There is more to the term “gait analysis,” than meets the eye, said Doug Richie, DPM, FACFAS, FAAPSM. In his lecture at the Western Foot and Ankle Conference, he focused on pearls in gait analysis and noted that several misconceptions exist among podiatrists on the subject.
 
“Many years ago, podiatrists sought ways to be reimbursed for this diagnostic procedure and found that rarely would third party payors cover the service,” he explained.
 
Dr. Richie added that although Current Procedural Terminology (CPT 96000-96004) codes do exist for gait analysis, in his understanding, the codes’ services only apply to studies that take place in sophisticated laboratories that use elements such as video-recorded examination, kinematic analysis, kinetic measurement and electromyography.¹ Whittle dubbed evaluations like the above, that use instrumentation to analyze gait, “clinical gait analysis” in 1996.² He noted that he finds most podiatrists do not utilize or have access to these technologies. Thus, the gait analysis most DPMs are familiar with constitutes “observational gait analysis” or “real time clinical gait analysis (RTCGA).”^3,4 In this style, one typically assesses gait visually and does not use computerized or recording instrumentation.
 
Dr. Richie said that some cite real time clinical gait analysis as one of the most widely used clinical assessments available to podiatrists.⁵ This approach can aid in musculoskeletal diagnosis, formulation of treatment goals, and evaluation of treatment outcomes. Characterization of real time clinical gait analysis has included references to its versatility⁶, and fundamental value as a skill for podiatrists.⁷ However, Dr. Richie went on to say that Harradine and colleagues, in their 2018 systematic review³, concluded that:
 
“Abnormal gait has been cited by many as the cause of MSK lower limb injury and yet there appears no reliable or systematic method by which the majority of clinicians can assess for it.” Additionally, the authors contended that “development of an adult MSK RTCGA tool or protocol could be useful for clinical practice. If types or ‘patterns’ of gait can be recognised, then linking this to injury, aetiology, treatment and outcomes would be beneficial.”³
 
Despite the lack of a reliable tool or protocol for noninstrumented gait analysis, Dr. Richie, founder and President of Richie Technologies, stressed that there is still significant value in watching a patient walk in clinical practice. He pointed out that in just a few minutes, a skilled clinician can determine:

• A patient’s level of mobility or disability during ambulation
• The alignment and motion of key segments of the lower extremity which may contribute to the chief concern or musculoskeletal condition
• How a patient’s footwear may contribute to the pathomechanics of the condition
• The efficacy of one’s treatment interventions for a specific musculoskeletal condition

In the rest of his presentation, Dr. Richie explored the real time gait analysis changes that occur in all three planes in conditions such as adult acquired flatfoot, plantar heel pain, hallux abducto valgus, and neuroma.
 
“Clinicians need to stay abreast of kinematic research of these common foot and ankle disorders in order to determine how certain conditions can affect gait,” he said. “By evaluating gait, a proper diagnosis and treatment plan can be developed. Gait analysis is just as valuable as other tools used in clinical practice such as imaging and laboratory tests.”
 
He pointed out that clinicians could work to improve their real time gait analysis skills by using video recordings with a cell phone or iPad, and don’t necessarily need specialized software, especially as their understanding and proficiency grows. At the same time, he acknowledged, video recording remains an effective patient education option.
 
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References
1.     Coding Ahead. CPT codes for motion analysis procedures. Available at: https://www.codingahead.com/cpt-codes-for-motion-analysis-procedures/ . Accessed May 19, 2023.
2.     Whittle MW. Clinical gait analysis: a review. Human Movement Science. 1996;15(3):369-387.
3.     Harradine P, Gates L, Bowen C. Real time non-instrumented clinical gait analysis as part of a clinical musculoskeletal assessment in the treatment of lower limb symptoms in adults: a systematic review. Gait Posture. 2018;62:135-139.
4.     Coutts F. Gait analysis in the therapeutic environment. Man Ther. 1999;4(1):2-10.
5.     Payne CB, Bird AR. Methods of gait analysis. In: Yates B, editor. Merriman’s Assessment of the Lower Limb. Churchill Livingstone; 2012: 308–320.
6.     Levine D, Richards J, Whittle MW. Whittle’s Gait Analysis. (5th ed) Churchill Livingstone; 2012.
7.     Southerland C. Gait Evaluation in Clinical Biomechanics. In: Valmassey RL, editor. Clinical Biomechanics of the Lower Extremity. Elsevier Health Sciences; 1995:149–179.