286 Canine Sports Medicine and Rehabilitation
for seeking a V‐OP solution, the total expense
of an orthosis, partial medial meniscectomy,
and rehabilitation may not be within budget
or it may not be less costly than surgical stabi
lization, partial medial meniscectomy, and
rehabilitation.
Media acquisition for conformation, stance,
and gaiting
Video is used for gait and active range of motion
(AROM) analysis. Video capture is best per
formed in a long hallway (e.g. 30 × 5 feet) with a
nonslip surface, or in an outdoor walkway.
Obtaining video prior to examination can be ben
eficial as many patients tire significantly by the
end of the comprehensive V‐OP examination. Use
of an electronic device (tablet or smart phone)
with a gait analysis app permits slow motion
viewing, still shots, and goniometry. At the time
of this writing, commonly used apps include
Coach’s Eye™, Dartfish™, and Hudl™.
Media should be obtained from the level of
the patient to reveal true motion without the
distortion of perspective. Standard media
obtained for each patient include combined
transverse and frontal plane views (patient
standing or moving toward and away from the
camera) and sagittal plane views (patient stand
ing or moving to the left and then to the right).
Each view should incorporate the whole patient
to further analyze the patient’s top line, all
limbs in relation to one another, and the trunk.
Importantly, the dog should be moving at an
even and steady pace, not pulling or lagging
behind, and not leaning in either direction.
Limiting any distractions in the area is helpful,
as is keeping a loose, but controlled, leash.
The V‐OP practitioner should evaluate each
video for conformation, gait abnormalities,
pathology, and measurement data (goniome
try/osteokinematics). Good‐quality media are
necessary to make a proper diagnosis, prescrip
tion, and treatment plan; therefore, taking the
time to capture good images is worthwhile.
Additionally, this media is important for com
parison as the treatment progresses.
While not all images are required for each
patient, common video clips include four‐leg
and three‐leg challenge stance and gaiting at
walk and trot. For the former, the patient is
positioned in a square stance with body weight
evenly distributed over all limbs and the head
facing directly forward. Video acquisition from
all sides is ideal. Three‐leg challenge stance,
which simulates AROM loading, is acquired by
lifting each limb sequentially. This is an isomet
ric method of assessing internal moments used
by the patient to resist external moments.
The second method of assessing internal
moments is by gaiting at the walk and trot. Since
the act of gaiting loads each limb differently,
and with more force than stance (Kirpensteijn
et al., 2000; Abdelhadi et al., 2013; Fischer et al.,
2013; Hogy et al., 2013; Jarvis et al., 2013; Fuchs
et al., 2014), these images can reveal the severity
of instability or weakness as well as more subtle
changes not seen in stance. Using a gait analysis
app, goniometry and limb alignment can be
assessed. By observing gait phases, information
can be noted on (1) sagittal, frontal, and trans
verse plane conformation; and (2) ambulation
abnormalities such as circumduction, varus,
valgus, base‐narrow or ‐wide, toed‐in or turned‐
out feet, or cow‐hocks.
Lastly, while assessing conformation and
gaiting it is critical to assess the line of progres
sion (LOP) for each limb. LOP describes the
orientation of the proximal limb and the distal
limb in stance and ambulation in the forward
plane. LOP reveals alterations in the frontal and
transverse planes. For many dogs the normal
LOP for the thoracic and pelvic limbs is from
the second or third digit due to a natural
tendency for mild external rotation (toeing out).
The Border Collie is an excellent example. If a
V‐OP device is prescribed attempting to create
an LOP corresponding to the third or fourth
digit (the cranial‐most aspect of the foot), a
forced internal rotation would be incurred pre
disposing to gaiting impairment and possible
wounds from the device. Rather, with natural
LOP in mind, the foot shell component should
accommodate external rotation while the
ground contact (sole of the device) realigns
LOP in the forward plane.Examination
The V‐OP examination includes a general health
assessment noting the presence of comorbidities
that may supersede or impact the current
issue. Neurological evaluation may be cursory
or complete depending upon presenting