Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis

Clin Biomech (Bristol, Avon). 2017 Nov:49:96-100. doi: 10.1016/j.clinbiomech.2017.08.012. Epub 2017 Sep 1.

Abstract

Background: Gait impairment in people with Multiple Sclerosis results from neurological impairment, muscle weakness and reduced range of motion. Restrictions in passive ankle range of motion can result in abnormal heel-to-toe progression (weight transfer) and inefficient gait patterns in people with Multiple Sclerosis. The purpose of this study was to determine the associations between gait impairment, heel-to-toe progression and ankle range of motion in people with Multiple Sclerosis.

Methods: Twelve participants with Multiple Sclerosis and twelve healthy age-matched participants were assessed. Spatiotemporal parameters of gait and individual footprint data were used to investigate group differences. A pressure sensitive walkway was used to divide each footprint into three phases (contact, mid-stance, propulsive) and calculate the heel-to-toe progression during the stance phase of gait.

Findings: Compared to healthy controls, people with Multiple Sclerosis spent relatively less time in contact phase (7.8% vs 25.1%) and more time in the mid stance phase of gait (57.3% vs 33.7%). Inter-limb differences were observed in people with Multiple Sclerosis between the affected and non-affected sides for contact (7.8% vs 15.3%) and mid stance (57.3% and 47.1%) phases. Differences in heel-to-toe progression remained significant after adjusting for walking speed and were correlated with walking distance and ankle range of motion.

Interpretation: Impaired heel-to-toe progression was related to poor ankle range of motion in people with Multiple Sclerosis. Heel-to-toe progression provided a sensitive measure for assessing gait impairments that were not detectable using standard spatiotemporal gait parameters.

Keywords: Ankle rocker; Electronic walkway; Footprint; Gait impairment; Heel – Toe sequence.

MeSH terms

  • Ankle
  • Ankle Joint / physiology
  • Biomechanical Phenomena
  • Disease Progression
  • Female
  • Gait / physiology*
  • Heel / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / physiopathology*
  • Muscle Weakness
  • Pressure
  • Range of Motion, Articular / physiology*
  • Rotation
  • Toes / physiopathology*
  • Walking / physiology
  • Walking Speed