Gait Examination: An Important Diagnostic Tool

When I was a podiatry student at the California College of Podiatric Medicine from 1979 to 1983, we learned many clinical skills to serve us well as future podiatrists. We learned how to examine the vascular, dermatological, neurological, and musculoskeletal status of our patients' feet and lower extremities. Instructors presented proper injection techniques and how to safely prescribe pharmacological agents to benefit our patients. In addition, faculty taught the practice of foot surgery so that when we entered our surgical residencies, we could become better foot surgeons.

However, there was one clinical skill that many of us podiatry students spent extra time practicing since we felt, early on, that this clinical skill would be essential for us as future podiatrists. This vital clinical skill that I have practiced, and taught now for the past four decades, is the visual clinical examination of walking and running gait. 

When I teach clinical gait examination, I use a systematic approach to provide the student, resident, or practicing podiatrist with a method by which they can easily perform an in-depth analysis of their patient's gait in a relatively short time. During my gait examination workshops, I first start at the head of the patient and then work down to their feet. We first assess the head position and motion, shoulder height, arm swing, and hip height. One next evaluates knee joint frontal and transverse plane position and asymmetries. Then the clinician looks at angle of gait, subtalar joint function and contact, midstance, and propulsive phase biomechanics, along with any other abnormalities in their gait function. Overall, a skilled podiatrist can accomplish a very good clinical gait evaluation in the office in about a minute, with a wealth of valuable clinical information potentially obtainable during that short time. 

Why do I strongly feel that gait examination is so critical to a patient's clinical evaluation, proper diagnosis, and most effective treatment? The gait examination allows me to detect any abnormal patterns that may arise from painful foot and lower extremity conditions, restrictions in the ranges of motion of any of the foot and lower extremity joints, abnormal foot and lower extremity structure, weaknesses of foot and lower extremity muscles, or any number of central nervous system or peripheral nervous system pathologies. In addition, the clinical gait examination allows me to see asymmetries in gait that may arise from, for example, limb length discrepancies or unilateral muscle weakness, conditions that often become much more evident once the patient starts walking or running in the hallway of my office.

Unfortunately, in our younger generation of podiatrists, many of whom focus more and more on becoming expert “foot and ankle surgeons” than expert podiatrists, the clinical skill of visual examination of walking and running gait appears to be heading on a downward trajectory. As with all other biomechanical knowledge and biomechanical clinical skills in today's younger podiatrists, I feel there is not enough instruction or practice devoted during their podiatry training or surgical residencies for them to be proficient in this important clinical examination technique. Possibly, with the advent of all the other diagnostic tools that today’s podiatrists have available to them today, taking a minute or two of their time to watch their patients walk and/or run in the hallway of their offices may seem such an antiquated and primitive clinical evaluation technique that it is not worth their time, nor potentially helpful for their patients.

Even though many podiatrists may not realize the importance of being able to perform a systematic and thorough gait examination of their patients, most patients do fully appreciate a podiatrist who takes the time to watch them walk or run in their offices. I can’t count the number of times where a patient has been so impressed with my diagnostic approach to their foot and lower extremity problem simply because I took the time during their examinations to watch them walk and/or run, and since none of the other podiatrists they saw before me took the time to do so.

Now is a good time for podiatry schools, podiatric residency programs, and podiatry seminars to spend more time on instruction and offer more courses on gait examination for both our younger and more seasoned podiatrists. There is no other clinical examination technique that can provide so much crucial biomechanical information to the busy podiatrist in so little time.

Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.

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