Research Article: Technique to reduce the minimum toe clearance of young adults during walking to simulate the risk of tripping of the elderly

Date Published: June 12, 2019

Publisher: Public Library of Science

Author(s): Jessica Beltran Ullauri, Yasuhiro Akiyama, Shogo Okamoto, Yoji Yamada, Kei Masani.


The elderly gait encompasses several disorders, including a lower minimum toe clearance (MTC) to the ground, which is a potential cause of tripping and falling while walking. Devices that assist in the MTC could reduce such risks. However, the development of effective assistive methods and their evaluation in the elderly might jeopardize their safety. To address this, young adults could take the place of the elderly. We present Muscle Activity Restriction Taping Technique (MARTT) that was devised to simulate the healthy-elderly gait characteristics in the young adults, particularly the lower MTC, by restricting the activity of lower-limb muscles. Two different restriction approaches, one that restricts muscles at the shank and the other at the shank and thigh, simultaneously, were tested at different walking speeds. Both approaches achieved a reduction in the MTC, regardless of the walking speed. The MTC was reduced to a median value lower than 10.1 mm, which is within the range of the MTC values reported for the elderly. The reduction of the MTC significantly increased toe contact to the ground. With the restriction of the shank muscles, the toe-contact frequency was more than twice as that in normal walking, and with the restriction of both the shank and thigh muscles, more than five times. In addition, MARTT reproduced the lower step length, the lower single support phase, and the joint motion compensation characteristic of the elderly gait, in the youth.

Partial Text

The elderly population in the world has considerably increased; thus, several needs must be met to ensure a good quality of life for the elderly. In particular, reducing the risk of falling is a major priority because considerable evidence establishes that a fall is detrimental to their health [1–4].

MARTT, a technique devised for reproducing the healthy-elderly gait characteristics in youth, particularly the lower Minimum Toe Clearance (MTC), was investigated in this study. This technique was implemented in the shank and thigh to limit the transversal area of muscle’ belly during muscle contraction, thereby limiting the range of motion in joints. As hypothesized, by using MARTT, the MTC median was significantly reduced to values lower than 10.1 mm, which agree with the MTC values found in the elderly, while reproducing other gait characteristics of the elderly, including lower single support phase and specific joint motion characteristics. Due to MTC reduction, the toe-contacts increased by at least double, when the shank muscles were restricted, and by five times, when both the shank and thigh muscles were restricted. The restriction of the shank muscles reduced principally the dorsal flexion of the ankle, while that of the thigh muscles reduced the hip flexion, without gait impairment.