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European Journal of Sport Science
ISSN: 1746-1391 (Print) 1536-7290 (Online) Journal homepage: http://www.tandfonline.com/loi/tejs20
Foot strike pattern in preschool children during
running: sex and shod–unshod differences
Pedro Á. Latorre-Román, Juan A. Párraga-Montilla, Ignacio Guardia-
Monteagudo & Felipe García-Pinillos
To cite this article: Pedro Á. Latorre-Román, Juan A. Párraga-Montilla, Ignacio Guardia-
Monteagudo & Felipe García-Pinillos (2018): Foot strike pattern in preschool children during
running: sex and shod–unshod differences, European Journal of Sport Science
To link to this article: https://doi.org/10.1080/17461391.2017.1422545
Published online: 17 Jan 2018.
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ORIGINAL ARTICLE
Foot strike pattern in preschool children during running: sex and
shod–unshod differences
PEDRO Á. LATORRE-ROMÁN
1
, JUAN A. PÁRRAGA-MONTILLA
1
,
IGNACIO GUARDIA-MONTEAGUDO
1
, & FELIPE GARCÍA-PINILLOS
2
1
Department of Corporal Expression, University of Jaén, Spain, Jaén, Spain &
2
Department of Physical Education, Sport and
Recreation, Universidad de La Frontera, Temuco, Chile
Abstract
Purpose: This study aims to determine the foot strike patterns (FSPs) and neutral support (no inversion [INV]/eversion
[EVE] and no foot rotation) in preschool children, as well as to determine the influence of shod/unshod conditions and
sex. Methods: A total of 1356 children aged 3–6 years (673 boys and 683 girls) participated in this study. A sagittal and
frontal-plane video (240 Hz) was recorded using a high-speed camcorder to record the following variables: rearfoot strike
(RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/ eversion (INV/EVE) and foot rotation on initial contact.
Results: There were no between-sex significant differences in both shod and unshod conditions in RFS. In the unshod
condition, there was a significant reduction (p< 0.001) of RFS prevalence in both boys (shod condition = 44.2% vs.
34.7% unshod condition) and girls (shod condition = 48.5% vs. 36.1% unshod condition). As for neutral support, there
were no between-sex differences in both shod and unshod conditions or in the shod–unshod comparison. Conclusion: In
preschool children, no between-sex differences were found in relation to prevalence of RFS and neutral support (no INV/
EVE). Shod running alters FSP of running barefoot, producing a significant increase of RFS prevalence.
Keywords: Running, early age, motor skill, barefoot
Highlights
.Foot strike patterns of preschoolers are influenced by shod/unshod conditions.
.No significant between-sex differences were found in relation to prevalence of rearfoot strike and neutral support.
.The rearfoot strike prevalence was ∼46% in the shod condition; this value is far below those found in adult runners.
Introduction
The preschool age is characterised by significant
changes in the acquisition of locomotor skills and
nervous system maturation (Tanaka, Hikihara,
Ohkawara, & Tanaka, 2012). There is an association
of motor skill competence and physical activity in
preschool children (Williams et al., 2008), in this
regard, children who do not master fundamental
motor skills may participate little in sport and
games during childhood and adolescence (Hardy,
King, Farrell, Macniven, & Howlett, 2010). In
addition, motor skills such as running are essential
in most children’s physical activities and promote
physical activity and fitness; in particular, running
speed can provide consistency as a gross motor skill
and probably reflects anaerobic fitness (Nguyen,
Obeid, & Timmons, 2011). The majority (70–75%)
of four-year-old preschoolers show mastery in
running (Hardy et al., 2010).
Running patterns are influenced by numerous
internal factors such as sex, age, and physical fitness
(Ferber, McClay Davis, & Williams, 2003;
Fukuchi, Stefanyshyn, Stirling, Duarte, & Ferber,
2014; Sinclair & Selfe, 2015); and external factors
such as running surfaces and footwear (An,
Rainbow, & Cheung, 2015; Gruber, Silvernail,
Brueggemann, Rohr, & Hamill, 2013; Lieberman
et al., 2010; Muñoz-Jimenez, Latorre-Román, Soto-
Hermoso, & García-Pinillos, 2015).
