What a gait analysis can tell you about foot pain

When the same injury keeps coming back, whether it’s heel pain, shin pain or a sore Achilles, the question is often not just what hurts, but why. A gait analysis looks for the answer in how you move.

What we look at

A gait analysis at the practice is part of the examination, not a separate test. We look at:

• Standing: foot posture, arch height and heel position, and how the knees and hips line up.
• Joint motion: how far the big toe, ankle and subtalar joint move, and how tight the calves are.
• Walking: how the heel strikes, how the foot rolls through the step, and how it pushes off.
• Running, for runners: foot strike, how far the foot lands in front of the body, step rate, and how the knee and hip move.
• Single-leg tests: balance, a single-leg squat and heel raises, which reveal weakness and control problems.
• Your shoes: the wear pattern tells its own story.

What it can explain

• Heel pain from a tight calf or an overloaded arch.
• Shin splints and stress fractures from high impact, a long stride or overstriding.
• Achilles problems from calf weakness or a sudden change in shoes.
• Ball-of-foot pain from pressure concentrated under certain metatarsals.
• Knee pain influenced by how the foot and hip control the leg.

Research on biomechanics and running injuries is a mix of strong and weak findings: an umbrella review found that biomechanical and morphological factors were among those linked to injury, alongside training characteristics, health and lifestyle.^[2] That’s why a gait analysis is interpreted together with your training history, not on its own.

What it leads to

• Custom orthotics or better footwear when foot mechanics are overloading a structure. We use a 3D foot scan to make orthotics; see custom orthotics.
• Strengthening: calves, foot muscles and hips.
• Running changes. The strongest evidence is for increasing step rate (more, slightly shorter steps). In a meta-analysis of gait retraining trials, step-rate retraining increased cadence and reduced impact loading, with moderate-certainty evidence.^[1] Changes are made gradually.
• Training changes: how fast mileage builds, and how hard days are spaced.

Common questions

Should I switch from landing on my heel to landing on my forefoot?

Not as a first step. In the gait retraining trials, changing foot strike had only low-certainty evidence behind it: it changed how the knee bent on landing but didn’t improve running economy.^[1] Increasing your step rate slightly is simpler and better supported, and a sudden switch in foot strike can overload the calf and Achilles while they adapt.

Can changing how I run prevent injuries?

It may. The trials showed that retraining changes running mechanics and lowers impact loading without hurting performance, and two trials found fewer injuries over the following year; there weren’t enough trials to judge the effect on pain.^[1]

Do I need a lab with a treadmill and cameras?

Usually not. Most of what matters shows up in a careful examination, watching you walk and run, and looking at your shoes. A slow-motion phone video of you running can add useful detail.

Is it worth it?

If you have a one-off injury with an obvious cause, you may not need one. If you have recurring pain, pain on both sides, or pain that returns every time you build your running, a gait analysis is worth doing, and it’s part of how we choose between store-bought and custom orthotics. See custom vs. store-bought orthotics.

When to see a podiatrist