Simply put; this is an assessment of the way in which our joint and muscles move together as we walk, run and function during our daily activities.
It includes clinical gait evaluation, a fundamental skill for podiatrists. We need to see the global picture of your body at work to assess the role your feet are playing in any dysfunction.
Many spinal problems start at your feet. If you feel pain in your neck, back, hips or knees, begin by checking your feet. Your feet are your foundation; they allow you to stand, walk and run. They support our weight and act as our body's main shock absorbers. Your feet contain one-quarter of your body's bones. Each foot has 26 bones and 19 muscles. Without a solid, balanced foundation the entire body becomes prone to imbalance and injury.
Why do a Biomechanical Assessment?
The basis of a biomechanical assessment is the cause-and-effect relationship between your foot, legs and upper body. Movement at one joint affects movement at other joints, and every time your foot hits the ground to take a step, any imbalance is passed all the way up your body. The foot is the stabilizing base between the rest of the body and the ground. Also, imbalances occurring in the spine, hip and knee can be compensated for by foot function. This may create a foot that is out of alignment or imbalanced contributing to foot pain and injury.
A foot that is not functioning in alignment is not a good shock absorber. This places abnormal stresses on your spine. With every step, shock is transmitted through your body. If your feet are balanced, they can absorb much of that shock. But if they're not in balance, the shock can add strain to upper body structures such as knees, hips and the spine. Over time, your body will attempt to compensate for imbalances. This compensation can occur in the feet or upper body and this imbalance can cause pain in areas such as your knees, hips, pelvis, lower back and neck.
The most effective stabilisation and realignment for your body is based on: the amount of imbalance in your weight-bearing feet, and the amount of physical stress added by your occupation, lifestyle or sporting and leisure activities. Evaluating all of these factors allows your Podiatrist to prescribe the correct support level that will most effectively meet your individual needs.
When do you need an Assessment?
- Do your feet roll in or out? Are your arches flat or high? Do you have bunions, claw toes, corns or callous?
- Are you aware that when you walk you feel lopsided or feel excessive pressure on any particular part of your body?
- Do you have pain associated with occupational or sporting activity that is repetitive and constant?
- Do you have new or longstanding pain in the back, hip, legs, knee or feet?
- Does a particular sporting or occupation activity contribute to joint/muscle overload?
Assessment may be targeted at a particular problem or aimed at prevention. Occupational or sporting activities may be relevant, with biomechanical assessment focusing on these. The Podiatrist will be looking to see if the combination of joint and muscle movement produce fluid gait with no overloading or stress on any particular joint or muscle group and if the basic skeletal structure is out of alignment and therefore more prone to dysfunction and injury.
Biomechanical assessment involves:
- Static analysis: both weight bearing and non-weight bearing, evaluation of joint motion, alignment and muscle tone and strength. Noted is the position and alignment of the body and the relationship between the foot and the ground.
- Dynamic measurement/observation (gait analysis) of joint motion. This focuses on the position and alignment of the foot to the ground during gait. Also observed are upper body positions .e.g. shoulder and hip and knee positions.
The podiatrist has various tools available to help with biomechanical assessment. The most important remains accurate history taking to understand your background of activity and any previous injury or health factors that may influence the way you walk and function. Observation of you standing and walking combined with muscle and joint testing. Assessment may be required in the workplace or during your sporting activity to gain a clearer picture. Other tools include the use of video gait analysis systems where required and a number of measuring devices used to asses joint position and movement.
Factors to Consider
Biomechanical assessment will consider age, mobility and the stresses placed on our bodies as we function
Age: Muscle strength, joint mobility, stages of bone growth or deterioration and wear and tear factors will all be influenced by the age of the patient.
Mobility: Factors such as: joint range of motion, pain, soft tissue (muscle tightness / laxity) vs. structural (bone and joint restrictions), and disease related joint and muscle symptoms.
Stressors: factors aggravating or causing pain, occupational and sporting influences or results of disease: e.g. Rheumatoid Arthritic joint changes.
Postural alignment: Any relationship to leg and back pain, an imbalance in weight bearing on feet, the state of foot mechanics and the influence of footwear.
Genetic predispositions to: medical conditions or structural and physical anomalies that may run in families.
What will it really tell us?
A gait analysis combined with an evaluation of footwear and walking, occupational and sports activities will usually show us the cause of a foot-related injury or area of pain. Often a simple x-ray or general medical investigation would not.
Such causes of pain include: Bunions, sprained ankles and other tendonopathies, shin splints, hip pain, low back pain, plantar fasciitis, metatarsalgia, Achilles tendonitis and bursitis and a leg length discrepancy.
These problems all have a biomechanical cause that is almost always connected with foot function.
Examples of malalignment and overload injury?-pictures, pictures of posture and assessment
Foot pain is not normal and should not be ignored; Podiatrists will often recommend custom foot orthoses as part of a treatment programme.
Podiatrists use the word orthotic to describe a foot-supporting device. They are prescribed to:
- Reduce the symptoms associated with many foot related problems
- Provide support.
- Accommodate foot deformity and relieve pressure on problem areas of the foot
- Improve foot position and the overall biomechanical function of the foot, leg and spine.
Foot orthoses allow the muscles, tendons and bones of the feet and lower legs to function at their highest potential. They can contribute to a decrease in pain by improved stabilisation and body alignment and can aid in the prevention of progression or development of a deformity.
Orthoses can be fitted from a range of prefabricated devices or prescribed and custom made. They can be made from various materials with different levels of flexibility. Your podiatrist will determine which device is most appropriate for your needs. The most effective result will be achieved by the consideration of: the amount of imbalance in your weight-bearing foot and the degree of physical stress created by your occupation or lifestyle. Evaluating both of these factors allows your Podiatrist to prescribe the stabilising support level that will most effectively address your needs.
Some prefabricated orthoses are available over the counter in shops such as pharmacies, but should be purchased cautiously. Care in proper fit of any device that applies force to the body must be taken to bring about the desired results and to prevent any fitting problems.
Who will benefit from the use of orthoses?
As well as providing relief for painful foot problems or an injury, those who may benefit from orthotics include:
- People who must walk or stand excessively at work.
- During active sports participation, orthotics will often enhance endurance, performance and strength.
- For overweight individuals, orthotics can help those who are overweight by reducing extra stress on the feet and stopping minor symptoms from getting worse. Orthotics can help reduce muscle fatigue and promote efficient muscle function. Improved alignment aids propulsion, increasing the efficiency of walking and running.
- Orthotics can be extremely effective in relieving foot fatigue and discomfort associated with arthritic and age related joint changes. They can be customised to include cushioning and deflections for painful weight bearing areas.
- Early intervention for alignment imbalances in children can be essential to avoid the development of subsequent symptoms in adult life. Orthotics may also be prescribed for children who have congenital and developmental foot disorders.
- The use of orthotics is recommended for many diabetic patients, who, due to the risk of vascular and nerve complications require extra foot protection. Orthotics may reduce pressure areas that can be prone to ulceration and protect feet that have reduced feeling.