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

Effects of Biomimetic Shoes on Healthy Young Children's Gait

Objective  To compare the spatial-temporal parameters and walking kinematics of toddlers wearing biomimetic shoes, regular shoes (daily use owned shoes), and barefoot. Methods  Spatial-temporal parameters (speed, step length, and stride width), the mean vertical displacement of the center of mass (COM), knee flexion peak, and maximal foot height were analyzed. Results  Children were not different in biomimetic shoes and barefoot conditions on speed, step length, and COM vertical displacement. There was no difference among conditions on stride width and foot height. The knee flexion peak was greater in shod conditions than barefoot. The regular shoes showed greater COM vertical displacement than biomimetic shoes and barefoot. Conclusion  The findings showed that shoes affected the walking pattern in young children, but a shoe with a biomimetic design had a lesser effect on the walking pattern.

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.

Understanding the Role of Children's Footwear on Children's Feet and Gait Development: A Systematic Scoping Review

Children's footwear plays an important role in the healthy growth of foot and gait development during the growing stage. This review aims to synthesize findings of previous investigations and to explore the biomechanical influences of different types of children's footwear on foot health and gait development, thus guiding the healthy and safe growth of children's feet and gait. Online databases were searched for potential eligible articles, including Web of Science, Google Scholar, and PubMed. In total, nineteen articles were identified after searching based on the inclusion requirements. The following five aspects of biomechanical parameters were identified in the literature, including spatiotemporal, kinematics, kinetics, electromyography (EMG), and plantar pressure distribution. Children's footwear can affect their foot health and gait performance. In addition, children's shoes with different flexibility and sole hardness have different effects on children's feet and gait development. Compared to barefoot, the stride length, step length, stride time, and step time were increased, but cadence was decreased with wearing shoes. Furthermore, the support base and toe-off time increased. Double support time and stance time increased, but single support time decreased. The hip, knee, and ankle joints showed increased range of motion in children with the rear-foot strike with larger ground reaction force as well. Future studies may need to evaluate the influence of footwear types on gait performance of children in different age groups. Findings in this study may provide recommendations for suitable footwear types for different ages, achieving the aim of growth and development in a healthy and safe manner.

Australian secondary school principals', parents', and students' attitudes to prescribed school footwear guidelines

BACKGROUND

Adolescents are often required to wear footwear that adheres to uniform guidelines at secondary school. There is a paucity of literature on factors influencing school footwear choice and what drives the development of school footwear guidelines. The aims of this study were to describe (i) current school footwear guidelines in secondary schools across Australia, (ii) factors that influence footwear choice in secondary school students and their parents, and (iii) principals, parents, and students' beliefs on factors which contribute to school footwear guidelines.

METHODS

An online survey was distributed to principals, secondary school students (aged 14-19 years) and their parents across Australia. The survey included questions on current school footwear guidelines, factors influencing footwear choice (for students and parents), participants beliefs on the effect footwear has on musculoskeletal health, current and previous lower limb pain, and beliefs on factors that contribute to school footwear guidelines. Parent and student responses to factors that influence their footwear choice were compared using proportional odds logistic regression. Students and parents' responses to factors influencing footwear guidelines were compared to principal responses using proportional odds logistic regression. Significance was set at an alpha of < 0.05.

RESULTS

Eighty principals, 153 parents and 120 secondary school students responded to the survey. 96% (77/80) of principals reported that their schools have set guidelines for school footwear. 88% of principals considered comfort to be important when developing school footwear guidelines. Proportional odds logistics regression showed that parents and students were 3.4 and 4.9 times more likely, respectively, than principals to rate comfort as being important when schools develop footwear guidelines. More than 40% of students reported experiencing musculoskeletal pain, and 70% of these students reported the pain to be exacerbated when in their school shoes. Less than a third of participants considered healthcare recommendations important to the development of footwear guidelines.

CONCLUSIONS

Nearly all principals that participated in this survey had set guidelines for school footwear. There is a discord between parents, students, and principals on the importance that factors such as comfort, play in the development of school footwear guidelines.

Comprehensive Understanding of Foot Development in Children Using Capacitive Textile Sensors

Knowledge of foot growth can provide information on the occurrence of children's growth spurts and an indication of the time to buy new shoes. Podiatrists still do not have enough evidence as to whether footwear influences the structural development of the feet and associated locomotor behaviours. Parents are only willing to buy an inexpensive brand, because children's shoes are deemed expendable due to their rapid foot growth. Consumers are not fully aware of footwear literacy; thus, views of consumers on children's shoes are left unchallenged. This study aims to embed knitted smart textile sensors in children's shoes to sense the growth and development of a child's feet-specifically foot length. Two prototype configurations were evaluated on 30 children, who each inserted their feet for ten seconds inside the instrumented shoes. Capacitance readings were related to the proximity of their toes to the sensor and validated against foot length and shoe size. A linear regression model of capacitance readings and foot length was developed. This regression model was found to be statistically significant (p-value = 0.01, standard error = 0.08). Results of this study indicate that knitted textile sensors can be implemented inside shoes to get a comprehensive understanding of foot development in children.

