Notes on Computer-Assisted Gait Analysis in the Amputated Foot

In her session at the American College of Podiatric Medicine meeting, Dr. Landau dove into the role of computer-assisted gait analysis in a post-amputation population, including the possible biomechanical, orthotic fabrication, and functional benefits.

In general, why is gait analysis post-pedal amputation so important?

The loss of function and resultant compensations that occur when a patient undergoes an amputation are both obvious and subtle. With computer-assisted gait analysis, the subtleties become much more obvious and quantitative. Identifying discrepancies in the temporal data of the gait cycle is very important, aside from just identifying areas of peak pressure. Neutralizing asymmetry is the goal to achieve optimum function to prevent overtaxing the superstructure. 

What challenges does this pose to clinicians and how might computer-assisted gait analysis help address these challenges?

The temporal data is unable to be assessed by the naked eye, unless there is an obvious discrepancy. Computer-assisted gait analysis bridges this gap with its technology by revealing the asymmetries, and not just peak pressures with quantitative data.

Can you share any brief examples of when this technique made an impact on patients?

With fabricating devices post-amputation and utilizing computer-assisted gait analysis to improve the orthoses’ function, I found that I was able to make both limbs function more symmetrically and within normal ranges, which were not present before. This included making the device for both the side with the amputation and the contralateral limb function optimally, which is the goal. As a result, patients can better keep their speed and independence, with less overtaxing of the proximal joints and posture, into their older years.

What one thing can DPMs do today to begin to incorporate this option in their practice?

Too often I see clinicians avoid observational gait analysis. I often start my visit by watching the patient walk into the room before I examine them and the amount of data that is revealed is astounding. I encourage those to not discount or discredit the value of observational gait analysis. And although observational gait analysis has been shown to be an unreliable indicator of foot function, it will reveal gross abnormalities or obvious irregularities. Video gait analysis, which can be done with your phone, will at least give you a record to review and compare for future visits. The purpose of the foot is to move the body, so I find that observing gait is the least invasive way to assess a patient's mobility. It is not without its drawbacks, as you can't see inside the shoe or under the foot and the events occurring at those times, therefore you can't measure the temporal data or observe peak pressure. That is why you need assistance, such as with computer-assisted gait analysis, to see these forces in the time in which they occur. 

Dr. Landau is fellowship trained in gait-related disorders of the lower extremity in children and adults and is an Assistant Professor of Orthopedics & Pediatrics at The New York College of Podiatric Medicine at Touro University in New York City.