What components should be included in a comprehensive podiatric biomechanical assessment and gait analysis template?

Comprehensive Podiatric Biomechanical Assessment and Gait Analysis Template

A comprehensive podiatric biomechanical assessment and gait analysis template should include assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity as core components to identify risk factors for foot complications and guide appropriate interventions. 1

Patient History Components

• Medical History:

  • Diabetes duration and control (HbA1c levels)
  • History of previous foot ulcers or amputations
  • Smoking history
  • Cardiovascular, retinal, or renal complications
  • Neuropathic symptoms (pain, burning, numbness)
  • Vascular symptoms (leg fatigue, claudication, rest pain)
  • Exercise tolerance

• Footwear Assessment:

  • Current footwear type and fit
  • Wear patterns
  • Insole/orthotic use

Physical Examination Components

1. Neurological Assessment

• Protective Sensation Testing:
  • 10g Semmes-Weinstein monofilament test at standardized sites
  • At least one additional test from:
    • Vibration perception using 128-Hz tuning fork
    • Pinprick sensation
    • Temperature perception
    • Ankle reflexes
  • Document presence/absence of Loss of Protective Sensation (LOPS) 1

2. Vascular Assessment

• Peripheral Arterial Disease Screening:
  • Palpation of pedal pulses (dorsalis pedis and posterior tibial)
  • Capillary refill time
  • Rubor on dependency
  • Pallor on elevation
  • Venous filling time
  • Ankle-Brachial Index (ABI) if indicated
  • Toe-Brachial Index (TBI) for patients with diabetes or renal failure with normal ABI 1

3. Biomechanical Assessment

Static Assessment

• Open Kinetic Chain Examination:

  • Range of motion assessment of:
    • First metatarsophalangeal joint
    • Midtarsal joint
    • Subtalar joint
    • Ankle joint
  • Subtalar joint neutral position assessment 2
  • Forefoot to rearfoot relationship
  • First ray position and mobility

• Closed Kinetic Chain Examination:

  • Foot posture in relaxed stance
  • Foot posture in neutral stance
  • Arch height and morphology
  • Limb length assessment
  • Knee alignment (varus/valgus)
  • Hip rotation
  • Pelvic alignment

Dynamic Assessment

• Gait Analysis:
  • Spatiotemporal parameters:
    • Stride length
    • Step length
    • Cadence
    • Gait cycle duration
    • Load response time 3
  • Kinematic analysis:
    • Heel strike
    • Foot flat
    • Midstance
    • Heel off
    • Toe off
    • Swing phase
  • Pressure distribution analysis:
    • Areas of peak pressure
    • Center of pressure progression
    • Timing of peak pressures

4. Dermatological Assessment

• Skin and Nail Evaluation:
  • Skin integrity
  • Presence of calluses or corns
  • Presence of erythema, warmth, or hemorrhage under calluses
  • Interdigital skin condition
  • Nail pathology
  • Presence of wounds or ulceration
  • If wounds present, use Wound, Ischemia, and foot Infection (WIfI) classification 1

5. Structural Assessment

• Foot Deformities:
  • Hallux valgus
  • Hammertoes
  • Claw toes
  • Prominent metatarsal heads
  • Charcot foot deformities
  • Pes planus/cavus

Risk Stratification

Based on the assessment findings, classify patients into risk categories:

• Low Risk: No LOPS, no PAD, no deformity
• Moderate Risk: LOPS with or without deformity
• High Risk: PAD and/or history of ulcer or amputation 1

Documentation and Reporting

• Clear documentation of all findings
• Comparison to previous assessments when available
• Specific recommendations for:
  • Footwear modifications
  • Orthotic interventions
  • Activity modifications
  • Follow-up frequency based on risk category
  • Referrals to specialists if needed

Common Pitfalls and Caveats

• Relying solely on one test for neuropathy assessment: Always perform at least two tests to confirm LOPS 1
• Missing vascular assessment: PAD is often asymptomatic; perform thorough vascular examination even in absence of symptoms 1
• Overlooking biomechanical factors: Altered biomechanics in the presence of neuropathy significantly increases ulceration risk 1
• Inadequate footwear assessment: Inappropriate footwear is a major contributor to foot complications 1
• Failure to educate patients: Patient education about foot self-care is critical, especially for those with LOPS 1

By implementing this comprehensive template, clinicians can systematically assess foot health, identify risk factors, and develop targeted interventions to prevent complications and improve outcomes in patients requiring podiatric care.