Comparing Ankle and Forefoot Gait Outcomes Through the Use of an In-Office Wearable

Research Type: Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results Introduction/Purpose: Gait analysis is essential for evaluating lower extremity pathologies but is traditionally limited to gait labs. The StrideLink wearable device, validated against traditional methods, enables accurate and accessible gait measurement in clinical settings. This study aimed to preoperatively compare gait parameters in patients with forefoot and ankle pathologies. We hypothesized greater gait alterations in ankle compared to forefoot pathologies, and investigated pain as a factor influencing the relationship between these two groups. Methods: 81 patients undergoing forefoot surgery (n = 58, age 57.98±13.23, 41 female) or ankle surgery (n = 23, age 48.09±18.24, 16 female) were evaluated for preoperative gait using a wearable device. Metrics measured included stride time (time between initial and subsequent heel contact), stance time (time between heel contact and toe push-off), and swing time (time between toe push-off and subsequent heel contact). Gait parameters were collected for both involved and uninvolved sides, with changes calculated as uninvolved - involved values. VAS pain scores were collected following trial or from an outcome database. Group comparisons were made using the Chi-Squared Test of Independence, while the Shapiro-Wilk and Levene’s tests assessed normality and homogeneity. Following data distribution, independent t-tests or Mann-Whitney U tests were used to identify significant differences (P < .05).Statistical differences were further analyzed to control for pain using an ANCOVA test and a simple linear regression analysis. Results: No significant differences were noted between group demographics. The ankle group had greater positive change in stance time than the forefoot, indicating prolonged stance phase on the uninvolved side (Figure 1A, p = .003). The ankle group also had a greater negative change in swing time than the forefoot, suggesting elongated swing on the involved side (Figure 1B, p < .001). Stride time showed no differences. When controlling for pain through ANCOVA, subgroupings were the primary driver of stance (p < 0.001) and swing time (p=0.003) changes, although pain also independently noted significant contributions to these changes (p=0.002,0.057). Linear regression found y-intercept differences between groups without slope differences, verifying persisting differences between groups controlled for pain (Figure 1C-D, p=.003, <.001). Conclusion: This study supports our hypothesis with significantly greater preoperative gait disturbances observed in the ankle population compared to the forefoot grouping. When evaluating this relationship, pain was found to independently contribute to increases in calculated differences. However, anatomical subgrouping had a greater independent effect on these differences, and persisted after controlling for pain. This suggests the involvement of other factors in creating this relationship between groups. Future work should incorporate underlying diagnoses, and patient outcomes to provide further clarity on why differences persist between these groups. Figure 1. [A-B] Quantification of change in stance and swing time by anatomical groupings. [C-D] Simple linear regression analysis of change metrics along a pain axis.