Here’s What Podiatrists Are Really Looking at When We Watch You Walk

“I feel like I’m on a catwalk” is the most common remark we hear when we ask you to walk as part of your podiatry assessment and to be fair, this is actually quite accurate.

All eyes (ie your podiatrist’s eyes) are on you as you are walking so that we can understand why you are experiencing pain and what we can do to fix it.

This is a gait analysis and is a complicated science. Each person moves slightly differently and it is our job to work out how we can get you walking more efficiently.

Your pattern of walking is referred to as your gait cycle.

It begins when your heel contacts the ground and ends when that same heel contacts the ground again.

This is why we often get you to do quite a bit of walking during your consultation (provided you are not in significant pain).

We need to watch the full gait cycle of both limbs to understand how they work separately and together.

During the gait cycle, your limb spends approximately 60% of the time in a ‘stance’ phase and the remaining 40% in a ‘swing’ phase where it is off the ground.

Within that cycle, we are watching how the entire limb moves including your hips, knees, ankles and feet. This can highlight weaknesses and imbalances between the limbs.

When it comes to your feet in the gait analysis, there are certain moments in the gait cycle that we are focusing on. These include:

  • Heel strike – when the heel first contacts the ground.
  • Foot flat on the ground – this is the point where the foot is under the most pressure
  • Heel lift – to begin to take your next step
  • Toe off – when you propel yourself forward
  • Midswing – how your limb and foot moves through the swing phase and prepares for the next heel strike

There are various extremely technical aspects that we are also looking for at every stage of the gait cycle, which would require a few lessons in biomechanics for you to come close to understanding.

So, let’s simplify it a little. Throughout the gait cycle, we are looking for key markers that may help to explain your pain or injury. This includes how the hip, knee, ankle and foot move throughout each of these stages.

Your Hips in the Gait Cycle:

During the gait cycle, we look at the position of the hips as often this can affect the rest of the gait cycle.

We look at the position from each aspect – left, right, front and back.

What we are looking for is how it functions and if there are any weaknesses that can point to other abnormalities such as a limb length discrepancy, where one leg is longer than the other.

Some of the key questions we ask ourselves include:

  • Is one hip lower than the other?
  • Do they angle inwards or outwards?
  • Do they look and function the same or does each hip function differently?

In regards to the gait cycle, the hips play a vital role in helping to stabilise the limb during stance, as well as helping the limb clear the ground and move forward with each step.

The position of the hips can directly affect the position of the knees, ankles and feet.

Your Knees in the Gait Cycle:

As podiatrists, we are often referred to by other allied health professionals when patients have knee pain.

This almost always happens if they have determined that the cause of this is due to their ankles and feet.

The position and function of the knees throughout the gait cycle can impact on every phase of this cycle, including influencing the position of the ankles and the feet and changing the amount of load placed on the feet.

Pain, weakness and injury can alter the way in which they function and therefore forces the rest of the lower limb to compensate for this.

Flexion and extension of the knee joint is crucial during the entire gait cycle. The knee must flex to allow the foot to clear the ground during the swing phase and it must be stable enough to withstand the loads placed up it during the stance phase.

The questions that we ask ourselves when we watch your knees in our gait analysis include:

  • Are the knees facing forwards or inwards/outwards?
  • Is there enough flexion and extension of the knee joint?
  • Are they functioning the same or differently?

Your Ankles in the Gait Cycle:

The ankle joint is what connects the lower leg to the foot and is extremely important throughout the entire gait cycle.

Weakness, injury or instability through the ankle joint can impact on the movement of the hips, knees and feet.

Throughout the gait cycle, the ankle moves predominantly in 2 directions: plantarflexion (up) and dorsiflexion (down).

The movements are crucial to ensure that your feet are able to move through all of the necessary stages including heel strike, foot flat and toe off.

It is also important during the swing phase to assist the knee with ground clearance.

The muscles that run through the ankle joint are responsible for making sure that they can guide the heel to the ground during heel strike and then control the ankle motion into foot flat, as well as allowing your foot to perform toe off.

The questions that we ask ourselves when we watch your ankles in the gait analysis include:

  • Are the ankles stable?
  • Are they moving through the correct range of motion?

Are they straight or are they angles inwards or outwards?

Reasons as to why the ankle joint may not be functioning properly include an ankle sprain, tight calves of a tarsal coalition (fusion of the bones).

Your Rearfoot (Heel) and Midfoot in the Gait Cycle:

In a normal gait cycle, the rearfoot (heel) is the first part of the foot to contact the ground and this signals the beginning of 1 cycle.

The position of the heel at heel contact can affect how the rest of the foot moves through the gait cycle.

If it is either positioned in inversion (inwards) or eversion (outwards), this can affect the way in which the midfoot and the forefoot progress through the cycle.

From heel contact, we then move into foot flat or ‘midstance’, where the whole foot is on the ground. This is where the midfoot is able to stabilise the body, absorb impact and help prepare the foot for propulsion.

Pronation through the midfoot often gets a bad wrap and whilst is it true that excessive pronation can lead to a range of issues, it is also necessary to a degree in order to assist with shock absorption.

The questions that we ask ourselves when we watch your rearfoot and midfoot in our gait analysis include:

  • What position is the heel in?
  • How does this affect the ankle and the midfoot?
  • Is the arch collapsing too much or too little?

How is the load being distributed throughout the foot?

Your Forefoot in the Gait Cycle:

The toes and forefoot are responsible for the propulsion phase of gait – that is, when your toes are flexed and your heels are off the ground to allow you to move forward to the next step.

This is also when the forefoot is under the most amount of pressure, meaning that an injury to this area can begin to affect the way in which you walk.

The big toe is the main driving force to allow your foot to propel you forward.

If the forefoot is not able to do this effectively, other parts of the feet must compensate to allow for propulsion.

The questions that we ask ourselves when we watch your forefoot in our gait analysis include:

  • Which part of the forefoot is taking most of the load?
  • Is the big toe able to function properly or are the other toes recruited to allow for propulsion?

Is there adequate movement through the forefoot?

So, as you can see there are a lot of things running through a podiatrist’s mind when they watch you walk.

This is just a brief summary of the main points that we are looking at but everyone is different and we need to take that into consideration as well.

We are also looking for different things when we watch you running as well!

If you’d like a thorough assessment of your walking or running patterns or are suffering from pain anywhere from the hips to the feet, come in and see us here at Watsonia Podiatry!

You can book in to see us by calling us on 03 9432 2689 or booking online here.

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