| Description |
- Evaluation of pain often relies on subjective patient reported outcomes (PROs) such as the Brief Pain Inventory. Supplementing such measures with objective endpoints can provide a deeper assessment of acute and chronic pain. In the present study, we evaluate quantitative gait analysis using a podiatric walkway that records pressure measurements and spatiotemporal parameters during a full gait cycle. We hypothesized that patients with neuropathic foot pain due to Morton neuroma (MN) would have abnormal gait and altered pressure loading from the affected foot detectable using these methods.
We recruited healthy volunteers (HV) and patients with symptomatic MN pain (MN) from the local community to form a normative dataset and an investigational pain cohort, respectively. Gait measurements from 42 HV and 10 MN revealed stability of gait parameters among HV and potential differences in MN gait patterns. The variance of metatarsal peak pressure (MPP) across all steps stabilized at 11 steps (CV=13.54%) for HV and 15 steps (CV=12.76%) for MN, indicating reliability of the measurement. We observed significantly lower MPP in the affected feet of MN (588+40.23 kPa) compared to non-affected MN feet (642.16+30.17 kPa); p=0.02, but an overall trend of higher MPP in both feet averaged together for MN compared to HV (615.50+33.73 vs. 585.40 kPa).
While we did not detect significant group-level differences between HV and MN, within-subjects comparison of pressure loading in MN revealed asymmetry between affected and non-affected feet. Further, HV data demonstrated stable phenotyping of normative gait, and other metrics such as contact area (CA) showed promising trends. One patient entering the study with a pain rating of 5 (out of 10) showed up to 76% reduction in CA of the affected foot relative to her healthy foot. This behavior was not mirrored in other MN patients, indicating individual differences in pain compensation that may diverge from larger cohort patterns as the study continues. These observations support application of gait analysis as a surrogate measure of pain, which may enhance objective endpoints in future clinical evaluations of functional outcomes in pain management.
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