A Scoping Review on Minimum Foot Clearance: An Exploration of Level-Ground Clearance in Individuals with Abnormal Gait

Abstract

Background: Falls are a major health concern, with one in three adults over the age of 65 falling each year. A key gait parameter that is indicative of tripping is minimum foot clearance (MFC), which occurs during the mid-swing phase of gait. This is the second of a two-part scoping review on MFC literature. The aim of this paper is to identify vulnerable populations and conditions that impact MFC mean or median relative to controls. This information will inform future design/maintenance standards and outdoor built environment guidelines. Methods: Four electronic databases were searched to identify journal articles and conference papers that report level-ground MFC characteristics. Two independent reviewers screened papers for inclusion. Results: Out of 1571 papers, 43 relevant papers were included in this review. Twenty-eight conditions have been studied for effects on MFC. Eleven of the 28 conditions led to a decrease in mean or median MFC including dual-task walking in older adults, fallers with multiple sclerosis, and treadmill walking. All studies were conducted indoors. Conclusions: The lack of standardized research methods and covariates such as gait speed made it difficult to compare MFC values between studies for the purpose of defining design and maintenance standards for the outdoor built environment. Standardized methods for defining MFC and an emphasis on outdoor trials are needed in future studies.

Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study

“…This difference in the number of analyzed strides might explain the difference in the quality of estimation, as analyzing a lower number of strides might lead to less data variability and to consequently more accurate estimations. The estimation of the paretic minimum foot clearance [ r = 0.89; MAE = 0.01 m; ICC(A,1) = 0.812; ICC(C,1) = 0.848] was found to be robust enough to be used in a clinical environment ( Al Bochi et al, 2021) . However, we have not found any other study that validated the estimation of this metric using IMUs in participants after stroke ( Yang et al, 2013 ; Parisi et al, 2016 ; Visi et al, 2017 ; Wang et al, 2018 ; Feuvrier et al, 2020 ; Arens et al, 2021 ; Arumukhom Revi et al, 2021 ; Laidig et al, 2021 ; Hendriks et al, 2022 ) or with other brain injuries ( Bourgeois et al, 2014 ; Sijobert et al, 2015 ; Moon et al, 2017 ; Behboodi et al, 2019 ).…”

A Scoping Review on Minimum Foot Clearance Measurement: Sensing Modalities

“…Studies focusing on the measurement modality of MFC are discussed further in this paper. Studies focusing on MFC values and how it is affected by various conditions are discussed in our companion paper [16].…”

“…We also review the suitability of using these modalities and methods for the estimation of MFC values on outdoor walkways by comparing the performance, portability, and complexity of each system. A companion paper answers RQ2 and identifies conditions that impact MFC and the range of MFC values individuals with these conditions exhibit [16].…”

Fatigue Effect on Minimal Toe Clearance and Toe Activity during Walking

“…Furthermore, the importance of foot activity has been recognized [ 14 , 15 ]. During a normal walk, the heel initially makes ground contact.…”

“…Pereira and Gonçalves investigated the effect of fatigue on motion patterns by walking on a treadmill for 20 min and showed that this fatigue was not high enough to change the motion patterns in older adults [ 25 ]. The effect of fatigue on MTC has not been well-investigated [ 14 ]. A technique to imitate the fatigue effect in older adults has recently been developed [ 26 ].…”