Education In Motion / Blog / February 2024 / Foot Propulsion using a wheelchair: Interventions to enhance efficiency and prevent sliding

Foot Propulsion using a wheelchair: Interventions to enhance efficiency and prevent sliding


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Using feet to propel the wheelchair

Sometimes it is more efficient for an individual to use one or both feet to assist with wheelchair propulsion. This is a very common occurrence with the elderly as in many cases, they walked previously and are used to using their feet or they have weak or arthritic arms that are less efficient for propulsion. A person with hemiplegia may also use the functional upper and lower limbs on one side for propulsion. Optional foot propulsion is usually attained when the heel makes contact and then completed as the toe leaves the ground. Having the ability to get the feet flat on the ground will allow for the heel toe movement.

Moving the wheelchair

A wheelchair user must overcome inertia and castor resistance to get the wheelchair to begin to move. Inertia is the tendency of an object to resist change in motion and this is what the rider must overcome to move the wheelchair. (Caspall et al, 2013) In the wheelchair world, the term rolling resistance describes the energy needed to keep the tires rolling at a steady pace to overcome forces that inhibit forward momentum. It is caused by the tire’s interaction with the surface (floor, carpet, sidewalk, street, gravel). Factors that may affect rolling resistance include the mass of the rider and the mass of the wheelchair system, the size and type of casters and wheels, and the weight distribution between the front casters and rear wheels. The type of surface is also a factor. (Tomlinson, 2000; Sherman 2022)

People who propel with their feet need a wheelchair that can be adjusted to meet their needs (Roquerjo et al 2015; Sherman, 2021; Heinrichs et al, 2021; Murata et al, 2014)0. This is an important statement because many foot propellers are often issued standard weight wheelchairs which are heavier and have no adjustability.  Lightweight and ultralight wheelchairs require less effort to propel. The energy loss of propelling the lightweight chair at specific velocity was 17% less than that of a standard non-adjustable wheelchair. (Requejo, et al., 2015) Lighter weight wheelchairs with adjustability can be configured to meet the induvial needs to maximize propulsion and functional skills in the wheelchair (Murata et al 2014; Heinrichs et al, 2021).

Alternative backward propulsion

Charbonneau et al (2013) assessed 18 people with hemiplegia who used a form of foot propulsion to move the wheelchair. They scored higher on the Wheelchair Skills Tests when propelling backward and demonstrated a preference for specific skills such as going up an incline, rolling on soft ground, and pushing over a threshold or a gap. Several participants preferred moving backwards and pushing with their feet than when moving forward and pulling the wheelchair behind them (Charbonneau et al 2013).

Configuring the Wheelchair and Seating

The set up of the wheelchair and optimal seating can assist with proper foot propulsion and decrease the effort required to start and maintain the movement of the wheelchair. If the set up is incorrect, secondary problems may occur after prolonged use such as pain and overuse at the ankles, knees, and hips as well as shearing from sliding out of the wheelchair (Murata et. al, 2015).  The following includes interventions that can be done to optimally configure the wheelchair for foot propulsion.

Seat Height

Without the ability to lower the seat height to the proper position for foot propulsion, a user could be at risk for sliding out of the chair when they try to reach the floor to propel with their feet (Roquerjo et al, 2015).  In a study conducted by Heinrichs et. al (2021), people who propelled with one foot showed an increase in speed and propulsion when the seat height was lowered to match their needs. When considering the wheelchair frame seat height with the rider having her feet on the floor, be sure to account for the height of the seat cushion. Some lightweight wheelchairs, such as the QS5 X, have ‘hemi’ options for an ultralow seat to ground height to promote foot propulsion.

Fixed tilt

Adjusting the seat to create a small amount of fixed tilt, where hips are lower than the knees, on the wheelchair frame or through seating can assist in more efficient foot propulsion.  It can also decrease the potential to slide forward in the wheelchair. Transfers should be assessed and practiced assuring the rider will be able to get out of the wheelchair. The range of motion at the pelvis and femur must be assessed to make sure the rider can sit with a sloped seat or the seat to back angle may need to be adjusted.  

Center of Gravity

Rolling resistance can be evaluated after positioning the rear wheel fore or aft. If somone is using one arm and one foot, the optimal position of the wheel is imperative for upper extremity propulsion. (Tomlinson, 2000; Roquerjo et al., 2015).

Pelvic Belt

A pelvic belt placed at the correct angle can stabilize the pelvis, while allowing for movement to self-propel. The angle of the strapping based on the pelvic positioning is critical. Please see this short video that discusses pelvic stabilisation.

Size and Type of Castors and Tyres

Tyres and castors matched to meet the propulsion needs can make a big difference when moving over carpet or thresholds. Proper maintenance is also a key to successful manoeuvring.


In summary, foot propulsion requires individual configuration just as much as propulsion with both hands. It is imperative that foot propellers who are long term users receive configurable wheelchairs which allow adjustments to accommodate for seat height, back angle, and center of gravity. This can ensure efficient propulsion and safety. Wheelchair skills should be assessed with proper training where needed.

The Wheelchair Skills Program is available and has specific videos catering to foot propulsion.

Clinical Support Information Citations

  1. Caspall, J.J., Seligsohn, E., Dao, P.V., & Sprigle, S. (2013). Changes in inertia and effect on turning effort across different wheelchair configurations. Journal of Rehabilitation Research & Development. 50(10), 1353-1362.
  2. Charbonneau R, Kirby RL, Thompson K. Manual wheelchair propulsion by people with hemiplegia: within-participant comparisons of forward versus backward techniques. Arch Phys Med Rehabil. 2013; 94(9):1707–13. [PubMed: 23500180]
  3. Heinrichs, N. D., Kirby, R. L., Smith, C., Russell, K. F. J., Theriault, C. J., & Doucette, S. P. (2021). Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 1 - wheeling forward on a smooth level surface. Disability and Rehabilitation: Assistive Technology, 16(8), 831–839.
  4. Heinrichs, N. D., Kirby, R. L., Smith, C., Russell, K. F. J., Theriault, C. J., & Doucette, S. P. (2022). Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 2 - wheeling backward on a soft surface. Disability and Rehabilitation: Assistive Technology, 17(3), 325–330.
  5. Koontz, A.M., Cooper, R.A., Boninger, M.L., Yang, Y., Impink, B.G., & van der Woude, L.H.V. (2005). A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. Journal of Rehabilitation Research & Development. 42(4), 447-458.
  6. Murata, T., Asami, T., Matsuo, K., Kubo, A., & Okigawa, E. (2014). Effects of Wheelchair Seat-height Settings on Alternating Lower Limb Propulsion With Both Legs. Assistive Technology, 26(3), 151–156.
  7. Requejo, P. S., Furumasu, J., & Mulroy, S. J. (2015). Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users. Topics in Geriatric Rehabilitation, 31(1), 26–41.
  8. Sherman, S. (2021). Potential causes of sliding for individuals who foot propel. Retrieved from
  9. Tomlinson, J.D. (2000). Managing maneuverability and rear stability of adjustable manual wheelchairs: An update. Physical Therapy, 80(9), 904-911.
Jessica Presperin Pedersen - Sunrise Medical USA

Jessica Presperin Pedersen - Sunrise Medical USA

OTD, MBA, OTR/L, ATP/SMS - Director of Clinical Education - North America

With over 40 years of clinical practice as an OT, Jessica Presperin Pedersen has worked in all sectors of the wheelchair and seating industry as a master clinician, supplier, manufacturing consultant, design representative, and educator.

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