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Foot and Ankle Gait Propulsion Strategy

Page Summary

  • Propulsion is the final part of the stance phase of gait, from heel rise to toe-off, when the foot stiffens to push the body forward.
  • The propulsion sequence involves tibial external rotation, talocrural plantarflexion, subtalar supination, navicular elevation, first ray plantarflexion and first metatarsophalangeal joint extension.
  • Subtalar supination changes midtarsal alignment so the calcaneocuboid and talonavicular axes are no longer parallel, which is thought to increase midfoot stability.
  • Restricted or delayed movement at one segment can cause compensations elsewhere, and a joint that moves late must then move faster, loading tissues more quickly.

Original Editor - Ewa Jaraczewska based on the course by Ari Kaplan

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction

Propulsion is the final part of the stance phase of gait. During this phase, the foot and ankle push the body forward and prepare the limb for swing. To do this efficiently, the foot must change from being relatively compliant during loading to relatively stiff at push-off.[1][2][3] Altered mechanics or abnormal loading during gait can contribute to structural changes and functional impairment.[4][5] This page describes how each segment of the foot and ankle contributes to propulsion, and how restricted or delayed movement at one segment can lead to compensations elsewhere.

The Propulsion Sequence

Propulsion begins with heel rise of the stance foot and ends at toe-off of the same foot. It has two phases.

  • Terminal stance: runs from heel rise on the stance side to initial contact of the contralateral foot.
  • Pre-swing: runs from contralateral initial contact until toe-off of the stance foot.

In practice, these events are not always clearly separated, so gait phases are better understood as overlapping transitions than as phases with fixed boundaries. For this reason, gait can be described by purpose: a loading strategy, a transition (midstance), and a propulsion strategy. Early midstance relates more to loading and late midstance more to propulsion. During late midstance, the ankle continues to dorsiflex and the foot resupinates. This increases tension in the plantar fascia and Achilles tendon and stiffens the arch in preparation for push-off.[1]

From heel rise, the foot and ankle move through a coupled sequence of movements, although there is some variation between individuals.[6][7] Working from proximal to distal, the tibia externally rotates, the talocrural joint plantarflexes and the subtalar joint supinates.[1][3] Subtalar supination is coupled with supination at the talonavicular joint, which elevates the navicular. The medial cuneiform then plantarflexes, followed by the first ray.[1][8] As the heel rises and weight moves onto the forefoot, the first metatarsophalangeal (MTP) joint extends and the sesamoids glide relative to the first metatarsal head.[1][9] Subtalar supination also changes the alignment of the midtarsal joint. The calcaneocuboid and talonavicular axes run roughly parallel in pronation, but are no longer parallel in supination. This change in alignment is thought to increase midfoot stability.[1]

Analogies for Explaining Propulsion

The following analogies can help clinicians think about propulsion and explain it to patients:[1]

  • Walking on sand is harder than walking on concrete. Sand gives way with each push, so the calf and stabilising muscles have to work harder to move the body forward. A foot that does not stiffen is similar, as it does not provide a firm base to push from.
  • A ball rolls easily down a hill, but a box has to be pushed. When the first MTP joint extends freely, the foot rolls forward over the big toe like a ball. When the joint is stiff, the body has to be pushed over it like the box.
  • A swimmer who starts a race late has to cover the same distance in less time, so they have to swim faster. A joint that starts moving late is in the same position. A subtalar joint that stays pronated too long, for example, still has to supinate before toe-off, so it moves faster and the tissues are loaded more quickly.

Potential Impairments and Compensations During Propulsion

Tibia

The tibia moves from internal rotation during loading to external rotation during propulsion.[3] Prolonged pronation can delay tibial external rotation, so the tibia enters late midstance still internally rotated and has further to rotate before push-off. This can limit or delay subtalar supination and talocrural plantarflexion. Reduced rotation at the knee, for example in knee osteoarthritis, can also limit tibial rotation, so knee rotation should be included in the assessment.[1]

Talocrural Joint

During propulsion, the talocrural joint plantarflexes as the talus glides anteriorly within the mortise.[10] Limited anterior talar glide restricts plantarflexion. Reduced anterior glide may also reduce posterior clearance within the joint, potentially increasing the risk of posterior impingement.[1][11] In a patient with posterior ankle pain at end-range push-off, assessing anterior talar glide and plantarflexion range can show whether limited glide is contributing.[1]

