KINEMATICAL ASPECTS OF FOOT MOVEMENTS DURING GAIT IN EARLY MULTIPLE SCLEROSIS PATIENTS

Abstract

Multiple Sclerosis patients sometimes experience their forward swinging feet to catch the floor unintentionally. Minimally impaired Multiple Sclerosis patients, during terminal-swing phases of gait, may even produce shuffling sounds, by the lateral soles of their feet over the ground. To prevent tripping, such patients should train their medial hamstring muscles.

Renewed interest in gait and balance in Multiple Sclerosis emerges, as the 1st International Symposium on Gait and Balance in Multiple Sclerosis testifies (International Journal of MS Care, 2011). However, little attention is given to the swing phase of gait in early Multiple Sclerosis patients. Remarkably, various early diagnosed Multiple Sclerosis patients produce audible shuffling sounds, caused by the lateral soles of their shod feet over the ground, during the terminal-swing phase of gait. The common cause seems to be foot-drop including foot-inversion. Foot-inversion is defined as turning the sole of the foot inward, while foot-eversion is turning the sole outward. Recent quantitative data on exercise therapies of ankle weakness patients clearly show that normal foot eversion goes together with simultaneous shank internal rotation. From a functional-anatomical point of view, normal internal shank rotation during knee flexion is effectuated by the medial hamstring muscles. Most authors therefore agree on training Multiple Sclerosis patients´ hamstrings. Strength training of hamstring muscles appears to have positive effects on muscular function and gait speed in Multiple Sclerosis patients. We presume that the abnormal lateral foot shuffling in swing may easily lead to the much-dreaded tripping, stumbling and falling with their far-reaching consequences. This should be avoided as much as possible.