title: Can toe-walking contribute to stiff-legged gait?
abstract: OBJECTIVE
  Spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, has previously been attributed solely to spastic quadriceps activity. In earlier work, the authors suggested that reduced knee flexion in swing can be attributed to other indirect factors, such as poor hip flexion and abnormal foot-ankle function during gait. The present study was undertaken to determine whether toe-walking, which often occurs in conjunction with stiff-legged gait, in and of itself, might explain some of the reduced knee flexion in swing.
  
  
  METHODS
  An analysis was performed of three-dimensional kinematic data collected from able-bodied subjects while walking on their toes vs. normal heel-toe walking.
  
  
  RESULTS
  Peak knee flexion was reduced significantly compared with normal heel-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 speed, 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 causes, such as intrinsic spasticity or abnormal muscle firing about the knee.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Kerrigan
authors.forename: D T
authors.initials: DT
authors.lastname: Burke
authors.forename: T J
authors.initials: TJ
authors.lastname: Nieto
authors.forename: P O
authors.initials: PO
authors.lastname: Riley
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology*; D016138:Walking / Q000502:physiology*