Can toe-walking contribute to stiff-legged gait?

Objective: Spastic paretic stiff-legged gait, defined as reduced knee flexi on in swing, has previously been attributed solely to spastic quadriceps ac tivity. In earlier work, the authors suggested that reduced knee flexion in swing can be attributed to other indirect factors, such as poor hip flexio n and abnormal foot-ankle function during gait. The present study was under taken to determine whether toe-walking, which often occurs in conjunction w ith 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 colle cted from able-bodied subjects while walking on their toes vs. normal heel- toe walking. Results: Peak knee flexion was reduced significantly compared with normal h eel-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 spee d, 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 cause s, such as intrinsic spasticity or abnormal muscle firing about the knee.