The effect of stroke on foot kinematics and the functional consequences

•Stroke survivors showed movement deficiencies in the intrinsic affected foot joints.•Stroke survivors showed reduced range of motion across most segments and planes.•Stroke survivors showed increased pronation and reduced supination.•Stroke survivors showed disruption of the rocker and the timing of joint motion.•The changes in pronation and supination were associated with limited walking ability.

BackgroundAlthough approximately one-third of stroke survivors suffer abnormal foot posture and this can influence mobility, there is very little objective information regarding the foot and ankle after stroke.ObjectiveAs part of a programme of research examining foot and ankle biomechanics after stroke, we investigated multi-planar kinematics and the relationship with function.MethodsIn a single assessment session, static foot posture (Foot Posture Index); mobility limitations (Walking Handicap Scale) and multi-segment foot and ankle kinematics during stance phase of walking were measured in 20 mobile chronic stroke survivors and 15 sex and age-matched healthy volunteers.ResultsCompared to the healthy volunteers, the stroke survivors demonstrated consistently reduced range of motion across most segments and planes, increased pronation and reduced supination, disruption of the rocker and the timing of joint motion. Changes in pronation/supination were associated with limited walking ability.ConclusionsThis study provides evidence of structural and movement deficiencies in the intrinsic foot segments affected by stroke. These would not have been detectable using a single segment foot model. Data do not support common clinical practices that focus on correction of sagittal ankle deformity and assumed excessive foot supination. Some of these abnormalities were associated with limitation in functional ability. Biomechanical abnormalities of foot and ankle are modifiable and there is potential for clinical studies and future developments of interventions to help prevent or treat these abnormalities which may improve functional ability post stroke.