Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis. (November 2017)

• Record Type: Journal Article
• Authors: Psarakis, Michael; Greene, David; Moresi, Mark; Baker, Michael; Stubbs, Peter; Brodie, Matthew; Lord, Stephen; Hoang, Phu
• Is Part Of: Clinical biomechanics. Volume 49(2017)
• Page Start: 96
• Page End: 100
• Publication Date: 2017-11
• Subjects: Heel – Toe sequence -- Footprint -- Ankle rocker -- Electronic walkway -- Gait impairment; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2017.08.012
• Languages: English
• ISSNs: 0268-0033

Abstract

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. Highlights: Heel-to-toe progression was measured in people with and without Multiple Sclerosis. In people with Multiple Sclerosis, heel-to-toe progression was severely compromised. Impaired heel-to-toe progression was related to poor ankle range of motion. The new test revealed functionally and clinically important inter-limb differences. Heel-to-toe progression is a sensitive measure to detect gait abnormalities.