Interview Questions for Foot and Ankle Biomechanics

Plantar pressure distribution refers to how weight is distributed across the sole of the foot when standing or walking. It’s a complex interplay of several factors, including the shape and flexibility of the foot, the type of footwear, and the underlying surface.

Ideally, pressure is distributed evenly across the heel, the metatarsal heads (the ball of the foot), and the arch. High pressure areas, particularly under the heel or metatarsal heads, can contribute to pain and injury. Conversely, insufficient pressure in certain areas, such as the arch, may indicate weakness or instability.

We can visualize this using pressure-sensitive insoles, which provide detailed maps of plantar pressure. These maps help clinicians identify areas of high or low pressure, revealing potential problems like overpronation (excessive inward rolling of the foot) or pes cavus (high arch). For example, a patient with plantar fasciitis often shows high pressure under the heel, while someone with a bunion may have concentrated pressure on the medial aspect of the first metatarsal head.

The subtalar joint, located between the talus and calcaneus bones, plays a crucial role in gait by allowing for inversion and eversion of the foot. This movement is essential for shock absorption, adapting to uneven terrain, and providing stability during the stance phase of gait.

During walking, the subtalar joint assists in controlling pronation (the inward roll of the foot) and supination (the outward roll). Proper subtalar joint function helps to efficiently distribute forces up the kinetic chain, minimizing stress on the knees, hips, and back. Dysfunction, such as limited subtalar joint movement or excessive pronation/supination, can lead to various problems, from plantar fasciitis to knee osteoarthritis.

Imagine the subtalar joint as a universal joint in a car’s drive shaft; it allows for smooth transition and adaptation of the foot to uneven surfaces. Problems in this joint would translate into discomfort and inefficiency in walking.

Plantar fasciitis, characterized by pain in the heel and arch, is commonly caused by repetitive strain on the plantar fascia, a thick band of tissue on the bottom of the foot.

Several factors contribute to this strain:

• Overpronation: Excessive inward rolling of the foot places increased tension on the plantar fascia.
• High-impact activities: Running, jumping, and other high-impact exercises can overload the plantar fascia.
• Improper footwear: Flat shoes or shoes with inadequate arch support can exacerbate the problem.
• Tight calf muscles: Tightness in the calf muscles can limit ankle dorsiflexion (bending the foot upwards), increasing strain on the plantar fascia.
• Obesity: Increased weight puts extra stress on the plantar fascia.
• Certain medical conditions: Conditions such as diabetes and rheumatoid arthritis can increase the risk of plantar fasciitis.

Consider a scenario where a runner suddenly increases their mileage without proper training. The increased stress on the plantar fascia can easily lead to inflammation and pain.

Assessing foot pronation and supination involves a combination of observation and measurement.

Observation: We assess the patient’s foot posture while standing and walking. Looking at the wear pattern of their shoes can also be informative. Excessive wear on the inner or outer sole of the shoe is a visual indicator of pronation or supination, respectively. We also observe the alignment of the knees and hips – these are affected by foot mechanics.

Measurement: Footprint analysis using ink or a pressure plate provides quantitative data on pressure distribution. Gait analysis (observation of walking patterns) using video recording and motion capture technologies is more sophisticated and allows for precise measurements of angles and movement patterns.

Another technique involves using a goniometer to measure the range of motion at the subtalar joint, providing further information on its function. In the clinical setting, we also employ physical exam maneuvers, palpating the foot structures for tenderness and assessing for any range of motion restrictions in the ankle and foot.

Ankle sprains are injuries to the ligaments that stabilize the ankle joint, most commonly caused by an inversion injury (rolling the ankle inward).

The biomechanics involve excessive plantarflexion (pointing the toes downwards) and inversion, stretching or tearing the ligaments on the lateral side of the ankle (anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament). The severity depends on the extent of ligament damage.

Imagine the ligaments as strong ropes holding the ankle bones together. When the ankle rolls inward, these ropes are forcefully stretched, and if the force exceeds their capacity, they tear, leading to pain, swelling, and instability.

The biomechanics also encompass the speed and direction of the force, the ground reaction force, and the individual’s pre-existing ankle stability. We can use biomechanical modelling to understand the forces involved in these injuries and design appropriate interventions for prevention and treatment.

