Online visual cues can compensate for deficits in cutaneous feedback from the dorsal ankle joint for the trailing limb but not the leading limb during obstacle crossing

Precise control of the ankle is required to safely clear the ground during walking. Skin input contributes to proprioception about the ankle joint, during both passive movements and level walking. How skin might contribute to proprioceptive control of the ankle during a more complex functional task such as obstacle avoidance is unknown. The purpose of this study was to investigate skin contribution from the dorsum of the ankle joint to safely cross an obstacle, and examine the interaction between vision and skin. It was hypothesized that the lead and trail limbs would be influenced primarily by visual information and skin cues, respectively. Eleven healthy adults crossed an obstacle with either (1) intact sensory input (control) (2) reduced skin input using a topical anesthetic (anesthesia), (3) reduced visual input of the lower half of the visual field (partial vision) or (4) simultaneous reduction of skin and vision (paired). Kinematic measures of phase-dependent changes during these conditions were examined while subjects crossed the obstacle with their anesthetised foot as either the leading or trailing limb. Interestingly, lead limb toe trajectory was significantly affected both by deficits in visual and skin input, although the joint angle strategies differed across these sensory conditions. Subjects increased lead hip flexion with partial vision but increased hip roll with skin anesthesia relative to control. In contrast, trail limb toe trajectory was affected only by visual sensory loss. Overall visual feedback and skin input from the ankle dorsum differentially affect lead and trail limb kinematics to successfully cross an obstacle. Interestingly, it appears vision is not entirely able to compensate for reduced skin input during obstacle crossing.