. I've seen results. They realised that this didn't work, so they stopped.
In medicine you can't base your treatment on averages, you must know the person you treat.
If I know the injury history of the runner, his weight, his age, his traininghistory, his foottype, the mobility of his relevant lower extremity-joints, and last but not least his running-gait, than I can judge which kind of shoe a must advise. This is something you cannot express infigures, I know, but in years one gets experienced in this.
And therfore I say: you cannot base a shoeadvice just on looking at feet. People with flat feet can run "neutral", but can also severly overpronate. And don't say, that overpronation does not cause problems, because I have seen too often that controlling overpronation solves problems. And no orthotics needed, just the right shoes.

Ian, just look at the posts just under yours. Very impressive in-shoe pressure-equipment, but not knowing what to do.

You have to use your common sense, and think, and not blindly rely on whatever equipment.

As you see, it's not only the video-equipment which we use, but a lot more. But we think it's a essential part.

By the way: a lot of podiatrics do only a static assessment of their patients, and I think this is basically wrong. One may draw faulty conclusions. I've seen people, who had overpronating varus-feet, and injured because of that overpronation, and got orthotics which made the pronation (and the injury) more severe. With the right shoe this was solved.

You said:"accurately predict the alterations in kinematic and kinetic variables for a given individual in a given shoe?" No, I can't, I completely agree with you, but some others cán just by looking at feet:wacko:. And if I a could, than would those variables be nothing more than figures, and say nothing more than when I use my common sense. You rely too much on figures/variables, but you cannot translate those figures to an individual.

I could keep writing, but I'm going to bed now. Greetings! Would like to hear from more people how they think in this matter, so please keep responding

 

That is exactly my point in starting this thread. No one has yet been able to explain how does a retailer decides if a, for example, a Nike Equalon or Asics Gel kayano, is more appropriate based on a video gait analysis? ...and I am not talking about trying the customer in the shoes on the treadmil as MOST shops do not do that. They just do a single video gait analysis and come up with a receommendation. Can you explain what is in the "recommendation" black box that observes the gait and decides between, for example, the Equalon and the Kayano (both a good shoes).

Here is an abstract I presented at the recent WCB:

Here is the data from just one runner:

It was the same pattern for each runner. In the parameter we tested, there was clearly a couple of shoes that were theoretically better and some shoes that were not. For each runner it was a different set of shoes ... is subject specific.

 

@Boots n all: forget what I said in the last post about your scan. I think that in this way you use the added value of a scan: find to much pressure under the foot.

:bash:

 

So what you are saying is that you consider several factors and then make a decision based on these factors + your experience? Just like the rest of us do then. Looks like we are all 'theorising' after all

Erm... here's the problem; it's difficult for me to believe you have anything you can teach me when your terminology is so out of date. (Arrogant enough for you?) May I suggest you read this thread.

That's a discussion you'll have to have with someone else. I do not use in-shoe pressure equipment to advise my patients on what I believe is appropriate athletic footwear for them.

Not where I'm from they don't. If that statement is true it reflects more on the Podiatry profession in the Netherlands than it does the Podiatry profession as a whole.

There you go again with your 'overpronation' nonsense... that thread again: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=39128&highlight=overpronation

I do not understand the point you are trying to make in this paragraph at all I'm afraid.

Ian.

PS Rant

 

No I cannot, because I have must know the runner who is going to use them.

Interesting study Craig. This is what I mean: you just can't do a proper scientific study on the effects of running shoes, because there are so many different runners and so many different runningshoes.
In above study there is a hypothesis made, and based on that some shoes were "better" and other were "less". But that hypothesis could be wrong. Maybe is a faster moving forward center of pressure not always better. Mayby it causes a too fast plantair flexion of the feet, and will the forefoot hit the ground harder. Is see this often with shoes, which are made too soft.

Thank you for your reply.

 

Hi Ian,

Yes, I can agree with that. Because we don't have another way to do it.

Nothing new in that thread, because it's exactly the way I think. I am physical therapist, and I know that podiatrists use different terminology as we for the same movement. And when we talk to an osteopath they use again other terminology. It's not fair to convict me on a different use of terms, if you are understanding what I'm saying. And I have to express myself in a foreign language, because Dutch you wouldn't understand at all

I'm glad with that Ian, but I'm afraid that in a lot of counties podiatrics are only static evaluating. Just go surfing over the internet, and read some other fora. The do that, because they do not take enough time for a proper examination of their cliënt. You are an inspired podiatrist, because otherwise you wouldn't be at this forum, but don't forget, there are a lot of professionals, who rely just on their routine.

I understand. That's probably because I didn't express myself well in English. I meant, that figures from a scan can be anamalous when compared to the average, but that these figures can be normal for the subject. So it is dangerous to depend only an a scan (or a videorecording of course).
I know, you never can be sure, but on the other way, that is the charm of working with people.

Ian.

PS Rant[/QUOTE]

Yeah, maybe it looked like a rant, but not so much as defending myself, but a call to convince the readers, that shoes are different, and the subjects running in them respond different to them. And video-recordings are a great help in detecting that response. Geatings,

Corné

 

I'm confused Corne. You are saying that there is nothing new in that thread (and I'm assuming from that comment that in essence you agree with its sentiment), and you are interacting with Podiatrists on this forum who you know do not subscribe to certain terminology. Yet your writings here are peppered with references to 'overpronation'... Care to explain? For the record you have superb English. But I'd rather read Dutch than read about 'overpronation'

I just don't know what facts you are basing this statement on?

You are preaching to the converted Corne. I doubt many reading here need convincing regarding subject-specific responses. It's kinda what we've been saying all along. Infact I think it's the reason Craig started this particular thread in the first place. Know your audience.

All the best

Ian