Several studies have identified the running biome-
chanics characteristics in both adults and adolescents
© 2018 European College of Sport Science
Correspondence: F. García-Pinillos, Departmentof Physical Education, Sport and Recreation, Universidad de La Frontera, c/ Uruguay,
1980, Temuco, Chile. E-mail: fegarpi@gmail.com
European Journal of Sport Science, 2018
https://doi.org/10.1080/17461391.2017.1422545
(Fukuchi & Duarte, 2008; Latorre-Román, Balboa &
García-Pinillos, 2017; Lohman et al., 2011; Nigg,
Baltich, Maurer, & Federolf, 2012; Silvernail,
Boyer, Rohr, Brüggemann, & Hamill, 2015).
However, running biomechanics in preadolescents
(Hollander, Riebe, Campe, Braumann, & Zech,
2014; Latorre Román et al., 2017) and preschoolers
(Lopes, Giacomini, Davis, & Hespanhol, 2016)
have been little examined. Many previous studies
showed that running biomechanics –specifically
foot strike patterns (FSP) –in both adults and chil-
dren, is influenced by shod–unshod conditions
(Latorre Román et al., 2017; Lieberman et al.,
2010; Lopes et al., 2016; Muñoz-Jimenez et al.,
2015; Wegener, Hunt, Vanwanseele, Burns, &
Smith, 2011). However, no significant differences
were found in FSP according to sex (Latorre
Román et al., 2017). In addition, although running
with forefoot strike (FFS) seems to be a characteristic
of human evolution (Daoud et al., 2012), recreational
endurance runners exhibit a high prevalence –
between 74.9% and 95.4% –of rearfoot strike
(RFS) (Hasegawa et al., 2007; Larson et al., 2011;
Latorre-Román et al., 2015). RFS has been associ-
ated with higher vertical loading, higher collision
forces and greater ankle stiffness (Almeida, Davis,
& Lopes, 2015; Butler, Crowell, & Davis, 2003;
Hamill, Gruber, & Derrick, 2014; Lieberman et al.,
2010), and some previous works have suggested its
association with a greater injury risk (Daoud et al.,
2012).
Research into footwear use in children is also of
great interest as footwear can have a lasting impact
on the developing foot (Franklin, Grey, Heneghan,
Bowen, & Li, 2015). Habitual footwear use has sig-
nificant effects such as a reduction in foot arch and
hallux angles in children 6–18 years old (Hollander
et al., 2017). In this context, other authors showed
that shoe-wearing in early childhood is detrimental
to the development of a normal longitudinal arch
(Bhaskara Rao & Joseph, 1992), suggesting that
shoe-wearing predisposes to flat foot (Ganesh &
Magnani, 2016). Therefore, growing up barefoot or
shod may play an important role in childhood foot
development, implying long-term consequences for
motor learning and health later in life (Hollander
et al., 2017).
For most of human evolutionary history, runners
were either barefoot or wore minimal footwear; FFS
and midfoot strike (MFS) pattern were probably
more common when humans ran in these conditions,
and they may protect the feet and legs from some of
the impact-related injuries now suffered by a high
percentage of runners (Daoud et al., 2012). Despite
the numerous studies trying to define the advantages
and disadvantages of certain FSPs and footwear in
the adult population (Kasmer, Liu, Roberts, &
Valadao, 2013), no studies have examined FSPs in
preschoolers in relation to sex and shod/unshod con-
dition. In addition, information about FSP in pre-
school children may lead to more appropriate shoe
designs for this population or a better understanding
of the role played by FSP for childhood foot
development.
Based on the previous information and taking into
account that preschool children are not influenced by
so many years of using cushioned shoes, the purpose
of the current study was to determine the FSP and
neutral support (no inversion [INV]/eversion
[EVE]/and no foot rotation) in preschool children,
as well as to determine the influence of shod/
unshod conditions and sex. The authors hypoth-
esised that the proportion of RFS would be lower in
preschool children than in adults and, at early ages,
there would not be between-sex differences in FSP
and neutral support.
Methods
A descriptive, cross-sectional observational study was
performed.