The Development of a Built-In Shoe Plantar Pressure Measurement System for Children

There is a rapid increase in plantar pressure from the infant to toddler stage, yet little is known about the reasons for this change. More information about plantar pressure distribution can help clinicians identify early-stage foot-related diseases that may occur during transitions from childhood to adulthood. This information also helps designers create shoes that adapt to different needs. This research describes the development of a low-cost, built-in shoe plantar pressure measurement system that determines foot pressure distribution in toddlers. The study aimed to improve and provide data on pressure distribution during foot growth. This was accomplished by implementing a plantar pressure capacitive measurement system within shoes. The capacitive sensors were laminated using a copper tape sheet on plastic backing with adhesive, elastomer layers, and a combination of conductive and non-conductive fabrics. Constructed sensors were characterized using compression tests with repeated loads. Results demonstrated that the sensors exhibited rate-independent hysteresis in the estimation of pressure. This enabled a calibration model to be developed. The system can mimic more expensive plantar pressure measurement systems at lower fidelity. This emerging technology could be utilized to aid clinicians, researchers, and footwear designers interested in how pressure distribution changes from infants to toddlers.

Parents, health professionals and footwear stakeholders' beliefs on the importance of different features of young children's footwear: a qualitative study

Background

A small but building pool of evidence of the impact of footwear on children’s function means understanding the different beliefs of stakeholders about footwear key features and flexibility is critical for translation into recommendations and to support parents and caregivers in purchasing footwear for their children. Therefore, this research aimed to describe how different stakeholders (health professionals, parents, and footwear industry representatives) described the importance of flexibility and other footwear features for young children.

Methods

This qualitative study was nested within an international modified Delphi online survey. Participants responded to open-ended questions about footwear component flexibility and asked if and why flexibility in these areas were important. Participants also described any other important footwear features. Inductive thematic analysis was used to generate themes.

Results

There were 121 responses from three stakeholder groups including health professionals (n = 90), parents of young children (n = 26) and footwear industry representatives (n = 5). Overarching themes described by participants included developmental impacts of footwear, therapeutic impact and how footwear may play a role in function.

Conclusion

There were key differences in how stakeholders viewed footwear and any perceived benefits of footwear components, much of which was not backed with empirical evidence. It was also identified that health professionals are using footwear within treatment recommendations. This work highlights the importance of understanding circumstances in which footwear may have a therapeutic impact or be the first line of treatment for children with complex foot needs. This is the first step in developing contemporary footwear recommendations for parents and caregivers.

How barefoot and conventional shoes affect the foot and gait characteristics in toddlers

Objectives

Barefoot shoes have recently become a popular alternative to conventional shoes among the parents of pre-school children. As the long-term effect of habitual shoe-wearing on the foot is still unclear, the aim of this study was to compare the arch index, dynamic foot anthropometry and gait parameters in toddlers who had been habitually wearing barefoot shoes or conventional shoes since their first steps.

Methods

30 toddlers– 15 habitually wearing barefoot shoes (BF group) and 15 habitually wearing conventional shoes (N-BF group)–participated in this study. Each child was measured twice during the study. The first data collection session occurred within one month after the first five consecutive unsupported steps were performed by the toddler. The second data collection session occurred seven months after this event. At each data collection session, the toddler was instructed to walk barefooted at its natural speed over an Emed^® platform (Novel GmbH, Germany). The Emed ^® software generated data regarding the arch index, dynamic foot anthropometry, foot progression angle, contact area, contact time, peak pressure and maximum force. The Wilcoxon signed-rank test was used to compare the differences between the 1^st and 2^nd data collections. The Mann-Whitney U test was used to compare the differences between the BF and N-BF groups.

Results

The results of this study show a higher plantar arch and a smaller foot progression angle in the BF group. The forefoot width in both the BF and N-BF groups remained proportional to the foot length after seven months of independent walking.

Conclusions

These findings may encourage parents and caregivers to introduce barefoot shoes or create a habitual barefoot time for their child.

