Foot Tapping Test as Part of Routine Neurologic Examination in Degenerative Compression Myelopathies: A Significant Correlation between 10-sec Foot-tapping Speed and 30-m Walking Speed

Abstract

Introduction: Leg spasticity in degenerative compression myelopathy causes impairment of fast and rapid repetitive movements, which tends to appear despite the disproportionate paucity of clinical weakness. As clinically useful measures used to quantify the slowness of voluntary leg movements in this pathological condition, we compared the foot tapping test (FTT) with the simple walking test, which is now considered the gold standard in this field.

Methods: We compared the FTT with the simple walking test, the grip-and-release test, and the functional scales of Nurick and the Japanese Orthopedic Association (JOA) in 77 patients with cervical compression myelopathy and 56 age-matched healthy subjects. The FTT was conducted on both sides separately, and the subject, while being seated on a chair, moved his/her toes up and down repeatedly to tap the floor as fast and as vigorously as possible for 10 sec with his/her heels planted on the floor.

Results: The number of 10-sec foot tapping in the patient group significantly correlated with the Nurick grades (r = -0.566; P < 0.0001), the JOA scores (r = 0.520; P < 0.0001), and the grip-and-release rates (r = 0.609; P < 0.0001). It also significantly correlated with the 30-m walking time (r = -0.507; P < 0.0001) and the number of steps taken (r = -0.494; P < 0.0001). Assessments of wheelchair-dependent patients and side-to-side comparison, in which the simple walking test plays no role, revealed significantly fewer FTT taps in wheelchair-bound patients than in the ambulatory patients and a significant trend for cervical compression myelopathy to dominantly affect the upper and lower limbs on the same side.

Conclusions: This study contributes to the reassessment of the currently underutilized FTT as part of a routine neurologic examination of degenerative compression myelopathy.

Keywords: Compression myelopathy; Foot tapping test; Grip-and-release test; Laterality; Leg spasticity; Simple walking test.

Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.

A foot tapping test. The subject sat on a chair with adjustable height so that the bilateral soles made contact with the floor, and the hip and knee joints flexed at approximately 90°. He/She moved his/her toes up and down repeatedly to tap the floor as fast and as vigorously as possible for 10 sec with the heels planted on the floor. He/She performed the test for both sides separately. The examiner counted the number of taps for each side.

Figure 2.

A comparison between the FTT results (abscissa) and the SWT (ordinate), ) in 67 ambulatory patients with cervical compression myelopathy. The number of taps in the FTT showed a significant negative correlation with the walking time (r=−0.507; P<0.0001) taken in the simple walking test.

Figure 3.

A comparison between the FTT results (abscissa) and the SWT (ordinate), ) in 67 ambulatory patients with cervical compression myelopathy. The number of taps in the FTT showed a significant negative correlation with the number of steps (r=−0.494; P<0.0001) taken in the SWT.

Figure 4.

A comparison between the FTT results (abscissa) and the GRT (ordinate)) in 77 patients with cervical compression myelopathy. The number of taps in the FTT showed a significant positive correlation with the number of grip openings in the GRT (r=0.609; P<0.0001).

Figure 5.

Midsagittal T2-weighted MRIs before (left) and after (right) laminoplasies from C3 to C6 in a 67-year-old woman with cervical spondylotic myelopathy. The JOA motor score for the lower limb improved from 1 point preoperatively to 2.5 points at 46 days postoperatively with the improvement of performance-based measures in the FTT (from 16 to 21 times for the right; from 18 to 24 times for the left) and in the SWT (from 46.7 to 35.4 sec for the walking time; from 70 to 63 steps for the number of steps).