A STEP-TO GAIT DECREASES PRESSURES ON THE FOREFOOT

Physical therapists use various gait training strategies to reduce str ess on the lower extremities, but we could iind no description or eval uation oi the step-to gait using a cane. The purpose oi this study was to evaluate the effect oi a step-to gait pattern and a cane on peak p lantar pressures on the forefoot and the heel. Ten healthy subjects we re evaluated (five females, live males, mean age = 24.6 +/- 4.9 years) . In addition, one subject with peripheral neuropathy was tested to de termine ii a patient could be trained to use the step-to walking patte rn and show similar results. All subjects were instructed in lour walk ing conditions: step-to with and without a cane and step-through with and without a cane. Walking speed during the step-through pattern (nor mal walking) was matched to the speed oi the step-to pattern. For the 10 healthy subjects, peak plantar pressures and walking speed oi each oi the lour conditions were compared using a 2 x 2 repeated measures a nalysis oi variance. One factor was gait pattern and one factor was us e oi a cane. Peak plantar pressures decreased an average of 53% on the forefoot but increased an average oi 14% on the heel when subjects wa lked using step-to gait compared with a step-through gait There was no effect due to use oi a cane or walking speed between the conditions. The patient with peripheral neuropathy demonstrated a similar pattern but greater magnitude oi changes compared with the healthy subjects. T he foot initiating the step-to pattern showed a reduction in peak plan tar pressures on the forefoot, probably because the loot remained flat during stance phase and a large push-off was not required. The step-t o pattern, however, results in a slower and less symmetrical gait. The use of a step-to gait may be beneficial for patient populations that need to reduce plantar pressures on the forefoot.