Impact of lower limb proprioception on balance and gait in hemiparetic patients: biomechanical analysis

Sensory and proprioceptive dysfunction in the lower extremities occurs in up to 89% of hemiparetic stroke patients and contributes to gait abnormalities, postural instability, and increased fall risk. However, the specific relationships between objectively measured proprioceptive deficits and quantitative balance/gait parameters remain incompletely characterized. This study investigated the associations between lower extremity proprioceptive impairments (foot sole sensation, position sense, and kinesthesia) and objective measures of balance and gait in hemiparetic individuals.

What is the association between lower extremity proprioceptive impairment (including foot sole sensation, position sense, and kinesthesia) and balance and gait parameters in hemiparetic individuals?

A cross-sectional study was conducted with 28 hemiparetic individuals (11 females, 17 males). Cognitive status, disability level, and functional status were evaluated using the Hodkinson Mental Test, Modified Rankin Scale, and Motricity Index, respectively. Foot sole sensation was assessed with Semmes-Weinstein Monofilaments. Position sense was evaluated via a novel lower extremity position test and kinesthesia sense using a digital electro-goniometer. Static balance was quantified with the Sport-Kat 550 device, Spatiotemporal gait parameters (stance/swing phase, pelvic symmetry, walking speed) were analyzed using the BTS G-Walk inertial sensor system.

The participants' mean age was 53.17 ± 10.24 years and the mean disease duration was 22.03 ± 22.56 months. Foot sole sensation correlated with total balance (big toe: r = 0.387, p = 0.042; lateral border: r = 0.382, p = 0.045) and pelvic symmetry (big toe: r = -0.436, p = 0.020; first metatarsal: r = -0.509, p = 0.006). Knee joint kinesthesia correlated with affected side's stance phase (r = -0.427, p = 0.023) and pelvic rotation symmetry (r = -0.409, p = 0.031). Ankle kinesthesia correlated with step length on the affected side (r = -0.365, p = 0.050).

Impairments in foot sole sensation, joint position sense, and kinesthesia are associated with balance and gait deficits in hemiparetic individuals. The moderate-to-strong effect size suggest clinically meaningful relationships, though the cross-sectional design and lack of a healthy control group prevent causal inference. Clinicians should consider routine sensory assessments and targeted sensory retraining as adjuncts to motor rehabilitation to improve functional outcomes.