As mentioned, gait analysis can be as modest as observation to note irregularities made visible by the naked eye. Systematic gait analysis however, incorporates a top-down and bottom-up visual orientation, ideal upon identifying subtle deviations. A top-down orientation provides data on symmetry, quantity, and quality of arm swing; pelvic rotation; pelvic tilt; and lateral trunk shift. The bottom-up orientation provides assessment of ankle, subtalar, midfoot, and hallux motion symmetry, quantity and quality. Where knee and lower leg movement is analysed. The focus of these different approaches focuses on potential exaggerated motion or insufficient propulsion from a locomotive unit, stance stability, shock absorption, and energy conservation.
Core postural muscle stability is suspected when excessive pelvis crest drops, and pelvic rotation is observed. Further testing of gluteal muscle function in open and closed kinetic chain positions would be warranted. Excessive hip adduction with knee valgus producing an increased dynamic quadricep angle is a significant observation.
Knee varus trust defined as a lateral knee shift may be indicative of lateral knee complex instability or osteoarthritis of the medial knee compartment. Early heel rise during propulsion is a common compensation for hallux limitus, sesamoiditis, or ankle equinus. Dananberg and Guiliano30describe a relationship between hallux limitus and spine pain related to deficient hallux extension in late stance phase when walking. A contralateral increased lateral shift is described as the lower extremity adapting to the loss of hallux extension with the concomitant decrease in hip extension at midstance. Spine pain patterns are related to the hallux limitus, and Dannenberg and Guiliano30 describe a 36% improvement with custom foot orthotics described to neutralize the deleterious effects of hallux extension los