Young children's footwear taxonomy: An international Delphi survey of parents, health and footwear industry professionals

OBJECTIVE

There is little consistency between commercial grade footwear brands for determining shoe sizing, and no universally accepted descriptors of common types or features of footwear. The primary aim of this research was to develop a footwear taxonomy about the agreed types of footwear commonly worn by children under the age of six. Secondary aims were to gain consensus of the common footwear features, when different types of footwear would be commonly worn, common terms for key footwear parts, and how movement at some of these footwear parts should be described.

MATERIALS AND METHODS

Opinions were collected through a three-round modified Delphi international online survey from parents, health professionals, researchers, and footwear industry professionals. The first survey displayed generic pictures about different footwear types and asked participants to provide a grouping term, when the footwear would be worn (for what type of activity) and any grouping features. The second and third rounds presented consensus and gathered agreement on statements.

RESULTS

There were 121 participants who provided detailed feedback to open-ended questions. The final round resulted in consensus and agreement on the names of 14 different footwear types, when they are commonly worn and their common features. Participants also reached consensus and agreement on the terms heel counter to describe the back part of footwear and fixtures as the collective term for features allowing footwear adjustability and fastening. They also agreed on terms to quantify the flexibility at footwear sole (bend or twist) or the heel counter.

CONCLUSION

This first taxonomy of children's footwear represents consensus amongst different stakeholders and is an important step in promoting consistency within footwear research. One shoe does not fit all purposes, and the recommendations from this work help to inform the next steps towards ensuring greater transparency and commonality with footwear recommendations.

Measurement of the Developing Foot in Shod and Barefoot Paediatric Populations: A Narrative Review

The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children’s feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.

A influência de calçados no arco longitudinal medial do pé e na cinemática dos membros inferiores de crianças no início da fase de aquisição de marcha

Objective  To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase.

Methods  Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE).

Results  The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE).

Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.

Variation, mosaicism and degeneracy in the hominin foot

The fossil record is scarce and incomplete by nature. Animals and ecological processes devour soft tissue and important bony details over time and, when the dust settles, we are faced with a patchy record full of variation. Fossil taxa are usually defined by craniodental characteristics, so unless postcranial bones are found associated with a skull, assignment to taxon is unstable. Naming a locomotor category based on fossil bone morphology by analogy to living hominoids is not uncommon, and when no single locomotor label fits, postcrania are often described as exhibiting a 'mosaic' of traits. Here, we contend that the unavoidable variation that characterises the fossil record can be described far more rigorously based on extensive work in human neurobiology and neuroanatomy, movement sciences and motor control and biomechanics research. In neurobiology, degeneracy is a natural mechanism of adaptation allowing system elements that are structurally different to perform the same function. This concept differs from redundancy as understood in engineering, where the same function is performed by identical elements. Assuming degeneracy, structurally different elements are able to produce different outputs in a range of environmental contexts, favouring ecological robusticity by enabling adaptations. Furthermore, as degeneracy extends to genome level, genetic variation is sustained, so that genes which might benefit an organism in a different environment remain part of the genome, favouring species' evolvability.

A comparison of young children's spatiotemporal gait measures in three common types of footwear with different sole hardness

BACKGROUND

It is unknown what the impact of sole hardness is on young children's gait. Yet, this feature is commonly marketed as having differing benefits for young children's walking and development.

RESEARCH QUESTION

What are the differences in spatiotemporal measures of gait during walking and running in three common types of young children's footwear with a soft sole, compared to a hard sole?

METHODS

The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (aged 2-4 years). Participants walked or ran the length of a GAITRite mat in a randomized order in a soft (Shore 48-53) or hard soled (Shore 60-65) sneaker, boot and sandal condition. Linear regression analyses were used to investigate the difference between footwear for the different gait parameters including velocity, cadence, step time, swing percentage, stance percentage, double support time and the toe in/out angle.

RESULTS

Children walked with a shorter stride length in the hard-soled sandals compared to the soft- soled sandals (p < 0.05). There were no other differences in spatiotemporal variables in the soft versus hard soled sandals during walking or running (p > 0.05). There were no differences in any spatiotemporal gait variables during walking or running in soft versus hard- soled runners and no differences in walking or running in soft versus hard-soled boots (p > 0.05).

SIGNIFICANCE

There were few differences in spatiotemporal parameters between soft and hard-soled footwear in both walking and running in three different types of footwear. This may be a positive finding for footwear designers and manufacturers, as a harder sole appeared to have limited impact on spatiotemporal gait parameters.

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.

