Foot posture after stroke: frequency, nature and clinical significance

Objectives: Clinical convention suggests that foot posture and movements are adversely affected by stroke and cause walking difficulties but there is little objective data to support or refute these beliefs. This study explores static foot posture in people with stroke and their relationship to weakness and spasticity and walking limitations. Design: Cross-sectional survey. Setting: Stroke services and support groups of two acute hospitals. Subjects: Seventy-two stroke survivors with mobility limitations. Main measures: Foot Posture Index; Demographics; Motricity Index (weakness); modified Ashworth Scale (spasticity); Walking Handicap Scale (walking limitations). Results: About one-third of participants had abnormal foot posture on the weak side, which was associated with walking limitations. Most (70%) had a symmetrical foot posture with similar frequencies of supination (13%) and pronation (16%) abnormalities. There was no relationship between foot posture and weakness and spasticity; age was the only independent predictor of foot posture abnormalities. Conclusions: A minority of people with stroke had abnormal or asymmetrical foot posture and equal numbers suffered pronation and supination abnormalities; these findings challenge the beliefs that underpin the clinical management of stroke-related foot problems.