Is the intermediate assessment of shod walking necessary on patients with orthopaedic or neuro-orthopaedic pathologies?

Ankle-foot-orthoses are a medically prescribed intervention that can make significant improvement to persons with pathological gait. Clinical gait analysis usually observes barefoot walking and if applicable, with orthoses. The effect of shoes as an intermediary between barefoot walking and walking with ankle-foot-orthoses is therefore generally overlooked. Also, little is known about the biomechanical effect of shoes on pathological gait. This study aims at bridging this gap in current literature and quantifying the isolated influences of footwear to improve the decision-making process of orthopaedic intervention. Barefoot, shod and if applicable, orthotic gait of up to 292 patients aged 2-63 years with orthopaedic or neuro-orthopaedic conditions were retrospectively analysed. Initial Contact was analysed by means of sagittal-plane videos. Temporospatial parameters as well as sagittal plane kinematics of the ankle and knee at specific instances in the stance phase were investigated using marker-based instrumented 3D-analysis. The overall improvement in the quality of Initial Contact was attributed more to shoes than ankle-foot-orthoses. Step length and speed were significantly increased by shoes but not by the addition of orthoses (p<0.01). Cadence remained unchanged by shoes but decreased significantly due to orthoses. Ankle kinematics improved with both shoes and orthoses. Only minimal effects on knee kinematics were observed in both interventions. Shoes being an important walking aid in pathological gait should be included in clinical gait assessment, especially when testing orthotics. Had their effect not been investigated, would improvements in pathological gait have been incorrectly credited solely to ankle-foot-orthoses.