Addressing the Data Acquisition Paradigm in the Early Detection of Pediatric Foot Deformities

The analysis of plantar pressure through podometry has allowed analyzing and detecting different types of disorders and treatments in child patients. Early detection of an inadequate distribution of the patient's weight can prevent serious injuries to the knees and lower spine. In this paper, an embedded system capable of detecting the presence of normal, flat, or arched footprints using resistive pressure sensors was proposed. For this purpose, both hardware- and software-related criteria were studied for an improved data acquisition through signal coupling and filtering processes. Subsequently, learning algorithms allowed us to estimate the type of footprint biomechanics in preschool and school children volunteers. As a result, the proposed algorithm achieved an overall classification accuracy of 97.2%. A flat feet share of 60% was encountered in a sample of 1000 preschool children. Similarly, flat feet were observed in 52% of a sample of 600 school children.

Soft soled footwear has limited impact on toddler gait

The development of walking in young toddlers is an important motor milestone. Walking patterns can differ widely amongst toddlers, and are characterised by unique biomechanical strategies. This makes comparisons between newly walking toddler’s and older children’s walking difficult. Little is currently understood regarding the effects of footwear on the gait in newly walking toddlers. A quasi-experimental pre-post study design was used to assess whether spatiotemporal parameters of gait, and in-shoe foot and lower limb kinematics, differed when walking barefoot and in soft-soled footwear in newly walking toddlers. There were 18 toddlers recruited, with 14 undergoing testing. The GAITRite system collected spatial and temporal data. The Vicon camera system collected kinematic data. The testing conditions included barefoot and footwear. Footwear tested was a commercially available soft soled shoe (Bobux XPLORER). Data was extracted directly from the GAITRite system and analysed. Walking in footwear did not change spatial or temporal data, however there were small but significant decreases in hip adduction/abduction range of motion (mean difference (MD) = 1.79°, 95% CI = -3.51 to -0.07, p = 0.04), knee flexion (MD = -7.63°, 95% CI = 2.70 to 12.55, p = 0.01), and knee flexion/extension range of movement (MD = 6.25°, 95% CI = -10.49 to -2.01, p = 0.01), and an increase in subtalar joint eversion (MD = 2.85°, 95% CI = 5.29 to -0.41, p = 0.03). Effect sizes were small for hip and ankle range, peak knee extension, and subtalar joint ranges (d<0.49), medium for knee flexion/extension range (d = 0.75) and large for peak knee flexion (d = 0.87). The magnitude of kinematic changes with soft-soled footwear were small thus the clinical importance of these findings is uncertain. Future longitudinal studies are needed to develop recommendations regarding footwear for newly walking toddlers.

The "price-tag" of foot health in infancy and early childhood: a cross sectional survey of UK parents

Children's feet are complex structures and strategies for supporting good foot health throughout childhood can be challenging. Greater awareness of the contemporary factors influencing decisions, such as footwear purchases, is needed to inform health narratives which are more closely aligned to parents' attitude and behaviours. The aim of this study was to explore parent's knowledge of children's foot health, understand the common foot health concerns and experiences with footcare services. A purposeful sampling approach was used to recruit parents of children aged 5 years and under. Participants completed a self-administered, online survey which consisted of 39 questions across six sections: (1) Participant demographics; (2) Developmental events (milestones such as crawling and walking); (3) Foot health concerns; (4) Developmental aids (products such as baby bouncers and baby walkers); (5) Footwear; and (6) Foot health information. Both adaptive and mandatory questions were used. Descriptive statistics were used to summarise closed-ended questions, and a summative content analysis was adopted to draw inferences from the text data. Two-hundred thirty-nine parents completed the survey, and this represented female participants (n = 213) aged between the ages 34-42 (n = 126) or 25-34 (n = 83) years of age. The survey generated responses from a wide geographical spread across the UK, but the majority of these were from the North West of England (n = 75) and South East of England (n = 46). Four main themes were drawn from the content analysis: (1) foot health concerns and seeking advice; (2) information and advice; (3) how parents support infant milestone events; and (4) footwear.Conclusion: This work provides insight into parents' perspective on the broad topics of children's foot health, identifying common experiences and concerns about their children's foot health and the factors which influence decision making. Understanding more about these issues will help health professionals support parents during infancy and early years. What is Known: • Maintaining good foot health throughout childhood is important and many factors influence decision making. • There is little understanding about how parents care for their children feet and their understanding of good foot health practices and services. What is New: • Insight into the common factors which influence parents' approaches to supporting early development and the typical concerns that parents encountered about their children's overall foot health and footwear. • Identifies areas of children's foot health for health professionals to target when developing information sources for parents.

Barefoot walking changed relative timing during the support phase but not ground reaction forces in children when compared to different footwear conditions

BACKGROUND

There is a paucity of available biomechanical kinetic data comparing shod and barefoot conditions in children.

