Gait analysis: Exercises or gait altering footwear, which is the most appropriate?
It's not uncommon or unreasonable to have a gait assessment to see if you have any abnormalities when you are walking or running. A gait assessment can identify a plethora of abnormalities and there are an equal number of corrective measures to combat these. Arguably, the most common analogy from a gait assessment is a pronating running gait. But is this diagnosis always the correct one?
Firstly, what is a pronating gait?
Pronation is when the medial arch or instep is markedly reduce or flat footed. In other words, you ankle turns inwards. The opposite is supination
Here is an example of someone who pronates when they run. Note the angle of the red line between lower leg and ankle. The red line isn't straight, it's at an angle as the ankle turns in slightly. Surely some corrective footwear to compensate for this is the answer? It's not as easy at that!
What is missing from this picture is the bigger picture. For an accurate gait analysis, you need to examine what the whole body is doing and not just the ankle.
A gait analysis should also be looking for a trendelenburg gait. This image highlights this perfectly. If we start by looking at the hip and pelvis, we can see that the hip of the leg that is not weight bearing has "dropped". In other words, it is not level with the weight bearing leg. Note how in this image, the person is compensating with trunk side flexion (side bending) towards the weight bearing leg. What the hip, knee and subsequently ankle do is compensate for this too!
This is another good example that highlights what all of the lower limb joints are doing during a trendelenburg gait. Firstly, note the dropped hip. Next, note how the femur (thigh bone) angles inwards. Moving down, see how the knee and tibia (shin) compensate that and send the shin back outwards. Finally, look at the ankle. It finally compensates by pronating! So, although the ankle appears to be pronating, this is a compensatory gait for a hip drop!
This is why people report knee pain and ITB syndrome with running! A hip drop gait or trendeleburg gait is owing to weakened gluteal muscles. Particularly Gluteus medius. This is correctable with corrective exercise. What this situation does not need is gait altering shoes! I have seen too many patients and clients in my clinics following a gait assessment who have been sold shoes that increase the medial arch because they appear to over-pronate. But this causes them blisters and pain. I have had clients frustrated at this because of the time and money spent and have been given ultimately false advise. There are 3 really easy assessments for a genuine pronating gait 1. When stood, does your foot actually pronate?
Do you have a medial arch? Can someone get 2 - 3 fingers underneath this medial arch?
2. Can someone lift your big toe off the ground?
People who pronate tend to over weight bear on the inside of their foot and therefore their big toe. If you cannot lift the big toe off the ground, then the chances are there is pronation present. If you can lift the big toe then this is unlikely.
3. If someone runs their finger down your tibial shaft (shin bone), what toe do you continue onto?
If you have a neutral foot position, you will trace to your 2nd toe. If you pronate, then you will trace to the big toe.
This is a more accurate assessment for pronation. If you don't pronate in standing but you suddenly pronate in running, then ask yourself or the analyst if this is not coming from your hips.
It would be unfair of me to say that all gait analyses give false information, because they don't. But make sure you get the full picture. I have had so many people confused and concerned about what running shoes to buy, when in reality you really don't need to be! If you can relate to this and want further advice, then please contact your friendly, local physiotherapist for an accurate assessment and exercise.
