Compensatory advantages of toe walking

Objectives: The study's hypothesis is that toe walking requires less peak muscle strength distally about the ankle and knee compared with normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal muscle weakness. Design: Motion analysis and force platform data were collected in able-bodied subjects during toe walking and normal walking. Sagittal plane joint torques reflecting muscle force requirements and joint powers reflecting nonisometric muscle contraction were compared between the two conditions using paired 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 variables during walking. Results: Peak ankle plantarflexor torque and ankle power generation during terminal stance and preswing were reduced (p <.001), as compared with normal heel-toe walking. The normal ankle dorsiflexor torque at initial contact and the knee extensor torque and knee power generation during loading response were all essentially absent during toe walking. Hip extensor torque and hip power generation during the loading response phase were greater for toe walking (p <.001). Conclusion: Toe walking may require less ankle plantarflexor, ankle dorsiflexor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal lower extremity weakness.