Participants
A total of 1356 children aged 3–6 years participated
in this study (age = 55 ± 10 months old, body mass
index [BMI] = 15.88 ± 2.61 kg/m
2
). Demographic
characteristics revealed that 673 children were male
and 683 were female, and they were selected from
30 schools in southern Spain. The sample was
selected by convenience in a large geographical area
of Andalusia in both urban and rural areas. Inclusion
criteria considered schooling in early childhood and
being free from physical and/or intellectual disabil-
ities. Parents voluntarily signed an informed
consent form for the participation of their children
in this study. The study was completed in accordance
with the norms of the Declaration of Helsinki (2013
version) and the study was approved by the Ethics
Committee of the University of Jaen (Spain).
Materials and testing
Body mass (kg) was measured using a weighing scale
(Seca 899, Hamburg, Germany), and body height
(cm) was measured with a stadiometer (Seca 222,
Hamburg, Germany). The BMI was calculated by
dividing body mass (kg) by body height
2
(in
2P. Latorre-Román et al.
metres). Sociodemographic data such as physical
activity (h/week) and use of screens (h/day) were
obtained through the Krece Plus questionnaire
(Serra Majem, Aranceta Bartronaq, Ribas Barba,
Sangil Monroy, & Pérez Rodrigo, 2003).
Sagittal and frontal-plane videos (240 Hz) were
recorded using a high-speed camcorder (Casio
Exilim EXF1, Shibuyaku, Tokyo 151–8543, Japan).
Videos were taken from a lateral view and a posterior
view, with two cameras placed 5 m from the runner
so that he or she could be filmed in the sagittal and
frontal plane, respectively. Filming location was
set along a corridor of 5 m. Video data were analysed
using a 2D video editor (VideoSpeed vs 1.38, Ergo-
Sport, Granada, Spain). The dependent variables
selected for the kinematics analysis are in line with
previous works (Hasegawa et al., 2007; Latorre-
Román et al., 2015; Muñoz-Jimenez et al., 2015)
and are as follows: FSPs at first contact with the
ground, from rearfoot to forefoot: RFS, where
initial contact is made somewhere in the heel or
back third of the foot; MFS, where the heel and
sole make contact almost simultaneously; and FFS,
where initial contact is made with the metatarsal
heads. Moreover, neutral support (no INV/EVE
and no foot rotation) in stance phase in shod/
unshod conditions was considered. Neutral support
(no INV/EVE) was observed in relation to rotation
on the anteroposterior axis and was registered when
the shoe contacts the ground in its central part; in
addition, a strike pattern in which the first contact
of the foot with the ground is produced by the
lateral or medial edge of the foot was defined as
INV and EVE, respectively. Support with no foot
rotation was observed in relation to rotation on the
vertical axis and it was registered when the shoe con-
tacts on the ground following a straight line marked
on the ground. External rotation and internal rotation
(ER and IR, respectively) were also analysed. Asym-
metries between the right and the left foot were also
analysed in each of the above variables. The visual
determination of the FSP has been used in other
studies and, despite it is not as exact as the biomecha-
nical determination, it is practical for the assessment
of a large cohort (Hollander et al., 2016). Running
speed was measured using two double-light barriers
(WITTY; Microgate Srl, Bolzano, Italy; accuracy of
0.001 s).
Procedure
In this experiment, the participants were asked to run
both with their own running shoes and unshod at a
comfortable speed chosen by themselves. The
research team conducted a demonstration, and the
children performed some familiarisation trials on
how to run. The participants ran for 40 m to the
recording area formed by a corridor 5 m long by
2 m wide. The running tests were performed on a
flat, hard, non-slip surface, with the start line and
finish line marked. Each participant performed two
trials in both footwear and barefoot conditions.
Running conditions were randomised for each child
in order to compare the unshod and shod conditions.
Statistical analysis
Data were analysed using SPSS, v.19.0, for Windows
(SPSS Inc, Chicago, USA), and the significance level
was set at p< 0.05. Descriptive statistics are rep-
resented as mean, standard deviation, frequency,
and percentage. To analyse the differences of FSPs,
INV/EVE, and foot rotation between sexes, chi-
square analysis was used. To analyse the differences
between quantitative variables, independent sample
t-test was used. To analyse the differences between
the shod and unshod conditions, McNemar’s test
was performed. In a sample of 50 participants,
intra-observer reliability was calculated using
Cohen’s kappa and proportion of agreement for
FSPs, INV/EVE, and foot rotation.