Foot arches are essential for shock absorption, propulsion, and overall foot function. Three main types exist:

• Normal Arch (Neutral Arch): Even weight distribution across the heel, metatarsal heads, and arch. This is considered optimal for efficient gait and shock absorption.
• Pes Planus (Flat Foot): Collapse of the medial longitudinal arch, resulting in increased pronation and potential strain on the plantar fascia and other foot structures. This often leads to problems in the knees, hips and back.
• Pes Cavus (High Arch): Exaggerated medial longitudinal arch, potentially leading to limited shock absorption, altered gait patterns, and increased stress on the metatarsal heads. This can create issues with calluses, and pain in the ball of the foot and the toes.

Each arch type has a distinct function, and deviations from the normal arch can significantly impact gait and contribute to musculoskeletal problems. For instance, a patient with flat feet may experience pain in the feet, knees, and lower back due to altered weight distribution.

Common gait deviations, often linked to underlying foot and ankle problems, include:

• Overpronation: Excessive inward rolling of the foot, often associated with flat feet. This increases stress on the plantar fascia, knees, hips, and back.
• Supination: Excessive outward rolling of the foot, often associated with high arches. This can lead to stress on the outer ankle, and pain in the lateral side of the foot.
• Short Stride Length: A decrease in the distance covered by each step, potentially indicating weakness, pain, or limited range of motion.
• Antalgic Gait: A limping gait to avoid pain in the affected limb. This shortens the stride length on the affected side.
• Foot Slap: A characteristic sound during walking indicating a sudden loss of control in mid-stance phase of gait, usually due to weakness of the muscles that control the foot.

The biomechanical implications of these deviations can range from minor discomfort to significant joint pain and injury. For example, consistent overpronation can contribute to plantar fasciitis, knee pain, and even hip osteoarthritis over time.

A plantar pressure map provides a visual representation of the pressure distribution across the plantar surface (sole) of the foot. Think of it like a heat map, but for pressure. Areas of high pressure are typically shown in darker colors, indicating more weight is being borne by that region. Areas of lighter color indicate lower pressure. Interpreting the map involves looking for several key features:

• Peak pressures: Identifying the location and magnitude of the highest pressure points is crucial. High pressures under the metatarsal heads (ball of the foot) are common, but excessively high pressures can indicate problems like metatarsalgia. High pressures under the heel might suggest plantar fasciitis.
• Pressure distribution patterns: A normal foot distributes pressure relatively evenly across the heel, midfoot, and forefoot. Abnormal patterns, such as excessive pressure on one side or another, or a significantly reduced pressure zone, suggest potential biomechanical issues.
• Contact area: The overall area of contact between the foot and the ground is also important. A smaller contact area may indicate an excessively high arch or rigid foot structure potentially leading to increased stress on smaller areas.
• Symmetry: Compare the pressure distribution between the right and left feet. Asymmetry can highlight imbalances and potential injury risk.

For example, a patient with a bunion might show significantly higher pressure on the medial (inside) aspect of the first metatarsal head. Clinicians use this information to guide diagnosis and treatment, such as recommending orthotics or specialized footwear.

Orthotics are custom-made or prefabricated inserts placed inside shoes to modify the mechanics of the foot and ankle. They’re used to correct biomechanical imbalances by providing support and altering pressure distribution. For example, a patient with flat feet (pes planus) might have excessive pronation (inward rolling of the foot). A medial wedge orthotic could help control pronation by supporting the arch and reducing stress on the tissues.

• Support: Orthotics provide support to weakened or unstable structures in the foot and ankle. This support can stabilize the foot during gait, reducing stress on the joints and soft tissues.
• Shock absorption: They cushion the foot, reducing impact forces during activities like walking or running, thus decreasing the risk of injury.
• Pressure redistribution: By altering the shape and contour of the foot, orthotics help redistribute pressure away from areas of high stress, such as a painful bunion or plantar fasciitis.
• Alignment correction: They can subtly adjust foot alignment, correcting for conditions like overpronation or supination (outward rolling of the foot).

Imagine a car’s alignment being off; it would wear down the tires unevenly. Similarly, biomechanical imbalances cause uneven wear and tear on the foot and ankle structures. Orthotics act like a realignment, promoting more even pressure distribution and healthier function.

Running is a high-impact activity placing significant stress on the foot and ankle. Each stride involves a complex interplay of forces and movements. The foot acts as a shock absorber, undergoing loading and unloading cycles repeatedly.

• Impact phase: The foot strikes the ground, absorbing the impact force. This force is distributed through the heel, midfoot, and forefoot. The plantar fascia and muscles play crucial roles in shock absorption.
• Midstance: The body weight is supported by the foot. The ankle joint provides stability while the arch of the foot acts as a spring.
• Push-off phase: The toes push off the ground propelling the body forward. This phase uses the calf muscles and involves plantar flexion at the ankle.

