Contributors of stiff knee gait pattern for able bodies: Hip and knee velocity reduction and tiptoe gait.
Stiff-knee gait (SKG) is commonly encountered in clinic; many other gait abnormalities are seen together with this pathology. Simulation studies revealed that diminished knee flexion (KF) velocity and increased knee extension moments are strongly related with SKG. This study aimed to determine whether tiptoe walking and hip-knee flexion velocity reduction causes SKG pattern in healthy participants.


METHODS
Fourteen able-bodied adults' (Av. age: 23.0±2.4) heel-toe (N), tiptoe (T), and walking with 5% body weight on both shanks (W) were analyzed using 3D gait analysis by controlling cadence (90step/min). Repeated measures analysis of variance was used followed by Bonferroni correction (p<0.05).


RESULTS
Walking velocity and cadence were similar for all conditions (p>0.1). Maximum hip flexion velocity was reduced (15%) significantly as well as the KF velocity (10%) in the W condition. The peak knee flexion (PKF) (8.3% for T, 8.6% for W) and total knee range (10.9% for T, 13% for W) were reduced for both conditions (p<0.05). The knee range in early swing and the duration between toe-off and PKF were reduced only in the weighted-leg condition (p<0.05).


CONCLUSIONS
Slow hip and knee flexion diminished all SKG parameters except timing of PKF. Tiptoe gait itself generated a borderline SKG pattern by reducing the PKF and total knee range. By considering that tiptoe gait and SKG commonly seen together, some of the SKG contributors can be treated by normalizing the ankle motion in the stance and increasing the hip-knee flexion velocity by rigorously planned muscle lengthening procedures and effective strengthening exercises.
Istanbul University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Division, Demirkapi Cad. Karabal Sk. Bakirkoy Ruh ve Sinir Hastaliklari Hastanesi, Bakirkoy, 34740 Istanbul, Turkey. Electronic address: ekin.akalan@gmail.com.
N Ekin
NE
Akalan
Institute of Biomedical Engineering, Bogaziçi University, Institute of Biomedical Engineering, Kandilli Kampüs, Cengelkoy, 34684 Istanbul, Turkey. Electronic address: shavkatkuchimov@gmail.com.
Shavkat
S
Kuchimov
Istanbul University, Health Sciences, Institute Cerrahpasa Tip Fakultesi Kampusu, Saglik Bilimleri Enstitusu, Kocamustafapasa, 34303 Istanbul, Turkey. Electronic address: adanapti@yahoo.com.
Adnan
A
Apti
Istanbul University, Faculty of Medicine, Division of Orthopedics and Traumatology Ortopedi ve Travmatoloji Anabilim Dali Istanbul Tip Fakultesi, Capa Fatih, 34730 Istanbul, Turkey. Electronic address: ytemelli@gmail.com.
Yener
Y
Temelli
Roessingh Rehabilitation Center, Roessinghsbleekweg 33, 7522 AH Enschede, Netherlands. Electronic address: a.nene@roessingh.nl.
Anand
A
Nene
D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology*; D006621:Hip Joint / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology*; D016138:Walking / Q000502:physiology*; D055815:Young Adult
Gait; Hip; Knee; Stiff-knee; Tiptoe