Referral, Clinical Assessment, Biomechanical Examination, and Gait Analysis
Canadian Certified Pedorthists enjoy an excellent relationship with Canada’s doctors and other medical professionals.
A Canadian Certified Pedorthist will conduct a complete assessment which includes, but is not limited to, the following elements:
UNDERSTANDING THE DIAGNOSIS: The pedorthist will assist the patient in understanding their medical condition including the potential causes, contributing factors, and recommended treatments.
CLINICAL ASSESSMENT: The main purpose of the assessment is to determine whether the medical condition with which the patient presents is related to poor foot structure or biomechanics. A thorough investigation includes:
History – It is imperative to gather a thorough history to identify patterns and expose factors contributing to the medical condition. This involves an in-depth inquiry of:
- Symptoms – description, duration, acute or chronic onset, injury patterns.
- Previous injuries – may affect or provide insight into the present state.
- Family history – to identify a potential pattern.
- Systemic diseases – many have a significant effect on the lower limb, i.e., diabetes, rheumatoid arthritis.
- Lifestyle and activities – help determine demand placed on feet throughout the day.
- Occupation – provides information on foot demand as well as footwear requirements.
- Footwear – footwear fit, style, wear patterns, and present condition (new or worn) can affect symptoms.
Biomechanical Examination – Foot structure and lower limb biomechanics are thoroughly examined during both static and dynamic non-weight-bearing and weight-bearing evaluation.
• Non-weight-bearing – determination of foot type; observation of pathologies, deformities, and abnormalities in appearance, structure, joint range of motion (hyper/hypomobility, restrictions/fixations, instability), muscle imbalances (hyper/hypoflexibility, weakness, tone), soft tissue anomalies (hyper/hypomobility, restrictions, adhesions), neurological (deficits/inhibitions/hyperactivity both sensory and motor), and vascularity (circulation deficits/swelling, edema).
• Weight-bearing – observation of foot position, lower limb alignment, symmetry and position of pelvis, overall posture, functional strength, range of motion, and balance testing during single and double stance.
• Functional testing – further examination and testing is tailored to the specific medical condition and presentation of symptoms to more accurately identify the nature of the problem.
Gait Analysis – observation of an individual while walking to identify unusual patterns or function resulting from abnormal lower limb or foot structure identified during examination. Each phase of the gait cycle is analyzed for irregularities and asymmetries of left to right:
- Heel Strike – referring to initial heel contact;
- Midstance – referring to full foot contact;
- Propulsion – referring to push-off; and
- Swing – referring to follow-through.
Evaluation – All of the information above must be considered to determine: (a) whether foot structure or alignment is playing a role in the presenting medical condition; and (b) whether a foot orthosis, footwear, and/or footwear modification is the appropriate method of treatment.
Only after a complete and thorough assessment of the feet and lower limbs can the most effective treatment solutions be determined and orthotic devices be designed. Such assessment is best conducted by a practitioner who has extensive training and expertise, such as a Canadian Certified Pedorthist.