Excessive pronation during running, for instance, increases the risk of plantar fasciitis and medial tibial stress syndrome (shin splints). Over-supination leads to other problems. Running shoes with good cushioning and support are crucial for mitigating the impact and helping maintain proper biomechanics.

Achilles tendinitis, inflammation of the Achilles tendon, often arises from biomechanical factors that overload the tendon. These include:

• Overuse: Sudden increases in activity level, intensity, or duration put excessive stress on the tendon.
• Improper footwear: Shoes lacking sufficient heel support or cushioning can increase strain on the Achilles tendon.
Muscle imbalances: Tight calf muscles, especially the gastrocnemius, increase tension on the Achilles tendon, increasing the risk of injury.
• Foot pronation or supination: Excessive pronation or supination alters the alignment of the foot and ankle, causing uneven stress distribution and potentially irritating the tendon.
• Ankle stiffness: Reduced range of motion in the ankle joint can alter the way force is transferred through the tendon, leading to overuse and inflammation.

Imagine the Achilles tendon like a rope constantly under tension. Any of the above factors can increase the tension beyond its tolerance, resulting in inflammation and pain. Addressing the underlying biomechanical factors is critical in managing Achilles tendinitis.

Assessing foot and ankle range of motion (ROM) is crucial for identifying biomechanical limitations. It’s done using goniometry (measuring angles) and observation of functional movements. Key ROM measurements include:

• Dorsiflexion: Movement of the foot upwards towards the shin.
• Plantarflexion: Movement of the foot downwards away from the shin.
• Inversion: Turning the sole of the foot inwards.
• Eversion: Turning the sole of the foot outwards.

Assessment involves visually observing the movement and using a goniometer to measure the angle of movement at each joint. For example, measuring dorsiflexion helps assess ankle flexibility, which is critical for normal gait. Limited ROM can indicate tightness in the calf muscles or joint stiffness, both contributing to biomechanical problems.

Foot and ankle stability relies heavily on intricate muscle coordination. Muscles work synergistically to control movement, absorb shock, and maintain proper alignment.

• Intrinsic foot muscles: Located within the foot, these muscles maintain the arch, control toe movement, and contribute to stability.
• Extrinsic foot muscles: Located in the lower leg (calf muscles), these muscles generate power for plantarflexion and dorsiflexion, essential for walking, running, and jumping.
• Tibialis anterior: Dorsiflexes and inverts the foot, crucial for foot clearance during walking.
• Tibialis posterior: Plantarflexes and inverts the foot, essential for arch support and stability.
• Peroneal muscles: Evert the foot, balancing the inverting action of other muscles.

Weakness in any of these muscles can compromise stability, leading to abnormal movement patterns and increased risk of injury. For example, weakness in the tibialis posterior can lead to flat feet and associated problems.

Different types of footwear have varying impacts on foot and ankle biomechanics. The design, materials, and structure affect pressure distribution, shock absorption, and overall foot function.

• High heels: Shift weight forward, increasing pressure on the forefoot and metatarsal heads, contributing to metatarsalgia and bunions. They also decrease ankle mobility and alter gait patterns.
• Running shoes: Designed with cushioning, support, and motion control features to absorb impact forces and promote efficient running biomechanics. Different running shoes cater to different foot types (pronators, supinators, neutral).
• Flat shoes: Provide minimal support and cushioning. They may increase strain on the plantar fascia and other supporting structures, especially in individuals with already existing biomechanical issues.
• Sandals: Offer little support and can lead to instability depending on their design. They are less protective than other footwear and increase the chance of injuries from foreign objects.

Choosing appropriate footwear is crucial for maintaining optimal foot and ankle health. Selecting footwear that fits well and complements your individual biomechanics can help prevent injuries and reduce discomfort.

Hallux valgus, commonly known as a bunion, is a deformity where the big toe deviates laterally (towards the other toes), causing a bony bump at the base of the big toe joint. This is often painful and can significantly impact mobility and comfort. Several factors contribute to its development:

• Genetics: A family history of bunions increases your risk. This suggests a predisposition towards certain foot shapes and joint laxity.
• Foot structure: People with certain foot types, such as flat feet (pes planus) or pronated feet (feet that roll inward excessively), are more susceptible. These structural abnormalities alter the biomechanics of the foot, putting increased pressure on the big toe joint.
• Footwear: Tight, pointed-toe shoes, and high heels significantly contribute to bunion development. These shoes squeeze the toes together, forcing the big toe to angle outward.
• Arthritis: Degenerative joint disease (osteoarthritis) in the big toe joint can further exacerbate the bunion deformity.
• Neuromuscular diseases: Conditions affecting muscle balance and nerve function can lead to abnormal pressure and alignment in the foot, predisposing individuals to bunions.

