Education in Motion / EIM Blog / December 2023 / Foot Propulsion Using a Wheelchair: Interventions to Enhance Efficiency and Prevent Sliding

Foot Propulsion Using a Wheelchair: Interventions to Enhance Efficiency and Prevent Sliding

Using Feet to Propel the Wheelchair

Sometimes it is more efficient for a wheelchair rider to use one or both feet to assist with propulsion. This is a very common occurrence with the elderly. 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. Optional foot propulsion for a rider using their feet 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

The rider must be able to initiate the wheelchair's movement. 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 interaction of the tires 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).

Wheelchair riders propelling with their feet need a wheelchair that can be adjusted to meet their needs (Requejo et al 2015; Sherman, 2021; Heinrichs et al, 2021; Murata et al, 2014). This is an important statement because many foot propellers are often issued standard weight wheelchairs which are heavier and have minimal adjustability. The 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 individual 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 had a preference for 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 setup 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 setup 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

If the seat-to-floor height is too high, riders are at risk for sliding out of the chair when they try to reach the floor to propel with their feet (Requejo et al, 2015). The best practice is to allow both feet to rest on the floor completely at rest, not just touching with the balls of the feet. When considering the wheelchair frame seat height, be sure to account for the height of the seat cushion. 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. At the same time, too low of a seat height may interfere with standing transfers, so a chair that allows some fine tuning adjustment can help with achieving the right balance.


Adjusting the slope, when hips are lower than the knees, in the seat on the wheelchair frame or through seating can assist in more efficient foot propulsion as well as decreasing the potential to slide forward in the wheelchair. Transfers should be assessed and practiced to ensure 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, else the seat-to-back angle may need to be adjusted.



A wheelchair with a knee pivot tilt can provide the optimal change in the upper body alignment against gravity while maintaining the feet properly positioned on the ground for foot propulsion. The position of tilt can off-load the boney prominences and decrease the potential for sliding. The QUICKIE ACCESS wheelchair can provide the tilt necessary for foot propulsion and also has the option of anterior tilt to assist with transferring out of the wheelchair.

Center of gravity

Rolling resistance can be evaluated after positioning the rear wheel fore or aft. If the rider is using one arm and one foot, the optimal position of the wheel is imperative for upper extremity propulsion (Tomlinson, 2000; Requejo et al, 2015). If the rear axle is too far back, this will load the front caster wheels and make maneuvering difficult. If it is too far forward, the system may not have enough rear stability.

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 stabilization.

Size and type of casters and tires

Tires and casters matches to meet the propulsion needs can make a big difference when moving over carpet or thresholds. Smaller caster wheels are easier to maneuver and to turn on smooth flooring surfaces. They also offer greater space for the lower limbs. However, if the rider travels outdoors with attendant propulsion at times, wider or larger caster wheels travel over thresholds and outdoor surfaces better. Proper maintenance is also key to successful maneuvering.


In summary, foot propulsion requires individual configuration just as much as when the rider is propelling with both hands. It is imperative that foot propellers who are long-term users receive ultralight wheelchairs which allow adjustments to accommodate for seat height, back angle, and center of gravity. Individual configuration to meet the riders' needs can assure efficient propulsion and safety. QUICKIE manual wheelchairs with removable leg rests can provide the adjustability needed to meet an individual's needs for optimal fit and foot propulsion. Wheelchair skills should be assessed with proper training where needed. The Wheelchair Skills Program is available and has specific videos catering to foot propulsion.


  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, R.L., 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., & can 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

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. Dr. Presperin Pedersen was a pioneer in the development of the profession of wheelchairs and seating in the 1980s and has spent the last two decades contributing to the research world to demonstrate evidence for knowledge translation in the clinic, advocacy, and product development. She is a RESNA and AOTA Fellow, serves on the Clinician Task Force, the Seating and Wheeled Mobility Committee for AOTA, and has shared her experiences internationally through publications and presentations.

Published: 2023-12-18

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