Can toe-walking contribute to stiff-legged gait?

OBJECTIVE: Spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, has previously been attributed solely to spastic quadriceps activity. In earlier work, the authors suggested that reduced knee flexion in swing can be attributed to other indirect factors, such as poor hip flexion and abnormal foot-ankle function during gait. The present study was undertaken to determine whether toe-walking, which often occurs in conjunction with stiff-legged gait, in and of itself, might explain some of the reduced knee flexion in swing. DESIGN: An analysis was performed of three-dimensional kinematic data collected from able-bodied subjects while walking on their toes vs. normal heel-toe walking. RESULTS: Peak knee flexion was reduced significantly compared with normal heel-toe walking (42.2+/-8.9 degrees toe-walking vs. 59.2+/-5.7 degrees heel-toe walking; P < 0.00001). CONCLUSIONS: This finding, which occurred when controlling for walking speed, may be clinically relevant for patients who have both a toe-walking and a stiff-legged gait pattern. Some of the reduced knee flexion in swing may be merely a consequence of toe-walking, rather than a result of other causes, such as intrinsic spasticity or abnormal muscle firing about the knee.

Knee joint torques: a comparison between women and men during barefoot walking.

OBJECTIVE: To determine if knee joint torques, which are likely relevant to the development and, possibly, progression of knee osteoarthritis, are equivalent between genders during natural, barefoot walking. DESIGN: Collected stereophotogrammetric and force platform data during comfortable, barefoot walking. Knee joint torques were plotted and statistically compared between genders using both an unpaired t test (p < .05) and an equivalence test (20% delta). SETTING: A gait laboratory. PARTICIPANTS: One hundred ten healthy, nondisabled young women and men. MAIN OUTCOME MEASURES: Four knee joint torque parameters normalized for height and weight: (1) peak and (2) duration of sagittal flexor joint torque from early to midstance, and (3) first and (4) second peak coronal (frontal) varus torque values during the stance period. RESULTS: No statistically significant differences between genders were found, and the values were equivalent between genders for each of the 4 knee joint torque parameters. CONCLUSION: These findings support the hypothesis that under similar barefoot conditions women and men have a similar intrinsic biomechanic risk for knee osteoarthritis. Future research to assess the effects of other potential biomechanic factors, such as shoe-wear and activity type, may assist not only in preventing knee joint osteoarthritis, but also in developing new rehabilitative strategies to treat osteoarthritis of the knee.

Kinetic alterations independent of walking speed in elderly fallers.

OBJECTIVES: To determine if joint kinetic gait alterations in fallers persist when they attempt to walk at a faster speed that is more comparable with nonfallers' comfortable walking speed. DESIGN: Retrospective, case-control study. Stereophotogrammetric and force platform data were collected. SETTING: A gait laboratory. PARTICIPANTS: Sixteen elderly subjects who had at least 2 falls in the last 6 months from an unclear cause and 23 elderly subjects with no history of repeated falls. MAIN OUTCOME MEASURES: Differences in all major peak joint kinetic (moment and power) values during the gait cycle between elderly nonfallers walking at comfortable speed and elderly fallers walking at (1) comfortable and (2) fast speed. RESULTS: Statistically significant differences present at both comfortable and fast walking speeds were present in 4 sagittal plane parameters. There was an increase in peak external hip flexion moment in stance, a reduction in peak hip extension moment, a reduction in knee flexion moment in preswing, and a reduction in knee power absorption in preswing. CONCLUSION: The presence and persistence of 4 specific alterations in sagittal plane joint kinetics at both comfortable and fast walking speeds imply specific intrinsic pattern differences and allow for new insights into the mechanics of gait in elderly people who fall. The presence of these alterations also suggests they may serve as potential identifiable markers to detect those who may be at risk for falls.