Subtalar and Midtarsal Joints

The subtalar joint should supinate through late midstance and terminal stance, allowing the foot to act as a rigid lever for push-off.[12] If supination is limited or delayed, the foot remains pronated for longer and then rapidly snaps into supination just before toe-off. The change in midtarsal alignment is also limited or delayed, so the midfoot may not stiffen in time and offers a less stable base to push from. This means that soft tissue structures, such as the plantar fascia or tibialis posterior, may have to work harder and can become overloaded. The rapid late supination can produce an excessive heel whip as force moves out of the sagittal plane into the transverse and frontal planes. Circumduction of the leg may also be seen.[1]

Navicular and First Ray

Navicular mobility is important for push-off.[13] As the arch stiffens, the navicular elevates and the cuneonavicular and first tarsometatarsal (TMT) joints plantarflex, keeping the first metatarsal head in contact with the ground.[14][1] Plantarflexion of the first metatarsal also gives the hallux the clearance it needs to extend at the first MTP joint. If the first ray does not plantarflex as the navicular elevates, the whole medial forefoot may lift, shifting load onto the lateral foot. If the navicular does not stiffen and elevate, mechanics further along the medial column may also be disrupted. Without first metatarsal plantarflexion, the hallux lacks clearance and may impinge dorsally as it extends. Over many years, repeated dorsal impingement could in theory contribute to spur formation and hallux rigidus.[1]

First MTP Joint

Limited hallux extension is a more common propulsion-specific impairment than limited talocrural plantarflexion.[1] As the hallux extends, the first metatarsal head and the sesamoids, which sit within the tendons of the flexor hallucis brevis, must glide relative to each other.[15] Extension can therefore be limited by reduced dorsal glide of the proximal phalanx on the first metatarsal, reduced progression of the first metatarsal over the sesamoids, or limited flexibility of flexor hallucis brevis.[1]

When hallux extension is limited, patients tend to compensate in one of three ways. Some shift weight laterally to unload the great toe, which increases stress on the lateral foot. Others roll off the medial side of the hallux, which pushes it laterally and reduces push-off, and over many years, this may contribute to hallux valgus.[16] [17] Others shorten their step and lift off early instead of rolling through.[1]

Patterns in Propulsion Strategy

Specific patterns of propulsion strategy may be seen at the foot and ankle, including excessive stiffness, insufficient stiffness, and mismatched stiffness and mobility.[1]

Table 1. Propulsion strategy patterns
Profile Mechanical picture Typical presentation
Excessive stiffness Little segmental motion, reduced energy absorption and transfer Stiff gait, early heel rise, reduced step length, excessive vertical bounce instead of forward progression
Insufficient stiffness Foot stays compliant, energy dissipates[2] Energy shifting to frontal and transverse planes, heel whip or leg circumduction
Mismatched stiffness and mobility One region lacks motion, another over-moves Limited dorsiflexion leads to over-pronation or foot external rotation, which can cause difficulty resupinating and heel whip

Assessing Propulsion

When assessing propulsion, start by observing where force is directed at push-off: forwards, or into the frontal and transverse planes. Consider also whether the problem arises during loading, propulsion or both, as a loading problem often affects propulsion. Working distally from the tibia can help identify the first segment that is limited or moving late, and the compensation the patient uses, such as excessive heel whip, lateral weight shift, medial collapse, early heel rise or a short step. It is also useful to consider timing, and whether a joint is moving late and then being forced to move quickly. Management should address the cause of the problem, not only the site of symptoms, as a midfoot or plantar fascia complaint may originate at the tibia or subtalar joint.This focus on mechanical efficiency does not replace diagnosis, so condition-specific management should continue alongside it.[1]

Key Take-Home Points

Propulsion depends on a linked sequence of movements. A problem seen during propulsion may originate during loading, or at a different segment from where the compensation or symptoms appear,[18] so assessment should look beyond the symptomatic area. Compensations allow the person to keep moving. They are not pathology in themselves, but they can point to reduced efficiency and altered tissue stress.