Results
The intra-observer reliability was obtained for FSPs,
kappa = 0.926, proportion of agreement = 98%. For
INV/EVE, Kappa = 1.000, proportion of agreement
= 100%. For the foot rotation, Kappa = 0.951, pro-
portion of agreement = 98%. The average kappa
value = 0.959 ± 0.03. Table I shows the overall
characteristics of the participants.
Sex groups also were similar according to age (p=
0.743) and BMI (p= 0.054). No significant differ-
ences were found in running speed when comparing
the shod/unshod conditions (shod condition = 2.23
± 0.53 m/s, unshod condition = 2.15 ± 0.60 m/s, p=
0.087). When evaluating sex differences, no signifi-
cant differences were found in running speed
between shod–unshod conditions (shod condition,
boys = 2.30 ± 0.60 m/s, girls = 2.15 ± 0.45 m/s, p=
0.055; unshod condition, boys = 2.19 ± 0.60 m/s,
girls = 2.10 ± 0.59 m/s, p= 0.339).
RFS prevalence in relation to sex and shod/
unshod conditions is shown in Figure 1. There
were no significant differences between the sexes
in both shod (left foot, p= 0.063; right foot, p=
0.228) and unshod (left foot, p= 0.984; right foot,
p= 0.404) conditions. In the unshod condition,
there was a significant reduction of RFS prevalence
in both boys (shod condition = 44.2% vs. 34.7%
Foot strike pattern in preschool children during running 3
unshod condition, p< 0.001) and girls (shod con-
dition = 48.5% vs. 36.1% unshod condition, p<
0.001). As for the rest FSPs, the following results
were found: In the shod condition, MFS = 31.3%
in boys and 31.4% in girls, FFS = 24.5% in boys
and 20.1% in girls; whereas in the unshod con-
dition, MFS = 40.7% in boys and 40.9% in girls,
FFS = 24.7% in boys and 23.1% in girls. Finally,
there was a significant increase of MFS prevalence
in both boys (p< 0.001) and girls (p< 0.001) in
the unshod condition.
Figure 2 shows neutral support (no INV/EVE) in
relation to sex and shod/unshod conditions. There
were no significant differences between sexes in both
shod (left foot, p= 0.761; right foot, p= .497) and
unshod (left foot, p= 0.492; right foot, p=0.399)con-
ditions or in the comparison between shod–unshod
conditions (boys, left foot, p= 1.000, right foot, p=
0.162; girls, left foot, p= 0.218, right foot, p=0.304).
The prevalence of neutral support in the shod con-
dition was 62.3% in boys and 63.7% in girls, while in
the unshod condition, 61.0% in boys and 61.2% in
girls. In relation to INV/EVE, in the shod condition,
INV = 15.50% in boys and 16.9% in girls, EVE =
22.20% in boys and 19.4% in girls; whereas in the
unshod condition, INV = 17.3% in boys and 18.15%
in girls, EVE = 21.7% in boys and 20.65% in girls.
Support with no foot rotation in relation to sex and
shod/unshod conditions is shown in Figure 3. There
were significant between-sex differences on the left
foot in the shod condition (p= 0.010), the girls dis-
played more percentage of support without rotation.
Additionally, there were no significant differences
between shod–unshod conditions (boys, left foot, p
= 0.487, right foot, p= 0.175; girls, left foot, p=
0.073, right foot, p= 0.095). The prevalence of
support without rotation in the shod condition was
48.2% in boys and 53.6% in girls; whereas in the
unshod condition, 47.3% in boys and 50.1% in
girls. In relation to ER and IR, the following results
were found. In the shod condition, ER = 39.1% in
boys and 35.1% in girls, IR = 12.7% in boys and
11.3% in girls; while in the unshod condition, ER =
40.6% in boys and 38.7% in girls, IR = 12.1% in
boys and 11.2% in girls.
FSP asymmetry is shown in Table II. In RFS, INV/
EVE and support without foot rotation, there were no
significant differences between sexes in the shod con-
dition. However, girls showed a higher percentage of
foot rotation asymmetry than boys in the unshod con-
dition. Additionally, girls obtained a greater percen-
tage of asymmetry and boys reduced this percentage
in the unshod condition compared with the shod
condition.