RESEARCH QUESTION

Do children wearing footwear have comparable gait velocity, ground reaction forces (GRF), spatiotemporal parameters, propulsive and braking impulses when compared to children walking barefoot?

METHODS

Seventy-five children were divided into four groups: Group 1 females aged 4-9 years old (n = 29). Group 2 females aged 3-5 years old (n = 16). Group 3 males aged 6-9 years old (n = 13). Group 4 males aged 4-8 years old (n = 17). Children walked at a self-selected pace over a walkway of force platforms. Each footwear and barefoot represented a separate condition. The order of conditions was randomized. A repeated-measures ANOVA was performed to investigate the effects of the footwear type on gait parameters in each group. Multiple comparisons with Bonferroni corrections were conducted when appropriate.

RESULTS

There were no statistical differences in velocity or in vertical and anteroposterior GRF across conditions for all groups. There was a significant effect of the footwear worn on time to loading response peak (p = 0.008), time to midstance force (p = 0.006), and time to propulsive peak (p < 0.001). For Group 3, there was a significant effect of the footwear worn on time to braking peak (p < 0.001) and time to propulsive peak (p < 0.001). Regarding impulses for Group 1, there was a significant effect of the footwear worn on the loading response impulse (p = 0.016) and terminal stance and pre-swing impulse (p = 0.001). For Group 4, there was a significant effect of the footwear worn on the loading response impulse (p = 0.028).

SIGNIFICANCE

There is no influence of the evaluated children's footwear on gait velocity or GRF.

A comparison of young children's spatiotemporal measures of walking and running in three common types of footwear compared to bare feet

BACKGROUND

Clinicians and footwear manufacturers often advise young children to wear soft-soled footwear when they are first learning to walk. There is limited evidence as to why this advice is given, and if soft-soled shoes are as close to barefoot as thought.

RESEARCH QUESTION

What are the differences in spatiotemporal measures of gait during walking and running in three common types of children's footwear with a soft-soled compared to barefoot in young children?

METHODS

The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (2 - 4 years). Participants walked or ran the length of a GAITrite mat in a randomized order for barefoot and soft-soled sneaker, boot and sandal conditions. Linear regression analyses were used to investigate the main effect of each soft-soled footwear compared to bare feet in the different gait parameters.

RESULTS

For walking and running trials, cadence decreased whereas step time and stride length increased in all footwear types compared to the barefoot condition. While wearing sneakers and sandals increased the stance percentage for walking and running trials, compared to barefoot, this difference was only apparent during the running trial for the boots. Likewise, although double support time increased for both the boots and sneakers in walking and running, compared to barefoot, this difference was only observed in the sandals during walking.

SIGNIFICANCE

This research found that various types of soft-soled footwear impacted gait compared to the barefoot condition, with some differences seen between walking and running trials. These findings challenge the assumption that soft-soled footwear facilitate a similar gait to barefoot walking and running, although the clinical significance of these differences is unknown.

Effectiveness of therapeutic footwear for children: A systematic review

BACKGROUND

It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children.

METHODS

A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers.

RESULTS

Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled "corrective and "functional" based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited.

CONCLUSION

Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.

The impact of shoe flexibility on gait, pressure and muscle activity of young children. A systematic review

Background

There is limited evidence of shoe impact in younger children, particularly in the context of immature gait patterns. It is unclear if the impact from shoes in younger children is similar to what has been seen in older children. This systematic review aims to identify any impact of shoe features on younger children’s gait, and if there are any differences between shoe sole flexibility compared to barefoot.

Methods

Study inclusion criteria included: typically developing children aged ≤6 years; comparison of barefoot and shod conditions (walking and/or running) with shoe features or style of shoe described; sample size > 1. Novelty types of footwear were excluded, as was any mention of in shoe support or modifications. Studies were located from six databases. Study methodology was assessed using the McMasters critical review form. Sample size weighted standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results

Four studies were included. Participant age ranged from 15.2 to 78.7 months, with 262 participants across all studies. All studies had limited methodological bias based on their design type. Compared to barefoot walking, shoes increased velocity, step time and step length. Shod walking decreased cadence. Peak plantar pressure was generally lower in the stiff shoe design and there was a higher peak plantar pressure in the Ultraflex shoes. No studies were found investigating muscle activation.

Conclusions

Shoes affect younger children’s gait in spatiotemporal gait aspects, similar to those seen in older children. There is limited evidence on effects of particular shoe features such as sole hardness, on gait, and no evidence of any changes in muscle activation patterns. Further research is required to evaluate the impact of different types of shoe and shoe features in this population to provide clinical advice on the type of shoe that is appropriate in this age group.

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.