Footwear suitability in Turkish preschool-aged children

Protocol Article: A Cross-Sectional Evaluation of Children's Feet and Lower Extremities

BACKGROUND

The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children's lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain.

METHODS

This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life.

RESULTS

We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children's lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children's feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain.

CONCLUSIONS

The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children's quality of life and prevent future diseases.

Biomechanical Insights Afforded by Shape Modeling in the Foot and Ankle

Advancements in volumetric imaging makes it possible to generate high-resolution three-dimensional reconstructions of bones in throughout the foot and ankle. The use of weightbearing computed tomography allows for the analysis of joint relationships in a consistent natural position that can be used for statistical shape modeling. Using statistical shape modeling, a population-based statistical model is created that can be used to compare mean bone shape morphology and identify anatomical modes of variation. A review is presented to highlight the current work using statistical shape modeling in the foot and ankle with a future view of the impact on clinical care.

ÜÇÜNCÜ TRİMESTERDA AYAKKABI UYGUNLUĞU, DÜŞME KORKUSU VE FİZİKSEL AKTİVİTE ARASINDAKİ İLİŞKİ

Purpose: Pregnancy is a time of intense physiologic and physical changes, especially in third trimester. The aim of this study was to investigate the relationship between the footwear suitability, fear of falling and physical activity in third trimester of pregnancy. Methods: One hundred twenty-three pregnant women aged between 18-40 years and a gestational age of 28 weeks and above were included the study. The Footwear Assessment Score was used to assess the suitability of the footwear. The fear of falling of the participants was measured using the Falls Efficacy Scale-International, and the physical activity level was measured using the International Physical Activity Questionnaire - short form. Results: A low negative correlation (r = -0.215; p < 0.05) was found between physical activity and fear of falling, and a low positive correlation (r = 0.256; p < 0.01) was found between footwear suitability and physical activity in pregnant women. There was no statistically significant relationship (r = -0.120; p = 0.185) between footwear suitability and fear of falling. Conclusion: According to the findings of the current study, it can be concluded that a more appropriate choice of shoes as the level of physical activity increases among pregnant women, and physical activity may reduce the fear of falling during pregnancy. Future studies are needed to investigate footwear suitability during pregnancy in more detail.

Impact of length and width of footwear on foot structure of preschool-aged children

Background

Due to the dynamics of developmental changes, the preschool age is of crucial importance for the later health and efficiency of the feet. The aim of this study was the analysis of the fitting of indoor footwear and its impact on the features of the foot structure in 6-year-old children.

Methods

The study group consisted of 100 children, including 50 girls and 50 boys at the age of 6 years. The applied device was the CQ-ST podoscope and the Clevermess. The data were analyzed based on Mann-Whitney U test, Chi-square test and regression analysis.

Results

About 60% of children wore correctly fitted shoes in terms of length and width. Multiple regression models with two variables explaining the variance of the Clarke's angle were statistically significant for girls (right foot: p < 0.001 and left foot: p = 0.009), and boys (right foot: p < 0.001 and left foot: p < 0.001). The influence of predictive variables on the values of the heel angle (γ) was statistically significant for girls (right foot: p < 0.001 and left foot: p < 0.001) and boys (right foot p < 0.001 and left foot: p < 0.001).

Conclusions

Both in the case of girls and boys, the frequency of using too long and too wide shoes was higher in relation to the frequency of using too short and too narrow shoes. The length and width of the shoes affected the length and width of the footwear both in girls and boys. The longer and wider the shoes, the lower the height of the arch. Longer shoes are accompanied by a greater transverse arch, and wider ones with a lower transverse arch of the foot.

Effect of Longitudinal and Transverse Foot Arch on the Position of the Hallux and Fifth Toe in Preschool Children in the Light of Regression Analysis

The aim of the study was to analyze the development of foot structure and the impact of longitudinal and transverse arching of the foot on the position of the hallux and fifth toe in preschool children. The study was carried out among 200 children aged 6 (100 G, 100 B). The research tool was the podoscope CQ-ST. The collected research results were analyzed with the use of the Mann–Whitney U test, Pearson Chi-square test and regression analysis. A statistically significant influence of the heel angle on the value of the varus angle of the fifth toe of the right (girls: p = 0.032; boys: p = 0.001) and left foot (girls: p = 0.004; boys: p = 0.005) was found. Boys’ feet are longer and wider than girls’ feet; moreover, they have a lower longitudinal arch. The frequency of longitudinal and transverse arch deformities of the feet, as well as valgus of the hallux and varus of the fifth toe do not depend on gender. In both sexes, decreasing the transverse arch of the foot has an influence on the severity of varus of the fifth toe. Changes in the height of the longitudinal foot arch does not affect the position of the hallux and fifth toe.