Discussion
The purpose of this study was to determine the FSPs
and neutral support (no INV/EVE and no foot
rotation) in preschool children, as well as to deter-
mine the influence of shod/unshod conditions and
sex. Several factors can influence the adoption of
FSPs during running, using a cross-sectional study
design; the main finding of this study is that FSPs
of preschoolers are influenced by shod/unshod con-
ditions. No significant between-sex differences were
found in relation to prevalence of RFS and neutral
support. Another relevant finding is that the RFS
prevalence was 46.35% in the shod condition; this
value is far below those found in adult runners
Table I. Overall characteristics of the participants
Boys
Mean (SD)
Girls
Mean(SD) p-Value
Age (months) 55.48 (11.05) 55.68 (10.91) 0.743
Body height (m) 108.19 (7.72) 107.15 (8.15) 0.064
Body mass (Kg) 18.87 (4.09) 18.03 (3.73) 0.003
BMI z-score 0.56 (1.16) 0.25 (1.20) 0.054
Use of screens (h/day) 2.10 (0.96) 1.89 (0.88) <0.001
Physical activity (h/week) 3.63 (2.83) 3.28 (2.10) 0.038
Walk without shoes (min/day) 106.53 (105.10) 105.86 (111.29) 0.923
Figure 1. Prevalence of RFS in relation to sex and shod–unshod
conditions. ∗∗p< 0.01
4P. Latorre-Román et al.
(Kasmer et al., 2013; Larson et al., 2011; Latorre-
Román et al., 2015). In addition, previous studies
in children and adolescents showed that RFS preva-
lence in shod condition was 69.8–85.9% (Latorre
Román et al., 2017; Mullen & Toby, 2013). There-
fore, we could indicate that children are originally
FFS and transitioned progressively towards RFS,
due to morphological/biomechanical changes associ-
ated with growth or due to the use of shoes.
As mentioned earlier, there were no significant
differences between sexes in both shod and unshod
conditions in RFS. Likewise, Latorre-Román et al.
(2015) and Latorre Román et al. (2017) found no sig-
nificant differences between sexes in FSPs in adult
runners in a long-distance road competition and chil-
dren 6–16 years old, respectively. Moreover, this
investigation showed and confirmed that barefoot
running alters FSPs from an RFS to an MFS and
FFS pattern. Therefore, it is noteworthy that the
results of this study demonstrate that the FSPs of pre-
school children are influenced by the use of footwear,
shod running alters FSP of running barefoot, produ-
cing a significant increase of RFS prevalence. These
results are in accordance with previous studies in
adult populations (Hamill, Russell, Gruber, &
Miller, 2011; Lieberman et al., 2010; Muñoz-
Jimenez et al., 2015) and with children (Hollander
et al., 2014; Mullen & Toby, 2013). In particular,
in habitually shod adolescents during running, there
was an increase in the prevalence of RFS, from
62% barefoot to 97% shod (Lieberman et al.,
2010). Likewise, a previous study showed that
running biomechanics of preadolescent children are
influenced by the use of footwear, especially by cush-
ioned running shoes, eliciting significantly increased
maximum and impact ground reaction forces, step
length, step width, and rate of RFS, which may
pose an injury risk (Hollander et al., 2014). In
addition, Wegener et al. (2011) showed that during
running, shoes encourage RFS in children.
On the other hand, Stacoff, Nigg, Reinschmidt,
Van Den Bogert, and Lundberg (2000) found that,
on average, subjects tended to show less INV in the
barefoot running condition compared to shod
running. In the current study, sex and unshod/shod
conditions had no influence on INV/EVE. Conver-
sely, Latorre Román et al. (2017) showed that in
the unshod condition there was a significant increase
of neutral support (no INV/EVE) both in boys and in
girls. In addition, in the present study, the prevalence
of neutral support was higher than in the study by
Muñoz-Jimenez et al. (2015) in long-distance
runners in both shod and unshod conditions and
the study by Latorre Román et al. (2017) in children
aged 6–12 years.
