title: A "step-to" gait decreases pressures on the forefoot.
abstract: Physical therapists use various gait training strategies to reduce stress on the lower extremities, but we could find no description or evaluation of the step-to gait using a cane. The purpose of this study was to evaluate the effect of a step-to gait pattern and a cane on peak plantar pressures on the forefoot and the heel. Ten healthy subjects were evaluated (five females, five males, mean age = 24.6 +/- 4.9 years). In addition, one subject with peripheral neuropathy was tested to determine if a patient could be trained to use the step-to walking pattern and show similar results. All subjects were instructed in four walking conditions; step-to with and without a cane and step-through with and without a cane. Walking speed during the step-through pattern (normal walking) was matched to the speed of the step-to pattern. For the 10 healthy subjects, peak plantar pressures and walking speed of each of the four conditions were compared using a 2 x 2 repeated measures analysis of variance. One factor was gait pattern and one factor was use of a cane. Peak plantar pressures decreased an average of 53% on the forefoot but increased an average of 14% on the heel when subjects walked using step-to gait compared with a step-through gait. There was no effect due to use of a cane or walking speed between the conditions. The patient with peripheral neuropathy demonstrated a similar pattern but greater magnitude of changes compared with the healthy subjects. The foot initiating the step-to pattern showed a reduction in peak plantar pressures on the forefoot, probably because the foot remained flat during stance phase and a large push-off was not required. The step-to 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.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA.
authors.forename: H E
authors.initials: HE
authors.lastname: Brown
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D005528:Foot; D005684:Gait; D006801:Humans; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D016474:Weight-Bearing