Findings From a Gait Analysis – How to Move Without Pain

After my second child was born I developed debilitating (and unexplained) foot, ankle, hip, and low back pain that persisted for a long time – until I started to address the weakness and instability starting with my feet. I’ve made a lot of progress since then, but when you’ve spent decades not understanding your body it takes a while to unravel!

So I was very excited to get an in-person gait analysis with Gait Happens for deeper insight into what I can improve. I’ve been lucky to cross paths with Gait Happens founders Jenifer Perez and Courtney Conley many times over the years and consider them friends – but they’re also amazing at helping people get out of pain! Let’s dive right in to what I learned.

Foot Strength Test

We started out with a foot strength test using a dynamometer. I learned from Dr. Conley that foot and toe strength are hugely important for optimal movement and injury prevention – but how much is enough?

They say you want to be able to generate 10% of your body weight both through your big toe and through the ball of your big toe (which measures outer ankle strength/peroneus longus) and 7% through the outer toes.

So the dynamometer gives you a very real look at whether you have adequate foot strength for your daily life. Here were my results:

	Goal	Actual Right	Actual Left
Big Toe	10 lbs	10 lbs	7 lbs
Ball of Big Toe	10 lbs	13lbs	5 lbs
Outer Toes	7 lbs	7 lbs	7 lbs

My right foot is on the money in terms of strength. But my left is significantly weaker! And the funny thing is it was my right foot that was injured and painful for so long – to this day it still is prone to issues and has arthritis/joint damage. So it may be that my right side is carrying too much of the burden!

So the strength of my left foot is going to be a focus for me now. I will continue doing this ToePro exercise, but with extra reps on my left side only to help even things out.

Gait Analysis

After the foot strength test we moved to the gait analysis on the treadmill. Oftentimes a static assessment only gives you partial understanding – you may present one way standing still, but then move in an entirely different way. And since a lot of the time our pain comes with movement, it makes sense to look at the body in motion.

Jen took slow motion video of me walking on the treadmill from all angles and was able to show me immediately a few things she noticed. The biggest red flag here was that I lift my toes a lot, especially on my (weaker) left foot.

This is called extensor substitution because the extensor muscles that lift the toes are doing what the tibialis anterior muscle (that flexes the ankles) should be doing. Extensor substitution can suggest limited ankle range of motion, but that’s not the case for this hypermobile girl.

Dr. Perez confirmed with a strength test that I actually just don’t have a lot of strength in my tibialis anterior, which runs up the front and side of your lower leg. In layman’s terms: I don’t have the strength to lift my foot high enough to clear the ground without extra help from my toes lifting (toe extensor substitution).

To work on this musculature imbalance I’ve added in these weighted tibial lifts. I’m also trying it with an elastic band under the direction of my physical therapist (good if you don’t have a kettlebell). This should help even things out so that nothing is being under or overused.

Another finding from the slow motion video was that I have medial heel whip – my heel whips in to the midline of my body when I lift it off the ground instead of staying straight. This finding (and the solution) was confirmed in the next step: a pedograph.

Pedograph

The 3rd component to my gait analysis was a pedograph. I walked over a special stamp that left a foot print on paper – the shading shows the pressure distribution through my feet as I walk.

My pedograph shows less shading under the big toe portion of the ball of my foot. Because in the dynamometer strength test I had good strength on my right side and significantly less strength of the left side, this relatively even pressure on the right and left suggests that I have a patterning issue. Meaning that regardless of the strength I have, my peroneus longus (that muscle on the outer ankle which helps the ball of the foot stay down) isn’t as involved as it should be in the gait cycle. This makes a lot of sense, as I get intermittent outer ankle pain – right where peroneus longus runs.

I am already going to be working on improving left foot and ankle strength, but for this in-motion issue I need to practice using peroneus longus more in-motion. To specifically help with that, I’ll be adding in this Peroneus Longus Patterning exercise.

I think this one will give me lot of bang for my buck because of how important the big toe is for good gait – and since I hope to take many thousands of steps every day for many more years to come, I’d like to have good gait.

Hip Assessment

The final piece was assessing my hips/pelvis, because this can affect and be affected by everything down the chain. Jen found a strength discrepancy between my left and right hip (unsurprising at this point), and that my right hip is rotated forward. I’ve known about my hip issues for a while, but only recently have begun to actively work on balancing the strength between both sides. I’ll be adding this exercise back in to work on improving symmetry and alignment.

What I Learned

My key takeaways are that I have a few areas of weakness that should make life easier by addressing. I totally did not have tibialis anterior/shin strength on my radar, so it was very helpful to have that weak link made known to me.

And the patterning issue of not getting enough pressure under the ball of my foot during the gait cycle also made a lot of sense given what has been hurting. I walked away with a few very actionable insights and I am excited to see where it takes me. Thank you Gait Happens!

Gait Happens provides virtual consultations as well as in-person consultations via their local practices – Total Health Solutions and Kinetic Chiropractic, both in Colorado.