Immediate effects of the toe spreader on the tonic toe flexion reflex

Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322.

BACKGROUND AND PURPOSE. The purpose of the study was to determine whether the use of a toe spreader to inhibit the tonic toe flexion reflex (TTFR) immediately alters temporal-distance gait characteristics, plantar surface contact, or muscle activity in the limb exhibiting the TTFR of subjects with hemiparesis secondary to supraspinal lesion. SUBJECTS. Eighteen adults with hemiparesis secondary to supraspinal lesions served as subjects for the standing portion of the study. Sixteen of the subjects participated in the gait portion of the study. METHODS. The study was a randomized, within-subject, between-conditions comparison consisting of standing and gait phases, with four conditions for each phase (shoe off, toe spreader off/on, shoe on, toe spreader off/on). Measures performed were ink footprint gait analysis and integrated electromyography from the limb exhibiting the TTFR. RESULTS. Presence of the TTFR was reduced significantly with the use of the toe spreader. Velocity and cadence were increased significantly by use of the toe spreader. CONCLUSION AND DISCUSSION. The toe spreader may be a useful treatment option for improving gait. The clinical significance of these findings, however, will depend on the functional context of toe-spreader use.