A pediatric orthopedic surgeon who referred a patient for an AFO mentioned that prior to sending the patient to see me, he was referring them to a prominent pediatric medical center for instrumented gait analysis. The purpose of that referral was to determine whether the AFO should be solid or articulated. I found it interesting that the surgeon considered instrumented gait analysis time- and cost-effective, especially since with travel time the visit would most likely require the greater part of a day. I also wondered what specific information the surgeon expected to obtain from the 3D motion analysis that would determine the AFO design. I was not aware of gait analysis data that could be used to conclusively determine which design would be most appropriate for a particular patient. I believed that my evaluation and consultation with the surgeon and physical therapist would have resulted in an appropriate design recommendation without the need for a costly and time-consuming session in the gait lab.
Even if instrumented gait analysis could provide determinative guidance for specific orthotic management decisions, this level of analysis is not performed on most patients prior to referral for orthotic care. Most O&P clinicians do not have access to 3D motion analysis equipment, or the skills required to collect and interpret the data, and rely on observational assessment methods to guide decisions about orthotic design. When performed by an experienced clinician, observation alone provides an appropriate basis for clinical decisions, but the process is less transparent and consistent than 3D instrumented analysis. Accordingly, observational assessment is less credible as a justification for services or for research purposes. Relying solely on observation also makes it more difficult to define protocols for treatment that can be applied by different clinicians in different contexts.