Walking on two feet is an evolutionary masterpiece. Watching an infant learn to stand and walk is a strong testament for the careful orchestration of the many systems of the body to produce balanced walking. The fact that we can walk, run and even stand with appropriate balance is unique in nature and a great blessing when functioning appropriately. Slight changes in the process can be very problematic and is often the reason your feet, legs and even hips and back hurt. We have even had patients with neck aches and headaches resolved by adjusting the ambulation (walking) pattern.
The System of Ambulation
To be able to ambulate appropriately, an individual must use coordinated muscle motion and balance to remain upright. The muscle motion coordination includes contracture of the muscles in the back and trunk to maintain correct positioning over the hips during walking. Poor balance is noted by attempting to adjust the trunk position forward or backward to keep from falling or by widening the legs to get a more stable base of gait. Further the sequential contracture of muscles of the hips, legs and feet create steps with appropriate bends at the hips and knees as well as heel strike, rolling through the midfoot area (midfoot stance) and toe off. The arms are likewise coordinated to create appropriate arm swing to assist in momentum and balance.
The foot portion of ambulation is further coordinated into supination (increasing the arch or rolling to the outside of the foot) and pronation (decreasing the arch or rolling to the inside of the foot) patterns. The ideal ambulation pattern combines appropriate combination of both supination and pronation. Ideally, we should land in a supinated position on heel strike and pronate through the midfoot to the great toe (hallux) for toe off. This provides the appropriate shock absorption to limit injury and produce appropriate motion.
Balance is likewise a specialized coordination of muscles as stated above and utilizing of three additional systems of the body: 1) the eyes, 2) the ears, 3)the feet. The eyes provide visual stimulus that ensure the head remains upright compared to the horizon. The ears have specialized hairs in the inner ear that help instruct the brain when the head is not upright. The feet use proprioception (the sensation of pressure to the foot) to determine if one foot is taking more weight to ensure the center of gravity is proportionally distributed over the legs and feet. Loss of any of these reduces the balance of an individual.
Gait Patterns Run In Families
Gait (the pattern of walking) is unique to each individual and can often be identifiable to a well trained eye. That being said, this pattern of walking was inherited from a father or mother and will often be passed to children. A father and a son or a father and a daughter will often stand similar and walk similar, although most gait patterns are progressive and get worse over time. Gait patterns that may be pain free and not causing deformity in children may produce long-term problems that are only seen later in life. Therefore identifying the gait pattern early and providing adjustments or treatments to improve this pattern may prevent the long-term sequelae. Treatment at any stage, however, will provide improvement or slowing of deformities and decreased pain.
What is a Gait Analysis?
Unlike standing on a platform at the store that reads the pressure areas of your foot to provide an insert or even unlike the “specialized” evaluation at a running store to place you in a motion control or neutral shoe, gait analysis is a much more specialized process. It is more similar to the skill of reading an ultrasound or an x-ray and providing the medical direction appropriate to that skill. It is therefore a skill that improves with experience and can be very valuable information for almost every individual. Some specialized information determined from this exam/analysis include:
- Does the individual have a high arch or a low arch? Weightbearing arch height is not always the same as non-weightbearing.
- Does the patient walk intoed (pigeon-toed), outtoed or rectus (strait)?
- What is the alignment of the leg on the foot?
- Is there a leg length discrepancy (is one leg shorter than the other)? This can be a true leg length difference, or the legs may just function like one is shorter than the other.
- Is there appropriate coordination of supination and pronation? Does the individual stay supinated or over-pronate?
- How does the foot function throughout gait?
- Is there appropriate coordination of muscles or is there muscle weakness? Is there stiffness or rigidity to tendons or joints?
- Is ambulation painful? Is the gait pattern consistent with accommodation for a problem?
- Are there balance concerns? Bent over gait, wide base of gait, short or choppy steps.
- Are there neurological concerns? Shuffle gait, difficulty walking, weakness, short or choppy steps.
- What adjustments should be made to the gait pattern to improve and prevent problems?
Pain is never normal. Therefore, evaluation of an individual gait pattern and appropriate treatment can often both resolve foot, ankle, leg, knee, hip and back pain and prevent long-term problems in the foot and ankle. Whether it is through training instructions for an athlete or prescription of an appropriate shoe insert or orthotic device, the goal is long-term, pain-free ambulation. We want everyone to remain active without associated foot and ankle problems no matter the age. Careful gait analysis is the key.