What does walking on tiptoes and on heels assess?

From the Research

Walking on tiptoe and on heels assesses neurological function, specifically testing the integrity of the peripheral nerves and the central nervous system. Tiptoe walking evaluates plantar flexion strength, primarily testing the S1 nerve root and gastrocnemius-soleus muscle complex, as supported by a study on the empirical evaluation of gastrocnemius and soleus function during walking 1. Heel walking assesses dorsiflexion strength, mainly testing the L4-L5 nerve roots and the anterior tibialis muscle. These simple tests are valuable components of a neurological examination that can detect weakness from conditions such as peripheral neuropathy, radiculopathy, or upper motor neuron disorders. Difficulty with tiptoe walking may indicate S1 radiculopathy or gastrocnemius weakness, while problems with heel walking often suggest L4-L5 radiculopathy or anterior tibialis weakness. The tests also evaluate balance, coordination, and proprioception, as highlighted in a study on gait disorders in adults and the elderly 2. When performing these tests, the examiner should observe for asymmetry, instability, or compensatory movements that might indicate underlying neurological deficits. Some key points to consider when assessing gait include:

• The preferred walking speed in older adults is a sensitive marker of general health and survival 2
• Gait disorders lead to a loss of personal freedom, falls, and injuries, and result in a marked reduction in the quality of life 2
• Sensory ataxia due to polyneuropathy, parkinsonism, and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes of gait disorders 2
• Hip and knee osteoarthritis are common non-neurological causes of gait disorders 2
• Thorough clinical observation of gait, taking a focused patient history, and physical, neurological, and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions 2.