Foot motion in children shoes—A comparison of barefoot walking with shod walking in conventional and flexible shoes

doi:10.1016/j.gaitpost.2007.01.005

Gait & Posture

Volume 27, Issue 1, January 2008, Pages 51-59

https://doi.org/10.1016/j.gaitpost.2007.01.005 Get rights and content

Abstract

The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inaequate footwear in childhood. Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot the objective of this study was to monitor the influence of commercial footwear on children's foot motion during walking. Furthermore, an attempt was made to reduce this influence by changing the physical properties of standard footwear. Children's barefoot motion pattern was monitored by a marker-based optical 3D-tracking method using a multi-segment foot model. In the study's first stage, barefoot walking was compared to walking with a commercial product. In the second stage it was compared to both, the pattern with the commercial product and with the shoe modified on the basis of the findings of the first stage of the study. Eighteen children (8.2 ± 0.7 years old) with no foot deformity and with the same shoe size were recruited for this study. It was found that tibio-talar ROM increased in the commercial shoe (26.6°) compared to the barefoot condition (22.5°, p = 0.001) whereas the medial arch changes for push-off were diminished since the variation in arch length was reduced from 9.9% (barefoot) to 5.9% (shoe, p < 0.001). Further, ROM in foot torsion along the long foot axis was reduced from 9.8° (bare) to 4.7° (shoe, p < 0.001). These parameters could be improved with more flexible footwear. The present study shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended not only for children in this age but for healthy children in general.

Introduction

Shoes are primarily used to protect the foot from injuries due to rough or uneven ground surfaces and from excessive impact due to a hard ground. Furthermore, shoes protect the feet from a cold and wet environment. This holds true, in principle, for children's shoes as well. However, it can be claimed, that optimum foot development can only occur in barefoot conditions. Stiff and tight footwear may lead to deformity and stiffness [1]. The design of children's shoes should be based on the barefoot model taking into account shock absorption and load distribution [1]. There are several studies indicating that inadequate footwear or even footwear in general may affect the physiological development of the foot. Rao and Joseph [2] showed that in 2300 children between the age of 4 and 13 years the incidence of a flat foot among those who used footwear (8.6%) was significantly higher compared to those who did not (2.8%). This effect was found in all age groups. Moreover, children wearing closed shoes showed a higher incidence for flat feet than those wearing sandals or slippers. Jerosch and Mamsch [3] documented that in children between 10 and 13 years of age only 36.5% had normal feet. The rest had mild to significant deformities, usually valgus (39.4%). Flat foot deformity was diagnosed in 19.1% and a hallux valgus in 17.1% of the children.

Little is known about the direct effects of foot wear on the kinematic behaviour of a child's foot. Fluoroscopic measurements are possible [4], but ethically inappropriate in children. Optical 3D tracking of markers placed on the foot is a valuable tool for the analysis of foot kinematics [5], [6], [7], [8], [9], [10] which is feasible also for children [11] but, to our knowledge, has never been applied to shod walking in children.

The aim of this study was to apply a marker-based optical method to bare foot walking as well as shod walking by perforating the shoe at locations at which markers were to be applied directly on the foot. The marker protocol used in the Heidelberg Foot Measurement Method (HFMM) [10] has therefore been reduced and the model simplified to monitor the child's foot movement “barefoot” within the shoe.

The aim of the first stage of this prospective study was to assess the influence of a typical and commercially available children's shoe (shoe1) on foot motion. The second stage aimed at developing a modified shoe (shoe2) based on the findings of stage one as well as the recommendations by Staheli [1]: his study suggested that a thinner and more flexible sole and upper would allow better afferent stimulus as well as better mobility of foot segments. In order to assess the new shoe design, the foot motion patterns in shoe1 and shoe2 were compared to the barefoot pattern.

Section snippets

Data collection

In the recruitment process, more than 100 children between 6 and 10 years of age were initially assessed. Eighteen children (age 8.2 ± 0.7 years, 8 girls, 10 boys) with no foot deformities, previous significant injuries or operations to their feet were elected for the study. All children were fitted with shoes of French size 33. Foot size effects in this small distribution of foot lengths (20.7 ± 0.4 cm) could be eliminated. All children and parents/carers consented according to the local ethics

Results

The foot kinematics measured for the 18 children are illustrated in Fig. 4. An obvious difference between a typical “barefoot pattern” and a “shoe pattern” was observed. The variation between the subjects (SEM) for both conditions was small compared to the differences between the two measurement conditions ‘shoe1’ and ‘no shoe’. Specifically the following differences were found:

The parameter “tibia foot flexion” (Fig. 4(A)) resembled findings of conventional gait analysis [12], but the data

Discussion

The question of optimal footwear choice has a long history and is important especially for the selection of children's shoes. This choice is not only influenced by health and protection issues but also price and fashion trends. Inorder to increase awareness in this respect, it is necessary to demonstrate evidence of the footwear's effects on foot shape and to study the direct consequences of the shoe on foot motion and function. In recent years, an increasing number of scientific contributions

Conclusion

The present study demonstrated that it is possible to measure the influence of footwear on foot motion offering an objective basis for functionally testing children shoes. The commercial shoe had a significant influence on the motion patterns particularly at the forefoot. The experimental shoe developed in the course of the study with a slimmer and more flexible design showed a tendency to reduce this influence and was closer to barefoot motion pattern. However, it was not a “neutral” shoe and

Conflict of interest

The author and all of the co-authors hereby certify that they have no financial interest in relation with this publication.

Acknowledgment

The financial support of the company Elefanten GmbH, Kleve, Germany, is gratefully acknowledged.

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Foot motion in children shoes—A comparison of barefoot walking with shod walking in conventional and flexible shoes

Abstract

Introduction

Section snippets

Data collection

Results

Discussion

Conclusion

Conflict of interest

Acknowledgment

Gait Posture

Clin Biomech

Gait Posture

J Biomech

Gait Posture

Gait Posture

J Biomech

Gait Posture

Shoes for children: a review

Pediatrics