Foot placement in a body reference frame during walking and its relationship to hemiparetic walking performance.

BACKGROUND Foot placement during walking is closely linked to the body position, yet it is typically quantified relative to the other foot. The purpose of this study was to quantify foot placement patterns relative to body post-stroke and investigate its relationship to hemiparetic walking performance. METHODS Thirty-nine participants with hemiparesis walked on a split-belt treadmill at their self-selected speeds and 20 healthy participants walked at matched slow speeds. Anterior-posterior and medial-lateral foot placements (foot center-of-mass) relative to body (pelvis center-of-mass) quantified stepping in body reference frame. Walking performance was quantified using step length asymmetry ratio, percent of paretic propulsion and paretic weight support. FINDINGS Participants with hemiparesis placed their paretic foot further anterior than posterior during walking compared to controls walking at matched slow speeds (P<.05). Participants also placed their paretic foot further lateral relative to pelvis than non-paretic (P<.05). Anterior-posterior asymmetry correlated with step length asymmetry and percent paretic propulsion but some persons revealed differing asymmetry patterns in the translating reference frame. Lateral foot placement asymmetry correlated with paretic weight support (r=.596; P<.001), whereas step widths showed no relation to paretic weight support. INTERPRETATION Post-stroke gait is asymmetric when quantifying foot placement in a body reference frame and this asymmetry related to the hemiparetic walking performance and explained motor control mechanisms beyond those explained by step lengths and step widths alone. We suggest that biomechanical analyses quantifying stepping performance in impaired populations should investigate foot placement in a body reference frame.