Multi-segment foot model reveals distal joint kinematic differences between habitual heel-toe walking and non-habitual toe walking.

Toe walking is observed in pathological populations including cerebral palsy, stroke, and autism spectrum disorder. To understand pathological toe walking, previous studies have analyzed non-habitual toe walking. These studies found sagittal plane deviations between heel-toe and toe walking at the hip, knee, and ankle. Further investigation is merited as toe walking may involve altered biomechanics at more distal joints, such as the midtarsal joint. The purpose of this study was to examine biomechanical differences between rearfoot strike walking (RFSW) and non-rearfoot strike walking (NRFSW) in the midfoot and ankle. We hypothesized that during NRFSW, midtarsal kinematics would diverge from those during RFSW in all three cardinal planes and ankle kinematics would display increased supination. Twenty-four healthy females walked overground with both walking patterns. Motion capture, electromyography (EMG), and force plate data were collected. A validated multi-segment foot model was used with mean difference waveform analyses to compare walking conditions during stance. Significantly different kinematics were found in all three planes for the midtarsal and ankle joint during NRFSW. The NRFSW midtarsal joint exhibited increased plantarflexion, eversion, and adduction with the largest differences occurring at initial contact and in the sagittal plane. The NRFSW ankle exhibited increased supination at initial contact and during early stance. These findings indicate that toe walking alters both distal and proximal foot joint kinematics in multiple planes. This may further the understanding of altered biomechanics during toe walking while providing a basis for future analyses of pathological gait.