Imagine trying to squeeze your foot into a shoe too narrow for it – the pressure forces the big toe out of alignment. This is a simple analogy for the effect of ill-fitting footwear on bunion development. Treatment options range from conservative measures like orthotics and wider shoes to surgical correction for severe cases.

Pes planus, or flat foot, is a condition characterized by the collapse of the medial longitudinal arch of the foot. Assessment involves a combination of visual observation and palpation:

• Visual Inspection: Observe the foot from both the medial (inner) and lateral (outer) aspects. Look for the presence or absence of a medial longitudinal arch. A flat foot will show minimal or no arch when the individual is standing.
• Weight-bearing examination: Assess the foot while the patient stands. The absence of an arch is a key indicator. Further observation of how the foot flattens while walking can provide important information about the severity.
• Palpation: Palpate the soft tissues along the medial longitudinal arch. Increased tension in the plantar fascia (the thick band of tissue on the bottom of the foot) is often associated with flat feet.
• Footprint analysis: A simple way to assess arch height is to have the patient step on a wet surface to create a footprint. Comparing this to a normal arch print is a quick, visual comparison.
• Range of motion tests: Assess the range of motion of the ankle and subtalar joints. Restricted range of motion is sometimes associated with flat foot.

A clear example would be a footprint showing a complete contact of the foot with the ground, with the medial border flattened. This is in contrast to a normal foot print, which typically shows a clear arch imprint. Treatment depends on the severity and underlying cause, ranging from supportive footwear and orthotics to surgical intervention in severe cases.

Gait analysis is the study of how an individual walks. Different gait patterns arise from various factors, including anatomical structure, neurological conditions, and musculoskeletal injuries. Here are some examples:

• Normal Gait: Characterized by a smooth, rhythmic pattern with a heel strike followed by a toe-off. Weight transfer is efficient and symmetrical.
• Antalgic Gait: A protective gait pattern adopted to minimize pain. The stride length on the affected leg is reduced to lessen the stress on the painful joint.
• Ataxic Gait: Seen in neurological conditions affecting balance and coordination. The gait is unsteady and uncoordinated, with a wide base of support.
• Spastic Gait: A gait pattern where the muscles are stiff and rigid due to spasticity. It involves stiff movements and difficulty with heel strike.
• Parkinsonian Gait: Characterized by shuffling steps, a stooped posture, and reduced arm swing. It’s caused by a rigidity in the body.
• Trendelenburg Gait: Caused by weakness of the hip abductors. The pelvis tilts downward on the unsupported side when the affected leg is lifted.

Consider a person with a painful knee. They might exhibit an antalgic gait, shortening their stride and minimizing time spent on the affected leg to avoid pain. Understanding these variations is crucial for accurate diagnosis and treatment planning.

Ankle fractures are common injuries with diverse biomechanical considerations. Classification often involves considering the location and type of fracture:

• Pilon fracture: A fracture of the distal tibia involving the articular surface (the weight-bearing surface of the ankle). It’s biomechanically significant due to its impact on joint stability and function. The complex articular surface requires precise reduction (realignment) and fixation to restore proper joint mechanics.
• Weber A, B, and C fractures: These are classifications of fibular fractures based on their location relative to the syndesmosis (the joint connecting the tibia and fibula). A Weber A fracture is below the syndesmosis, B is at the level, and C is above, each impacting stability differently and requiring unique treatment approaches.
• Trimalleolar fracture: Involves fractures of the medial malleolus (ankle bone on the inner side), lateral malleolus (ankle bone on the outer side), and posterior malleolus (the back portion of the tibia). This severely compromises stability requiring extensive fixation. The biomechanical challenges are multifaceted.
• Avulsion fractures: Caused by ligamentous pull, involving small bone fragments pulled away from the main bone. These can affect joint stability and require consideration of ligamentous injury along with the fracture itself.

The biomechanical considerations focus on restoring the articular surface integrity, joint stability, and overall bone alignment to ensure optimal weight-bearing and mobility. For example, a malunion (incorrect healing) of a pilon fracture can lead to chronic pain and osteoarthritis.

