Zusammenfassung
Die klinische Ganganalyse verfügt heute über ein gut definiertes Repertoire von unterschiedlich aufwendigen validen und reliablen Untersuchungstechniken, die allesamt durch die rasante Rechner- und Softwareentwicklung rascher auswertbar und somit auch für den gezielten klinischen Gebrauch besser handhabbar sind. Die Fragestellung der Untersuchung definiert den Einsatz der jeweiligen Methoden. Die klinische Ganganalyse kann uns als diagnostisches Instrument Einblicke in die Pathobiomechanik bzw. Pathophysiologie komplexer Gangstörungen geben, deren Verständnis Voraussetzung für die funktionsgerechte Therapiewahl ist. Bei Fragen des Funktionsscreenings nach rekonstruktiven Eingriffen im Sinne der Qualitätskontrolle, zur Festlegung eines Schweregrades einer Funktionsstörung, zum objektiven Vergleich konkurrierender therapeutischer Verfahren, zur Überprüfung eines Rehabilitationserfolges, aber auch zur quantitativen Überprüfung des Effekts von Orthesen, Einlagen und Schuhwerk können einfache ganganalytische Untersuchungen mit standardisiertem Parametersatz für Aussagen genügen, für die kein weiteres klinisches Diagnostikverfahren zur Verfügung steht und die sich in ein klinisches Gesamtkonzept einfügen.
Abstract
Clinical gait analysis comprises a well defined repertoire of various methods for valid and reliable assessment. The rapid development of corresponding hardware and software has substantially decreased the efforts necessary for data processing and has promoted the clinical applicability of the procedures. The clinical question defines the amount of methodological input. Clinical gait analysis may provide diagnostic insight into the pathobiomechanics and the pathophysiology of complex gait disorders for which a profound understanding of the underlying causes is a prerequisite for adequate treatment. The methods may help in the screening of gait function following reconstructive surgery as a measure of quality control, the assessment of the severity of a gait disturbance, the evaluation of a rehabilitation process, or the quantification of the effect of orthoses, insoles or specific shoe ware. Simple procedures of gait analysis may suffice to obtain information on gait function which can not be derived by mere clinical observation and which can be incorporated into a clinical concept.
Literatur
Alexander IJ, Chao EYS, Johnson KA (1990) The assessment of dynamic foot to ground contact forces and plantar pressure distribution: a review of the evolution of current techniques and clinical applications. Foot Ankle Int 11: 152–167
Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S (2005) Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 20: S0942–2056
Bauer G, Zenkl M, Schierle M, Rosenbaum D, Mutschler W, Claes L (1993) Störung der Gangfunktion nach Metatarsale-5-Basisfrakturen. Unfallchirurg 96: 483–487
Becker HP, Rosenbaum D, Zeithammel G, Gerngross H, Claes L (1994) Gait analysis after ankle ligament reconstruction (modified Evans procedure). Foot Ankle Int 15: 477–482
Becker H-P, Rosenbaum D, Kriese T, Gerngroß H, Claes L (1995) Gait asymmetry following successful surgical treatment of ankle fractures in young adults. Clin Orthop 311: 262–269
Becker H-P, Rosenbaum D, Zeithammel G, Gnann R, Gerngroß H, Claes L (1996) Comparison of ankle ligament reconstruction principles: Tenodesis versus anatomical repair. Clin Orthop 325: 194–202
Becker HP, Rosenbaum D, Claes L, Gerngroß H (1997) Dynamische Pedographie zur Abklärung der funktionellen Sprunggelenkinstabilität. Unfallchirurg 100: 133–39
Bergmann G, Graichen F, Rohlmann A (1993) Hip joint loading during walking and running measured in two patients. J Biomech 26: 969–990
Brand RA (1987) Can biomechanics contribute to clinical orthopaedic assessments? J Biomech 9: 453–457
Cavanagh PR, Simoneau GG, Ulbrecht JS (1993) Ulceration, unsteadiness, and uncertainty: the biomechanical consequences of diabetes mellitus. J Biomech 26: 23–40
Cavanagh PR, Dingwell JB (2000) Gait analysis: kinematic and kinetic studies of the foot and ankle. In: Myerson MS (ed) Foot and ankle disorders. WB Saunders, Philadelphia London Toronto Sydney, vol 1, p 50–82
Chau T (2001) A review of analytical techniques for gait data: Part 1: Fuzzy, statistical and fractal methods. Gait Posture 13: 49–66
Chau T (2001) A review of analytical techniques for gait data. Part 2: neural network and wavelet methods. Gait Posture 13: 102–120
Chao EYS (1987) Gait analysis: a survey. In: Bergmann G, Kölbel R, Rohlmann A (eds) Biomechanics: basic and applied research. Nijhoff, Dordrecht Boston Lancaster, p 33–50
Crenshaw SJ, Pollo FE, Brodsky JW (2004) The effect of ankle position on plantar pressure in a short walking boot. Foot Ankle Int 25: 69–72
Davies MB, Betts RP, Scott IR (2003) Optical plantar pressure analysis following internal fixation for displaced intra-articular os calcis fractures. Foot Ankle Int 24: 851–856.