Relationship of the Use of Short Footwear with the Development of Hallux Valgus in a Sample of Andalusian Schoolchildren

Background: Several studies have shown the relationship between poor footwear fit and the risk of feet deformities. The available evidence seems to show that the development of hallux valgus deformity in the feet of schoolchildren may be related to the use of shoes that are poorly fitting in length. The objective of this cross-sectional study was to analyze the relationship between poor footwear fit in length and risk of developing hallux valgus. Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length was obtained and compared to the inner length of the shoe in 187 schoolchildren. Hallux valgus angle (HVA) was measured on weight-bearing podogram image obtained from the longest foot in 188 schoolchildren. Results: By default, the footwear was poorly fitting in length (too short or close-fitting) in 38.5% of the schoolchildren, with boys having the worst footwear fit; though no significant differences stood out. (p = 0.276). Regarding the HVA, no significant differences were recorded according to age or gender (p = 0.573). A strong correlation was observed between too-short footwear and the increase in HVA in 10-year-old boys (r = 0.817; p = 0.025) and in 9-year-old girls (r = 0.705; p = 0.005). Conclusions: Inadequate footwear fit in length may be a predisposing extrinsic risk factor for the development of hallux valgus in schoolchildren of both sexes. Results of the present study demonstrate the need to adapt the sizes of footwear to the rapid increase in foot-length that occur at puberty to avoid the risk of developing hallux valgus, especially at the ages of onset pubertal foot growth.

Children should be seen and also heard: an explorative qualitative study into the influences on children's choice of footwear, their perception of comfort and the language they use to describe footwear experiences

BACKGROUND

Footwear has an essential role including protection of the feet, overall performance, foot health and potentially, supporting normal development of the foot. In addition to these physical aspects which may influence choice of footwear design, there are psychological influences on what a person chooses to wear. The concept of footwear 'comfort' spans physical and psychological perceptions of comfort in adults. However, there is little understanding of what influences children's footwear choices, how children perceive footwear comfort, or the language used to describe footwear experiences. Therefore, this study aimed to explore these three parameters as the first step to informing the development of a scale to measure footwear comfort in children.

METHODS

A pragmatic qualitative design with thematic analysis as an analytical approach was implemented. Passive observation and short interviews were carried out with 23 children (aged 1-12 years) at a footwear manufactures headquarters and store. Prompts included shoes being tried on and field-notes were taken relating to verbal and non-verbal communication. Field notes were coded then themes were identified, reviewed and named.

RESULTS

Overall, the children equated comfort to softness. However, influences on footwear choice were multidimensional including aesthetics, psychosocial influences, identified 'comfort' and 'discomfort' areas, practical issues and predictive concerns; all interacting with the age of the child.

CONCLUSIONS

For children, footwear comfort is a complex phenomenon having physical, cognitive, social and emotional developmental components. This can be seen in how the children perceive the 'feel' of the shoe and how the shoe is assessed in the context of how the shoe meets the child's physical and psychosocial developmental needs. In younger children footwear preference is related to idiosyncratic tastes in aesthetics, physical ability and comfort. As children age, societal influences begin to expand the social function of footwear denoting group membership, to include themes that transcend the functional and social function of footwear. The knowledge from this study can inform the development of age group specific tools to evaluate comfort.

The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

Background

Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren.

Methods

The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis.

Results

About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle.

Conclusion

A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study

The aim of the study was to assess the characteristics of footwear altogether and to compare the effect of appropriate-fitting and ill-fitting footwear on functional performance, balance, and fear of falling (FoF) in older adults. Individuals who wore appropriate-fitting (n = 61) or ill-fitting footwear (n = 92) were enrolled in the study. Footwear was evaluated using the Footwear Assessment Scale (FAS). The participants were assessed using the Berg Balance Scale (BBS) for balance, the Timed Up and Go test for functional performance and the Activities-specific Balance Confidence scale for FoF. Tests were conducted twice for each individual with or without footwear. Differences between the groups were analyzed using the MANOVA for scores of balance, performance and fear of falling and Chi-squared test for homogeneity. The Paired t-test was used to compare test scores with or without footwear. It was concluded that appropriate-fitting footwear improves balance, reduces fear of falling and may affect functional performance positively. ClinicalTrials.gov No: NCT04151654.

Influence of footwear fitting on feet morphology in 9 year old girls

Background

The human foot is shaped throughout all life in a way that is individual for every human being. Footwear fitting in the process of foot development is the issue covered by a limited range of empirical studies. This prompted the authors to undertake this subject of the study aimed at the influence of fitting of regularly worn inside the school footwear on feet morphology in primary schoolgirls.