Motion capture technology plays a pivotal role in gait analysis, providing objective and quantitative data. Specialized cameras track reflective markers placed on the subject’s body, capturing three-dimensional movement data. This allows for detailed analysis of gait parameters like:

• Joint angles: Precise measurements of joint angles throughout the gait cycle, identifying deviations from normal patterns.
• Step length and cadence: Measures of the length of each step and the number of steps per minute, revealing asymmetries or abnormalities.
• Ground reaction forces: Measurement of the forces exerted on the ground during walking. Helps assess loading patterns on different joints and body segments.
• Spatio-temporal parameters: Timing and spatial aspects of the gait cycle, providing insight into movement efficiency.

The data can be analyzed using specialized software to create detailed reports and identify areas needing attention. For instance, it can help a clinician identify subtle differences in joint movement that contribute to pain and dysfunction. A clinician can use this objective data to help refine treatment plans for patients with gait abnormalities, helping them recover mobility and reduce pain.

Scoliosis is a lateral curvature of the spine. Differentiating between functional and structural scoliosis is essential for appropriate management:

• Structural Scoliosis: A fixed curvature that persists even when the patient bends forward (Adam’s forward bend test). The vertebrae themselves are rotated and the deformity is often irreversible. It often has an underlying cause like a genetic predisposition or congenital abnormalities.
• Functional Scoliosis: A temporary and flexible curvature that corrects itself when the patient bends forward. It’s often caused by a difference in leg length, muscle imbalances, or posture issues. Often, it can be resolved with conservative treatment focusing on posture correction and balance.

The Adam’s forward bend test is a crucial part of the assessment. In a patient with structural scoliosis, a rib hump will be visible when they bend forward, demonstrating the fixed rotational component of the curvature. This is absent in functional scoliosis.

Ligaments play a crucial role in providing stability to the foot and ankle. They are strong, fibrous bands of connective tissue that connect bones and limit excessive joint movement. Key ligaments include:

• Deltoid ligament (medial ankle): Provides significant support to the medial side of the ankle joint, resisting eversion (turning the foot outwards).
• Lateral collateral ligaments (lateral ankle): Composed of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). These ligaments resist inversion (turning the foot inwards).
• Plantar fascia: A thick band of tissue on the bottom of the foot, functioning as a dynamic ligament, supporting the medial longitudinal arch.

Imagine the ligaments as strong ropes holding the bones together. When one of these ligaments is torn, it compromises joint stability. This lack of stability can manifest in instability, pain, and recurrent injuries. The extent of ligamentous injury affects the biomechanics and functional outcome, underscoring the importance of proper diagnosis and treatment.

Aging brings several biomechanical challenges to the foot and ankle. Think of it like this: our bodies, including our feet, are like finely tuned machines. Over time, wear and tear takes its toll. Common problems include decreased flexibility in the joints (think stiff ankles and toes), reduced muscle strength and power (leading to instability and poor balance), and changes in the foot’s structure, like flattening of the arches (pes planus) or the development of bunions. This results in altered gait patterns, increased risk of falls, and a higher incidence of conditions like plantar fasciitis and arthritis.

• Decreased Range of Motion: Stiffness in the ankle, subtalar, and metatarsophalangeal joints restricts normal movement, impacting gait efficiency.
• Muscle Weakness: Weakened intrinsic and extrinsic foot muscles compromise arch support, shock absorption, and propulsion during walking. This can lead to overpronation.
• Structural Changes: The loss of fat pads on the soles of the feet reduces cushioning, increasing pressure on the bones and joints. Changes in bone density and cartilage integrity increase the risk of fractures and osteoarthritis.

These changes often combine to create a vicious cycle, where one problem exacerbates others, leading to pain, disability, and reduced quality of life. For example, decreased ankle dorsiflexion (ability to bring your toes towards your shin) can lead to compensatory movements higher up the kinetic chain, resulting in knee and hip pain.

The kinetic chain in foot and ankle biomechanics refers to the interconnectedness of the body’s segments. It’s like a chain reaction: movement in one part affects the rest. For example, the way your foot interacts with the ground during walking influences the movement of your ankle, knee, hip, and even your spine. Problems in one segment can cause compensation in others, leading to pain and injury.

Imagine kicking a soccer ball: the movement begins in your brain, initiating impulses to your hip, then knee, then ankle, and finally your foot. If the ankle joint is stiff or weak, the compensation happens higher up, potentially overstressing the knee or hip joint. Similarly, poor foot biomechanics can lead to problems in the knees (patellofemoral pain syndrome) and hips (bursitis or osteoarthritis). We need to assess the entire kinetic chain to determine the root cause of foot and ankle pain and design effective treatment strategies.

