The Next Step: How Markerless Motion Capture and AI Are Transforming Gait Analysis in O&P

In a clinic in New Hampshire, a prosthetist pulls out his smartphone and records a patient walking down the hallway. No reflective markers, no cumbersome lab setup—just a simple video. Moments later, the software spits out gait data that usually takes a motion lab hours to produce. In Minneapolis, a VA motion analysis lab hums with activity. Cameras capture a veteran’s stride as clinicians translate kinematic reports into meaningful alignment decisions. Engineers and clinicians are collaborating to bring real-time motion analysis out of the lab and into everyday practice. Markerless motion capture and artificial intelligence (AI) are ushering in a new era of gait analysis in O&P. The potential is huge—but so are the challenges. During the Academy’s Gait Analysis Unconference in June, four voices in the field—Pamela Hale, CPO, Séamus Kennedy, BEng (Mech), CPed, FAAOP(A), Trey Cimorelli, MSPO, CPO, and Juan Cave II, MSPO, CPO, FAAOP—shared how they’re using technology to improve outcomes, the obstacles they face, and what gait analysis might look like in the next decade. From Observation to Objective Data For decades, gait analysis in O&P has relied heavily on the clinician’s trained eye. A patient walks, the clinician watches, and alignment or component changes are made based on visual assessment and experience. While effective, this method is inherently subjective. Hale recalls her excitement the first time she used a markerless motion capture app in the clinic. “I could actually have [gait data] in the palm of my hand almost in real time,” she says. “I could make a change, see the difference, and actually have objective data instead of just assumptions based on my eyes.” For Hale, the technology’s biggest surprise was both its power and complexity. “It was almost more information than I expected. The learning curve wasn’t just about how to capture the video—it was about figuring out which data actually matters.” She quickly homed in on key measures like walking speed, step-length symmetry, and joint angle timing. These metrics not only guide socket adjustments or component changes but can also help justify clinical decisions to payers. The Clinician’s Reality: Time and Space While technology makes gait analysis more accessible, clinicians still face very human challenges: limited time, space, and reimbursement. Kennedy, co-owner of Hersco Ortho Labs, a long-time pedorthics and biomechanics enthusiast, approaches gait analysis with curiosity and pragmatism. Kennedy is fascinated by the possibilities of advanced gait analysis but recognizes the constraints. “It’s all about time and space,” he says. “To truly see a patient or runner in real-world motion, you need enough room and enough time. And in a busy clinic, that’s hard to come by.” While elite sports podiatrists might jog alongside runners in Central Park, most O&P practices can’t dedicate that kind of bandwidth. This is where compact, efficient technology has the potential to bridge the gap—if it’s accurate, affordable, and doesn’t slow clinicians down. From Multicamera Labs to Single-Phone Solutions If Hale and Kennedy highlight the why of objective gait analysis, Cimorelli embodies the how. A prosthetist and researcher, Cimorelli has spent the last four years developing a markerless motion capture system that can serve both research and clinical purposes. What began as an experiment using a single cell phone evolved into a multicamera system after early tests revealed a significant flaw: the prosthesis. “Pretrained algorithms didn’t work well on prosthetic users,” Cimorelli says. “Especially when the prosthetic limb was visible—key point detection would fail, and if we can’t detect the joints accurately, we can’t measure anything accurately.” By adding cameras and training the system on diverse patient data, Cimorelli’s team achieved much greater accuracy. That progress is now feeding back into single-camera applications, making them more viable for everyday clinical use. Looking ahead, he envisions AI not just collecting data but assisting with decision-making. “Imagine a system that can suggest alignment adjustments, like a microprocessor knee app does now,” he says. “Not to replace the clinician, but to make us more efficient.” Still, he’s cautious about overreliance on automation. “We have to make sure we’re not blindly trusting AI,” Cimorelli says. “Every step of the way, we need checks and balances to ensure accuracy and protect patient care.” Inside the Motion Lab While portable systems are on the rise, motion analysis labs remain a gold standard for detailed gait data. At the Minneapolis VA, Cave oversees a gait lab that serves several departments, including prosthetics. On a typical week, they analyze one to two patients, focusing on complex cases or research studies. Cave’s mission is to translate kinematic reports into clinical insight. “If you see a long step in the report, you should be able to visualize it and decide what that means for the socket or alignment,” he explains. “It’s about connecting the dots between data and reality.” But Cave is also quick to dispel the fantasy that motion labs are a turnkey solution for routine care. “A full-body marker set can take weeks to process,” he says. “Clinicians think a lab will make life easier, but unless you have an answerable question and can get the results quickly, it’s not realistic for day-to-day care.” The VA team is now exploring markerless and community-based motion capture to track patients at home and identify fall risk factors or mobility declines long before the next clinic visit. The Barriers: Reimbursement and Adoption All four experts agree that the biggest hurdle to widespread clinical adoption is reimbursement. Without a clear L-Code to bill or return on investment, many clinics are reluctant to buy cameras, train staff, or dedicate time to gait analysis beyond visual observation. “If it’s not reimbursed, it either has to be so easy and fast that it doesn’t slow you down, or it has to clearly improve care in a way that justifies the cost,” Cimorelli says. Cave notes that clinician buy-in is another barrier: “It’s seen as a research thing or something extra,” he says. “Once you show the silver lining—the moments where data really changes your decision-making—then adoption starts to grow.” The Future: Fast, Portable, and Patient-Centered So, what will gait analysis in O&P look like in ten years? Hale predicts widespread phone-based motion capture and hopes clinicians embrace objective outcome measures as a routine part of care. Kennedy envisions miniaturized sensors embedded in orthotics or shoes, capturing data in real-world conditions. Cimorelli is focused on accurate single-camera systems and AI that enhances—not replaces—the clinician’s judgment. Cave is looking to the community, with in-home monitoring that tracks step length, speed, and fatigue patterns to improve outpatient care and fall prevention. Across all perspectives, one theme is clear: the human element still matters. “Maybe AI will tell us what to do someday,” Cave says. “But taking the human out of it makes care feel cold. At the end of the day, patients still need us.” A Call to Action for the O&P Community Gait analysis is moving out of the lab and into the palm of our hands. The technology is ready, or nearly ready, but the profession must decide how to use it. That means advocating for reimbursement, sharing best practices, and embracing the shift from subjective observation to objective, data-driven care. For clinicians, the message is simple: start somewhere. Record a video. Try a single-camera app. Experiment with integrating data into your notes. Every step toward objective measurement moves O&P closer to a future where better insight leads to better outcomes. Because in the end, gait analysis isn’t about cameras or algorithms. It’s about helping people walk confidently into their lives. Kiley Armstrong, MS, MPO, CPO, is a research prosthetist and orthotist, Northwestern University’s Feinberg School of Medicine, and co-chair of the Academy’s Gait Scientific Society. Sara Marmar, MS, MPO, CPO/L, is an orthotist/prosthetist, Orthotic Care Services, Minnesota, and co-chair of the Academy’s Gait Society. Academy Society Spotlight is a presentation of clinical content by the Scientific Societies of the Academy in partnership with The O&P EDGE . Opener Art: InfiniteFlow/stock.adobe.com

The Next Step: How Markerless Motion Capture and AI Are Transforming Gait Analysis in O&P

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