Debrunner HU, Jacob HAC (1998) Biomechanik des Fußes. In Grifka J (Hrsg) Bücherei des Orthopäden, Bd 49, 2. Aufl. F. Enke, Stuttgart
Dhalla R, Johnson JE, Engsberg J (2003) Can the use of a terminal device augment plantar pressure reduction with a total contact cast? Foot Ankle Int 24: 500–505
Dennis DA, Mahfouz MR, Komistek RD, Hoff W (2005) In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 38: 24–253
Denoth J(1987) Analyse von Belastung und Beanspruchung des Bewegungsapparats. Swiss Med 9: 35–41
Döderlein L, Wolf S (2004) Der Stellenwert der instrumentellen Ganganalyse bei der infantilen Zerebralparese. Orthopäde 33: 1103–1118
Dubois D, Revuelta N, Blatt J-L, Maynou C, Migaud H, Thevenon A (2001) Analyse tridimensionelle de la marche après arthrodèse sous astragalienne unilatérale. Rev Chir Orthop 87: 685–695
Eils E, Nolte S, Tewes M, Thorwesten L, Volker K, Rosenbaum D (2002) Modified pressure distribution patterns in walking following reduction of plantar sensation. J Biomech 35(10): 1307–1333
Eils E, Behrens S, Mers O, Thorwesten L, Volker K, Rosenbaum D (2004) Reduced plantar sensation causes a cautious walking pattern. Gait Posture 20: 54–60
Han TR, Chung SG, Shin HI (2003) Gait patterns of transtibial amputee patients walking indoors barefoot. Am J Phys Med Rehabil 82: 96–100
Hatze H (1986) Methoden biomechanischer Bewegungsanalyse. Österreichischer Bundesverlag, Wien
Hennig EM, Milani TL(1993) Die Dreipunktunterstützung des Fußes. Z Orthop 131: 279–284
Hillmann A, Rosenbaum D, Schroter J, Gosheger G, Hoffmann C, Winkelmann W (2000) Electromyographic and gait analysis of forty-three patiens after rotationplasty. J Bone Joint Surg 82-A: 187–96
Hillmann A, Rosenbaum D, Winkelmann W (2000) Plantar and dorsal foot loading measurements in patients after rotationplasty. Clin Biomech 15: 359–364
Hof AL (2000) On the interpretation of the support moment. Gait Posture 12: 196–199
Kanesaku K, Banks SA, Honjo S, Nakata O, Kato H (2004) Fluoroscopic analysis of knee arthroplasty kinematics during deep flexion kneeling. J Arthroplasty 19: 998–1003
Kinner BJ, Best R, Falk K, Thon K-P (2002) Is there a reliable outcome measurement for displaced intra-articular calcaneal fractures? J Trauma 53: 1094–1102
Kitaoka HB, Schaap EJ, Chao EYS, An K-N (1994) Displaced intra-articular fractures of the calcaneus treated non-operatively. J Bone Joint Surg 76-A: 1531–1540
Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop 410: 69–81
Komistek RD, Kane TR, Mahfouz M, Ochoa JA, Dennis DA (2005) Knee mechanics: a review of past and present techniques to determine in vivo loads. J Biomech 38: 215–228
Kwon O-Y, Minor SD, Maluf SK, Mueller MJ (2003) Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture 18: 105–113
Lange B, Chipchase L, Evans A (2004) The effect of low-dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. J Orthop Sports Phys Ther 34: 201–209
Maluf KS, Mueller MJ (2003) Comparison of physical activity and cumulative plantar tissue stress among subjects with and without diabetes mellitus and a history of recurrent plantar ulcers. Clin Biomech 18: 567–575
McPoil TG, Cornwall MW, Yamada W (1995) A comparison of two in-shoe plantar pressure measurement systems. The lower extremity 2: 95–103
Mittlmeier Th, Morlock M (1991) Belastungsmessungen am posttraumatischen Fuß. Orthopäde 20: 22–32
Mittlmeier Th, Morlock MM, Hertlein H, Fäßler M, Mutschler W, Bauer G (1994) Analysis of morphology and gait function following intraarticular calcaneal fracture. J Orthop Trauma 7: 303–310
Mittlmeier Th, Morlock MM, Kollmitzer J, Zwick-E-B, Lob GC (1996) Efficiency of gait measurement after complex foot trauma. Foot Ankle Surg 2: 197–208
Mittlmeier Th, Weiler A, Söhn T, Kleinhans L, Mollbach S, Duda G, Südkamp NP (1999) Functional monitoring during rehabilitation following anterior cruciate ligament reconstruction. Clin Biomech 14: 576–584
Moe-Nilssen R, Helbostad JL (2004) Estimation of gait cycle characteristics by trunk accelerometry. J Biomech 37: 121–126
Nurse MA, Nigg BM (2001) The effect of changes in foot sensation on plantar pressure and muscle activity. Clin Biomech 16: 719–727
Perttunen JR, Antilla E, Södergård J, Merikanto J, Komi PV (2004) Gait asymmetry in patients with limb length discrepancy. Scand J Med Sci Sports 14: 49–56
