Joint movements associated with minimum toe clearance variability in older adults during level overground walking

Sylvester C. Carter, Mitchell Z. Batavia, Gregory M. Gutierrez, Elizabeth A. Capezuti

Research output: Contribution to journalArticlepeer-review


Background: Approximately one-third of falls are caused by the swing foot contacting an object or the ground, resulting in a trip. The increased incidence of trip-related falls among older adults may be explained by greater within-person minimum toe clearance (MTC) variability. Research question: Will kinematic variability at any of the 6 major joints in the lower limbs, individually or in combination, be associated with MTC variability? Methods: This cross-sectional study investigated whether single or multiple joint movements best explained MTC variability in older adults. Twenty healthy older adults (7 males, 13 females; mean age = 71.3 ± 7.2 years) were recruited. Participants were fitted with a modified Cleveland Clinic marker set and walked for 50 trials at self-selected speeds over a 7-meter walkway (with a rest at 25 trials) while 6 infrared cameras recorded kinematics. Results: Seven joint movements were evaluated, and swing hip flexion-extension variability was the only joint movement significantly associated with MTC variability (r = 0.577, p = 0.008) and explained 29.6% (adjusted R2) of the variance of MTC variability in older adults (F (1, 18) = 8.897, p = 0.008). Significance: Identifying the joint movement/s associated with inconsistencies in toe clearance will improve our understanding of endpoint control in older adults and may lead to the development of effective trip prevention strategies.

Original languageEnglish (US)
Pages (from-to)14-21
Number of pages8
JournalGait and Posture
StatePublished - Jan 2020


  • Falls
  • Foot clearance
  • Minimum toe clearance
  • Tripping

ASJC Scopus subject areas

  • Biophysics
  • Orthopedics and Sports Medicine
  • Rehabilitation


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