Compensatory advantages of toe walking

Objectives: The study's hypothesis is that toe walking requires less peak m uscle strength distally about the ankle and knee compared with normal heel- toe walking and thus may have compensatory advantages for patients with upp er motor neuron injury and distal muscle weakness. Design: Motion analysis and force platform data were collected in able-bodi ed subjects during toe walking and normal walking. Sagittal plane joint tor ques reflecting muscle force requirements and joint powers reflecting nonis ometric muscle contraction were compared between the two conditions using p aired t tests, applying a Bonferroni correction for multiple comparisons. Setting: A gait laboratory. Subjects: Seventeen able-bodied adults, 9 of whom were ballet dancers. Main Outcome Measures: Peak hip, knee, and ankle joint torque and power var iables during walking. Results: Peak ankle plantarflexor torque and ankle power generation during terminal stance and preswing were reduced (p <.001), as compared with norma l heel-toe walking. The normal ankle dorsiflexor torque at initial contact and the knee extensor torque and knee power generation during loading respo nse were all essentially absent during toe walking. Hip extensor torque and hip power generation during the loading response phase were greater for to e walking (p <.001). Conclusion: Toe walking may require less ankle plantarflexor, ankle dorsifl exor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury an d distal lower extremity weakness.