Resources

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 Kaplan A. Foot and Ankle Gait Propulsion Strategy and Clinical Reasoning Course. Physiopedia Plus, 2026.
  2. ↑ 2.0 2.1 Magalhães FA, Fonseca ST, Araújo VL, Trede RG, Oliveira LM, e Castor CG, Pinto RZ, Souza TR. Midfoot passive stiffness affects foot and ankle kinematics and kinetics during the propulsive phase of walking. Journal of Biomechanics. 2021 Apr 15;119:110328.
  3. ↑ 3.0 3.1 3.2 Chan MC, Rudins MA. Foot biomechanics during walking and running. In Mayo Clinic Proceedings 1994 May 1 (Vol. 69, No. 5, pp. 448-461). Elsevier.
  4. ↑ Li J, Bonte C, Audenaert E, Burssens A, Peiffer M, Huysentruyt R, Van den Borre I, et al. Impact of weight-bearing on foot shape: a geometric and morphometric assessment using principal polynomial shape analysis. Sci Rep. 2026 May 12;16(1):21692.
  5. ↑ Huang D, Zhang C, Song W, Gao J, Tian H, Li H, et al. Gait variability and biomechanical distinctions in individuals with functional ankle instability: a case-control study based on three-dimensional motion analysis. Eur J Med Res. 2025 Jun 19;30(1):493.
  6. ↑ Dubbeldam R, Nester C, Nene AV, Hermens HJ, Buurke JH. Kinematic coupling relationships exist between non-adjacent segments of the foot and ankle of healthy subjects. Gait Posture. 2013 Feb;37(2):159-64.
  7. ↑ Williams LR, Ridge ST, Johnson AW, Arch ES, Bruening DA. The influence of the windlass mechanism on kinematic and kinetic foot joint coupling. J Foot Ankle Res. 2022 Feb 16;15(1):16.
  8. ↑ Phillips RD, Law EA, Ward ED. Functional motion of the medial column joints of the foot during propulsion. J Am Podiatr Med Assoc. 1996 Oct;86(10):474-86.
  9. ↑ French M, Thorhauer ED, Kimura T, Sangeorzan BJ, Ledoux WR. Displacement of the Metatarsal Sesamoids in Relation to First Metatarsophalangeal Joint Extension. Foot Ankle Orthop. 2022 Sep 26;7(3):24730114221126457.
  10. ↑ Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train. 2019 Jun;54(6):589-602.
  11. ↑ Toyooka T, Tsushima E, Sugiura S, Matsushita Y, Takata A, Omori Y, Okamoto Y, Nishikawa S. Talus Position Correlates With Dorsiflexion Range of Motion Following a Lateral Ankle Sprain: A Cross-Sectional Study. Health Sci Rep. 2025 Mar 10;8(3):e70550.
  12. ↑ Resende RA, Pinheiro LS, Ocarino JM. Effects of foot pronation on the lower limb sagittal plane biomechanics during gait. Gait & Posture. 2019 Feb 1;68:130-5.
  13. ↑ Sato T, Iida K, Ohkawa T, Fukui T. Relationship between ankle–foot-complex mobility during static loading and frontal moment impulses of knee and hip joints during the stance phase. Gait & Posture. 2024 Feb 1;108:301-6.
  14. ↑ Cornwall MW, McPoil TG. Relative movement of the navicular bone during normal walking. Foot Ankle Int. 1999 Aug;20(8):507-12.
  15. ↑ Kondo M, Iwamoto Y, Kito N. Relationship between forward propulsion and foot motion during gait in healthy young adults. J Biomech. 2021 May 24;121:110431.
  16. ↑ Dygut J, Strąk J, Detyna J, Piwowar M. Dynamic-passive correction of hallux valgus and associated static foot deformities. Acta of Bioengineering and Biomechanics. 2023 Jan 1;25(1):65-77.
  17. ↑ Lei N, Liu X, Xu H, Chen Z, Ouyang X. Sports and Rehabilitation Medicine Perspectives in the Functional Management of Hallux Valgus. Journal of Visualized Experiments (JoVE). 2026 May 8(231):e70062.
  18. ↑ Harutaichun P, Boonyong S, Pensri P. Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis. Phys Ther Sport. 2021 Jul;50:130-137.
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