Alternative measures of toe trajectory more accurately predict the probability of tripping than minimum toe clearance

Tripping is responsible for a large percentage of falls. Minimum toe clearance (MTC) during the swing phase of gait is commonly used to infer the probability of tripping (POT). However, there is limited empirical evidence to support the relationship between these two variables, and other measures of toe trajectory may better predict POT than MTC. The goals of this study were to: 1) quantify the relationship between MTC and POT; and 2) explore alternative measures of toe trajectory that may predict POT more accurately than MTC. POT was estimated by comparing the distribution of tripping obstacles measured along heavily-used, paved sidewalks on a university campus, to the toe trajectory of 40 young adults obtained while walking over an obstacle-free walkway in a research laboratory. POT exhibited a curvilinear relationship with MTC, and regression equations were established to predict POT from MTC. POT was more accurately predicted when using virtual points on the bottom of the anterior edge of the shoe to determine MTC, compared to using a physical marker located on top of the toes to determine MTC. POT was also more accurately predicted when using a new measure of toe trajectory (the area below 40 mm and above the toe trajectory, normalized by the swing length), compared to just MTC. These are the first empirical results supporting a direct, quantitative relationship between MTC and POT. These results may improve the ability to identify risk factors that influence POT, and aid in developing interventions to reduce POT.