We assess the impact of footwear on gait using various tools and methods, including gait analysis (using motion capture systems and force plates), and observational gait assessment. Footwear affects gait in many ways; the height of the heel, stiffness of the sole, and the type of support all play a role.

For instance, high heels drastically alter ankle joint range of motion, potentially leading to changes in the way people walk, increase pressure on the forefoot, and contribute to metatarsalgia. Similarly, shoes with minimal support can lead to excessive pronation and potentially plantar fasciitis. We would assess things like stride length, cadence (steps per minute), foot contact time, and the timing and magnitude of forces through the foot during gait. Differences in gait parameters with different footwear can provide valuable insight into footwear suitability and its potential to impact a patient’s biomechanics and overall health. We often use standardized gait analysis protocols to objectively compare gait with different shoes.

The windlass mechanism is a crucial aspect of foot function, particularly during push-off in walking and running. Imagine the windlass (a crank for raising heavy objects) as the lever system formed by your plantar fascia and the metatarsophalangeal joints of your toes. When you rise onto your toes, the plantar fascia tightens and acts like a windlass, pulling up the arch of your foot. This stiffens the midfoot, improves its stability, and enhances the efficiency of propulsion. It is crucial for transferring energy during gait and significantly impacts shock absorption and load distribution.

Disruption of this mechanism, due to factors like plantar fasciitis, a weakened plantar fascia, or pes planus, can significantly impair this efficiency, increase pressure on the metatarsal heads, and can cause discomfort.

Jumping and landing involve a complex interplay of forces and joint movements. During the jump, concentric muscle contractions (muscle shortening) in the legs generate the force needed for propulsion. The body stores energy in the plantar fascia, Achilles tendon, and muscles during this phase. Landing involves eccentric muscle contractions (muscle lengthening) to control the rapid deceleration of body mass.

Proper landing technique is crucial to prevent injuries. This includes flexing the hips, knees, and ankles to absorb impact, engaging core muscles for stability, and maintaining a neutral spine. Poor landing technique, such as stiff legs, can lead to significant forces concentrated on the ankle, knee, or hip joints, increasing the risk of stress fractures, ligament sprains, or other injuries. We assess landing biomechanics using motion capture systems to measure joint angles, moments, and forces during landing and identify potential problems.

Assessing the effectiveness of an orthotic device is a multi-faceted process. We look at both subjective and objective measures. Subjectively, we evaluate patient-reported outcomes such as pain reduction, improved comfort, and increased functional ability (e.g., walking distance, ability to perform activities of daily living). Objectively, we employ various methods:

• Gait Analysis: Comparing gait parameters (stride length, cadence, joint angles, ground reaction forces) before and after orthotic use. Improvements in these parameters suggest improved biomechanics.
• Pressure Mapping: Measuring plantar pressure distribution to identify areas of high pressure and assess how the orthotic redistributes pressure and reduces peak pressures.
• Clinical Observation: Assessing posture, gait patterns, and joint alignment to evaluate the effectiveness of the orthotic in correcting any biomechanical impairments.
• Patient Feedback: Regularly monitoring patient feedback is vital for assessing the comfort and effectiveness of an orthotic. Adjustments may be needed based on patient feedback and clinical observations.

A combination of subjective and objective assessments provides a comprehensive evaluation of the orthotic’s effectiveness in addressing the patient’s specific biomechanical needs.

Force plate analysis is a powerful tool in gait assessment. Force plates are embedded in the floor and measure the ground reaction forces (GRFs) exerted by the body during walking, running, or jumping. These forces are three-dimensional vectors, providing information about the magnitude and direction of the forces in the anterior-posterior, medial-lateral, and vertical directions.

The data acquired from force plates provides insights into various gait parameters, including:

• Peak Vertical Force: Indicates the impact force during heel strike. Higher peak forces might indicate problems such as increased risk of impact-related injuries.
• Impulse: Represents the total force applied over a period of time, reflecting the momentum during each step.
• Center of Pressure (COP): Tracks the movement of the pressure center under the foot and allows us to analyze foot placement and stability.
• Time-based parameters: such as stance phase duration, swing phase duration, and double-support time.

By analyzing these parameters, clinicians can identify gait deviations and biomechanical problems, such as excessive pronation, antalgic gait (compensatory gait pattern due to pain), or muscle imbalances. This information is essential in diagnosis, treatment planning, and monitoring the progress of interventions such as orthotics or rehabilitation programs.