Perry JE, Hall JO, Davis BL (2002) Simultaneous measurement of plantar pressure and shear forces in diabetic individuals. Gait Posture 15: 101–107
Prodromos CC, Andriacchi TP, Galante JO (1985) Relationship between knee joint loads and clinical changes following high tibial osteotomy. J Bone Joint Surg 67-A: 1188–1194
Rammelt S, Grass R, Zawadski T, Biewener A, Zwipp H (2004) Foot function after subtalar distraction bone-block arthrodesis. J Bone Joint Surg 86-B: 659–668
Ramseier LE, Jacob HAC, Exner GU (2004) Foot function after ray resection for malignant tumors of the phalanges and metatarsals. Foot Ankle Int 25: 53–58
Reinschmidt C, van den Bogert AJ, Nigg BM, Lundberg A, Murphy N (1997) Effect of skin movement on the analysis of skeletal knee joint motion during running. J Biomech 30: 729–732
Rosenbaum D, Lübke B, Bauer G, Claes L (1995) Long-term effects of hindfoot fractures evaluated by means of plantar pressure analyses. Clin Biomech 10: 345–351
Rosenbaum D, Bauer G, Augat P, Claes L (1996) Calcaneal fractures cause a lateral load shift in Chopart joint contact stress and plantar pressure pattern in vitro. J Biomech 29: 1435–1443
Rosenbaum D, Bertsch C, Claes LE (1997) NOVEL Award 1996: 2nd prize. Tenodeses do not fully restore ankle joint loading characteristics: a biomechanical in vitro investigation in the hind foot. Clin Biomech 12: 202–209
Rosenbaum D, Becker H-P (1997) Plantar pressure distribution measurements. Technical background and clinical applications. Foot Ankle Surg 3: 1-14
Rosenbaum D, Becker HP, Sterk J, Gerngroß H, Claes L (1997) Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability. Foot Ankle Int 18: 765–771
Rosenbaum D, Becker HP, Wilke HJ, Claes LE (1998) Tenodeses destroy the kinematic coupling of the ankle joint complex. A three-dimensional in vitro analysis of joint movement. J Bone Joint Surg 80-B: 162–168
Rosenbaum D, Engelhardt M, Becker HP, Claes L, Gerngroß H (1999) Clinical and functional outcome after anatomic and nonanatomic ankle ligament reconstruction: Evans tenodesis versus periosteal flap. Foot Ankle Int 20: 636–639
Russo SJ, Chipchase LS (2001) The effect of low-dye taping on peak plantar pressures of normal feet during gait. Aust J Physiother 47: 239–244
Sacco ICN, Amadio AC (2000) A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients. Clin Biomech 15: 196–202
Schmidt R, Meyer-Wölbert B, Röderer M, Becker HP, Benesch S, Fels T, Gerngroß H (1996) Dynamische Ganganalyse. Mittel zur Qualitätssicherung nach operativ versorgten Sprunggelenkfrakturen. Unfallchirurg 102: 110–114
Selen HAM, Anemaat S, Janssen HMH, Deckers JHM (2003) Effects of prosthesis alignment on pressure distribution at the stump/socket interface in transtibial amputees during unsupported stance and gait. Clin Rehab 17: 787–796
Stacoff A, Reinschmidt C, Nigg BM, van den Bogert AJ, Lundberg A, Denoth J, Stüssi E (2000) Effects of foot orthoses on skeletal motion during running. Clin Biomech 15: 54–64
Stüssi E (1987) Was heisst Ganganalyse? Swiss Med 9: 8–13
Sutherland DH (2001) The evolution of clinical gait analysis part I: kinesiological EMG. Gait Posture 14: 61–70
Vasarhelyi A, Baumert T, Fritsch C. Hopfenmüller W, Gradl G, Mittlmeier T (2005) Partial weight bearing after surgery for fracture of the lower extremity — is it achievable? Gait Posture 21: im Druck
Weijers RE, Walenkamp GHIM, van Marneren H, Kessels AGH (2003) The relationship of the position of the metatarsal heads and peak plantar pressure. Foot Ankle Int 24: 349–353
Wetz HH, Hafkemeyer U, Drerup B (2005) Einfluss des C-Leg-Kniegelenk-Passteiles der Fa. Otto Bock auf die Versorgungsqualität Oberschenkelamputierter. Eine klinisch-biomechanische Studie zur Eingrenzung von Indikationskriterien. Orthopäde 34: 298–319
Winter DA (1980) Overall principle of lower limb support during stance phase of gait. J Biomech 13: 923–927
Zijlstra W, Hof AL (2003) Assessment of spatio-temporal gait parameters from trunk accelerations during human walking. Gait Posture 18: 1-10
Zijlstra W (2004) Assessment of spatio-temporal parameters during unconstrained walking. Eur J Appl Physiol 92: 39–44
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Mittlmeier, T., Rosenbaum, D. Klinische Ganganalyse. Unfallchirurg 108, 614–629 (2005). https://doi.org/10.1007/s00113-005-0978-0
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DOI: https://doi.org/10.1007/s00113-005-0978-0