Additionally, the literature on foot rotation is
scarce in children, and more research is needed to
highlight the effect of shod and unshod running on
this parameter, although a previous study displayed
that barefoot and minimalist running increased
tibial internal rotation (Sinclair, Greenhalgh,
Brooks, Edmundson, & Hobbs, 2013). In the
present study, there were no significant differences
between shod and unshod conditions. Moreover,
the prevalence of support without foot rotation was
higher than in the study of Muñoz-Jimenez et al.
(2015) in long-distance runners in both shod and
unshod conditions, and the study by Latorre
Román et al. (2017) in children aged 6–12 years.
Finally, kinetic asymmetries between both legs
could expose one of the lower limbs to more stress
and injury risk (Zifchock, Davis, & Hamill, 2006; Zif-
chock, Davis, Higginson, McCaw, & Royer, 2008);
however, these studies showed no differences in
asymmetry levels between injured and uninjured
runners. Therefore, it is still unclear how kinematic
asymmetry relates to overuse running injury. In
addition, few studies have documented gait asymme-
try in runners in both shod and unshod conditions
(Larson et al., 2011; Muñoz-Jimenez et al., 2015).
Muñoz-Jimenez et al. (2015) showed that the shod/
unshod conditions are not decisive in the presence
Figure 2. Prevalence of neutral support (no INV/EVE) in relation
to sex and shod–unshod conditions.
Figure 3. Prevalence of support without foot rotation in relation to
sex and shod–unshod conditions. ∗p< 0.05, ∗∗p< 0.01
Foot strike pattern in preschool children during running 5
of asymmetry. Likewise, the data obtained in the
present study indicated that the shod/unshod con-
ditions and sex do not show a clear influence on the
asymmetry of FSPs in preschool children.
Because humans evolved to run barefoot, a bare-
foot running style that minimises impact peaks and
provides increased proprioception and foot strength
is hypothesised to help avoid injury, regardless of
whether shoes are worn (Lieberman et al., 2010).
Therefore, a style similar to barefoot running may
be the natural way of running learned at an early
age. In this regard, the barefoot running style in
relation to FSPs should be preserved in children by
promoting barefoot practices in their usual physical
activity (e.g. running on the beach and grass,
walking barefoot at home). Although, the long-term
effects of using cushioned shoes during growth on
FSP and injury prevalence are currently unknown.
The main limitation of this study is the determi-
nation of the FSP using a video analysis system
because it is less accurate than using a complete
motion capture system. The strengths of this study
include its large population sample of children, and,
to our knowledge, it is the first study to determine
the FSPs in preschool children.
Wearing shoes predisposes to flat foot in children
because shoes inhibit the development of the arch
of the foot due to lack of intrinsic muscle activity
that is required for the development of the arch,
leading to weakness of the intrinsic muscles
(Ganesh & Magnani, 2016). The sensory stimulation
associated with the barefoot activity may produce a
protective increase in muscle activity that is capable
of elevating the arch (Thomas & Michaud, 2012).
Therefore, as clinical implications, the authors
would emphasise that the extent of the FSPs differ-
ences between shod and unshod running requires
further investigation into the effects of FSP and foot-
wear on long-term growth and development of the
feet of the preschool children.
In conclusion, no between-sex differences were
found in relation to prevalence of RFS and neutral
support (No INV/EVE, support with no foot
rotation) in preschool children. The fact of wearing
shoes alters the FSP according to barefoot running
by leading to an increase of RFS prevalence.
Acknowledgements
The authors would like to express their thanks to all
the schools (Andalusia, Spain) that have collaborated
in this study.
Disclosure statement
No potential conflict of interest was reported by the authors.
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Table II. Asymmetry in the RFS, neutral support, and support without foot rotation in shod/unshod conditions in relation to sex
Shod condition
(%)
p-Value
Unshod condition
(%)
p-ValueBoys Girls Boys Girls
FSP 18.4 19.0 0.779 20.2 18.6 0.456
Neutral support 22.5 19.4 0.180 22.7 22.6 0.965
Support without foot rotation 28.5 27.5 0.723 26.3∗34.2∗0.002
Note: FSP: foot strike patterns.
∗Significant differences with shod condition (p< 0.05).
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