Methods

The study group comprised 100 girls aged 9. Feet characteristics were recorded by CQ-ST podoscope. The footwear fitting to the feet of the examined girls was tested using the Clevermess device. The data were analyzed based on the Student’s t test, Wilcoxon test and regression analysis.

Results

Appropriately fitted right indoor footwear was worn by 48% of the subjects while the left one by 43% of the group. Appropriate fitting in relation to the left and right foot width was noted in 23% of the group. The statistically significant combined effect of predictors characterizing footwear on the value of Wejsflog index of the right (p < 0.001) and left (p < 0.001) foot and influence of the length excess on the heel angle of the left foot (p = 0.006) were found.

Conclusions

Most examined girls wear poorly fitted indoor footwear. The length excess of the indoor footwear has connections with the Wejsflog index of the right and left foot and the heel angle of the left foot. The larger the length excess, the lower the transverse arch. In the production of indoor footwear the differences in the feet width should be taken into account.

Footwear fit in schoolchildren of southern Spain: a population study

Background

Recent studies support the theory that ill-fitting shoes are an important source of pain and may lead to foot malformations in the medium term. Taking as reference the ideal allowance considered in the literature, the purpose of this study was to verify the outdoor footwear fit in a population of schoolchildren of southern Spain.

Methods

Five hundred and five children within the range of 3–12 years of age participated in this study. Using a measuring instrument designed and validated for this purpose, maximum foot length, width and height were obtained from the longest foot. These measurements were compared with the inner length, width and height of the footwear. An adequate toe allowance of 5–15 mm in length and 10 mm in width were estimated.

Results

Inner footwear length was shorter than foot length in 33.3% of the schoolchildren. Based on the allowance established, it was observed that the footwear of the schoolchildren was too short and too narrow in 72.5 and 66.7% of the cases, respectively.

Conclusions

Only one third of the participants analysed had well-fitted footwear. The results show that it is necessary to raise awareness among parents and teachers about the importance of replacing, periodically, the footwear of children in primary education. Manufacturers should adapt the lasts considering the use of 90th percentiles instead of mean values obtained from the growth curves of schoolchildren’s feet.

Key concepts in children's footwear research: a scoping review focusing on therapeutic footwear

BACKGROUND

Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children's gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children's footwear and to establish the range of studies that considered therapeutic footwear.

METHODS

A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children's footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies.

RESULTS

The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional).

CONCLUSION

Children's footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children's therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children's therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.

Big issues for small feet: developmental, biomechanical and clinical narratives on children's footwear

The effects of footwear on the development of children's feet has been debated for many years and recent work from the developmental and biomechanical literature has challenged long-held views about footwear and the impact on foot development. This narrative review draws upon existing studies from developmental, biomechanical and clinical literature to explore the effects of footwear on the development of the foot. The emerging findings from this support the need for progress in [children's] footwear science and advance understanding of the interaction between the foot and shoe. Ensuring clear and credible messages inform practice requires a progressive evidence base but this remains big issue in children's footwear research.

Gait and footwear in children and adolescents with Charcot-Marie-Tooth disease: A cross-sectional, case-controlled study

OBJECTIVE

Children with Charcot-Marie-Tooth disease (CMT) report problems with gait and footwear. We evaluated differences in spatio-temporal gait variables and gait variability between children with CMT and typically developing (TD) children, and investigated the effect of footwear upon gait.

METHOD

A cross-sectional study of 30 children with CMT and 30 age- and gender-matched TD children aged 4-18 years. Gait was assessed at self-selected speed on an electronic walkway while barefoot and in two types of the child's own footwear; optimal (e.g., athletic-type runners) and suboptimal (e.g., flip-flops).

RESULTS

Children with CMT walked more slowly (mean (SD) -13.81 (3.61) cm/s), with shorter steps (-6.28 (1.37) cm), wider base of support (+2.47 (0.66) cm; all p < 0.001) and greater base of support variability (0.48 (0.15) cm, p = 0.002) compared to TD children. Gait was faster in optimal footwear than suboptimal (-7.55 (1.31) cm/s) and barefoot (-7.42 (1.07) cm/sec; both p < 0.001) in the combined group of children. Gait in suboptimal footwear was more variable compared to barefoot and optimal footwear. Greater base of support variability and reduced balance was moderately correlated for both groups (CMT and TD).

CONCLUSION

Gait is slower with shorter, wider steps and greater base of support variability in children with CMT. Poor balance is associated with greater base of support gait variability. Suboptimal footwear negatively affects gait in all children (CMT and TD), which has clinical implications for children and adolescents with CMT who have weaker feet and ankles, and poor balance.