The key to getting good results from treatment is having a good diagnosis and a good understanding of how the problem has occurred. I see so many posts on Facebook groups, etc from people asking for advice on say, ankle pain and then a big list of ideas that have worked for someone or other. We know this is a hit and miss approach that we cannot use in the clinic – surprise surprise. We need information – that is why when you come into the clinic I may talk to you for quite some time. I am building up a picture of what the problem feels like when it hurts, what makes it hurt, what were you doing days, weeks may be months before the problem occurred, even an old injury that happened years ago might be making its presence felt. This collecting of information is so important.
We then move on to the assessment and this helps build the picture of what I think is going on and why you are presenting with the issues you are presenting with. I will palpate the area of pain but also other areas that I feel may be connected. I move your joints and feel how they move, I will ask you to do specific movements and judge both strength and quality of the movement. Then I will ask you to walk and/or run. I will look at how you move and how this may relate to the problem you are coming to see me about. I can video and then we can look in more detail and you can see what I am talking about. Then we can discuss what is happening and what needs to happen to sort out the problem. The one thing that is missing from this scenario is data on how you are loading your feet when you move over them. How much pressure you put on each foot and where this pressure is distributed on each foot. How do you move from contact to toe-off – or do you even toe off? Now I can access this information.
This is me on a 15 second balance. Slightly more weight on the left rearfoot and right forefoot. This would make sense as my pelvis can get rotated in this direction and need some chiropractic intervention!
I have used pressure mats in the past as well as in-shoe pressure insoles. There are issues with all of these systems with data and usability. I have been keeping an eye on this updated system and now think it is time to add it to my clinic and offer it as a service to help with coming up with treatment plans. It can also be used to give some good data on the effectiveness of treatments and make sure we are doing all we can and show you are progressing. This system also has a built-in program to help with designing 3D Phits orthoses. I have come around to these and think that they have certain features that complement the ones I currently use. I now feel I have a range of orthoses that will suit most situations. I can use the data from the pressure analysis to help design all the orthoses I offer, this is something I am looking forward to using.
So the system I have invested in is an RSScan pressure mat. This is 1m long and contains 8000 sensors. It is powered by the laptop and so I can take it outside (weather and ground conditions permitting) to look at some proper outside running data. Mostly it will be used inside! To start we will always go through the full assessment as usual. We need this information before we start to look at the pressure data.
Once we have the biomechanical assessment information I will ask you to stand off the mat barefoot, relaxed and looking straight ahead. We capture a snapshot and then do a 15 seconds recording of you standing still – or not standing still. This will tell us how much pressure is on each foot, and which bit of each foot, the angle of your feet with regard to your pelvis, how much you move in each direction. The total amount of movement of your centre of mass can be calculated in all directions. We can then look at you doing a variety of exercises to use as a baseline before treatment but also if there is any issues with particular movements. So I may ask you to do a squat and if there is a restriction in an ankle, knee or hip we shall see how you compensate in both the squat and how you stand up again. We can do any exercises on the mat, single-leg squats, deadlifts, jumps, hops, even press-ups! We can see if you favour one side over the other or how you land and leave the ground. It all builds up information we can use to understand why you are having the problems you do.
This is my 15 seconds right foot balance. We can see how much I move as we can play in real time, but also have some data in the boxes regarding the location of pressure and how much I moved during this recording. Good for comparison of left and right and post treatment.
I will then ask you to walk over the mat a few times. We need about 6 good foot prints per foot. The software knows what a good footprint looks like and will discard anything that is not suitable. You just walk up and down and try to walk as normal as possible. This is the hard bit but with a bit of practice seems to be ok. You can also run across the mat in shoes as well. Most of the clinics have enough room to do this inside, just about.
There is a whole load of data we can look at. The angle of your foot strike in relation to your hips and knee, the progression of the centre of mass over your foot – so do you fall inwards towards the arch or go to outside of your foot. Even if you move one way then the other, we shall know. Which bit of your foot hits the ground first and with how much force, so if you are trying to change a foot strike we can see this, we can also see the loading rate. These two things go together and can be difficult to see clearly on video alone, but combining the pressure data and video gives us a huge amount of information.
Their software will place sensors on the main areas of your feet and we can look at how these are loading with regard to timing and amount of load. This can be useful when looking at why a certain area of your foot is painful – like ball of the foot pain. We can also show before and after treatments to see if we are reducing the pressure on a particular area. The timing of the load over a big toe can also give us information on how you are moving into the push off phase of your gait cycle.
This is my dynamic foot scan, there is a lot of data and this is just a bit of what we can see. Left foot slightly turned out, Centre of pressure line closely follows the centre of foot bisection, spend too much time on my left heel and have a funny little blip on both big toes (blue line on the graph on the right). There is a big difference in the way I load my left foot to my right, and my right looks a more ‘normal’ graph but my gives me more trouble! This is why history and discussion about what is going on is so important!
These are the main things we can look at. The data is kept and we can use it to check on progress further down the line following treatment intervention. A full report can be sent to you explaining what we have seen and what it means.
We can also use this information to help design any of the custom orthoses I use. The software is linked to the Phits 3D orthoses and will provide suggestions on what it feels is required. We can go with this or override. I have been using this information to help design the Podfo orthoses as well. These are also 3D orthoses but use a different manufacturing process. Both of these orthoses have features that I feel may work for you in more efficient way or suit your lifestyle or function. This will all be discussed at the time.
There is no obligation to feel that you need orthoses either. The gait scan data will provide us with information that will help with hands on treatment and/or rehabilitation exercises. I may be able to reduce pressure on a forefoot area with manual therapy and rehab exercises in many cases. Not everyone needs, or wants to wear orthoses. They can help, and for some people, will be of a huge benefit, but there are different ways to come to the same outcome.
Hopefully this gives you a flavour of what we can do with the scan data. There is a whole lot of information from a very quick process. Something we can use at the time to give us more information to help understand why you may be getting the problems you present with. Also to come back to at a later date to compare with once you have undergone some rehabilitation.
I receive a lot of information regarding loads of equipment and things that will help make my practice better, to obtain better outcomes and get you all back pain free. I cannot take them all, no one can. So I have to sift through and see what I feel is actually going to help me allow to me to work in the way that I want to work. I want to be happy with what I am offering and working in a way that I am happy with. I know this will not suit everyone and that is fine. It would not work if we all worked in the same way – where would that leave us if something doesn’t work or we do not like the way the treatment effects us? But if you feel that this is something that you would get some benefit from then please contact me and I would be happy to chat with you and see if we need to take this further. If you are a therapist and think your clients would benefit from this level of gait analysis then also please get in touch.
This article was written by Accelerate Performance Centre’s lead podiatrist Colin Papworth. Colin’s experience extends to working with professional footballers and their clubs, athletes from within Team GB and also special needs athletes. He is highly regarded as he offers a wealth of knowledge and practical experience.