Gait analysis

What is gait analysis, and what is it for?

Gait analysis is a way of measuring how you walk. You may also hear it called a gait assessment or walking assessment¹. It can be as simple as a clinician watching you walk, or as detailed as a laboratory using cameras and sensors.

It's meant to answer a clinical question, such as guiding a treatment decision or monitoring change over time, rather than being a stand-alone test². Instrumented versions can measure things like walking speed and step length, how your joints move, the forces through your feet, and muscle activity³. The results can shape treatment recommendations, including physiotherapy and orthotics (shoe inserts)⁴.

Who needs it, and how often?

Full clinical gait analysis is for children and adults whose walking problems are complex, and can't be picked up by watching you walk or a routine examination⁴. Conditions seen include cerebral palsy, other neurological conditions, and lower-limb or foot deformity⁴. It isn't something everyone needs.

Common reasons are considering surgery or botulinum toxin, or suspecting that walking is getting worse⁴. With foot deformity, it can also help find the source of pain or track change over time¹.

How often depends on the question being asked. For children with cerebral palsy, checks after surgery are described at 6, 12 and 24 months¹. For other people, a standard repeat schedule isn't clear yet, so ask your clinician what they plan and why.

What happens during a gait analysis?

It depends on the kind. Your clinician may start by watching you walk, from the front and the sides, over at least several metres with nothing in the way⁵. They may time you over a short course at your usual pace⁶, or ask you to stand from a chair, walk 3 m, turn, walk back and sit down (the Timed Up and Go test)⁵.

In a laboratory, small reflective markers are attached to your legs and cameras track them as you walk, so the movement at your hips, knees and ankles can be worked out⁷. Force plates in the floor can measure the forces through the ground with each step, and muscle activity can be recorded as well³.

If tests are repeated, using the same footwear or going barefoot each time makes results easier to compare⁸. It's fine to ask the clinic what will be measured, how your results will be used, and what to wear.

What do the results mean, and how accurate are they?

Your results are compared with reference data from healthy adults. There's no single normal range, because walking varies widely with age and sex⁹, and height, leg length, weight and body mass index matter too¹⁰. A good report describes what was measured, any notable differences from the reference group, and a direct answer to the question you were referred with². Gait findings alone don't give a set risk level, so what happens next depends on that answer and your wider assessment.

Laboratory 3D testing measures averages such as walking speed and step timing with low error¹¹. Wearable sensors do well on average step and stride measures, but are less dependable for how much steps vary or how even they are¹². Camera systems without markers are good for speed, step measures and hip and knee bending, but not yet accurate enough for the ankle⁸. Watching by eye is subjective, so results can vary¹³. Much of this testing was in healthy adults, so it may not apply to children, people with health conditions or people using walking aids¹²⁸.

What are the limits, and are there alternatives?

Laboratory analysis is expensive, uses a lot of resources and is mostly fixed in one place, so access is limited¹²⁹. Different centres also use different protocols, which makes results harder to compare¹⁰. It can help guide treatment decisions, but whether it improves patients' outcomes isn't clear yet¹⁴². For children with cerebral palsy, a clinical guideline supports it to help plan treatment¹⁵.

Alternatives include observation and simple timed tests, such as walking speed over a set distance⁵. In older adults, gait speed is a quick, inexpensive and reliable measure of how well you're functioning¹⁶. Wearable sensors and video-based systems are lower-cost options, though their results are mixed¹⁷. For older adults, balance tests can track balance but can't replace a full falls risk assessment¹⁸.