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Foot strike pattern in preschool children during running: sex and shod–unshod differences

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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.
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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
shodunshod 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 36 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 shodunshod 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 childrens 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 (7075%)
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 shodunshod 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 618 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 36 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 1518543, 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, McNemars test
was performed. In a sample of 50 participants,
intra-observer reliability was calculated using
Cohens 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 shodunshod 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 shodunshod
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 shodunshod 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 shodunshod
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 69.885.9% (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 616 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 612 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 612 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 shodunshod conditions.
Figure 3. Prevalence of support without foot rotation in relation to
sex and shodunshod 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
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Neutral support 22.5 19.4 0.180 22.7 22.6 0.965
Support without foot rotation 28.5 27.5 0.723 26.334.20.002
Note: FSP: foot strike patterns.
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... The gross motor J o u r n a l P r e -p r o o f function of children with CP can be classified using the Gross Motor Functional Classification Scale-Expanded and Revised (GMFCS E-R), which is an ordinal scale of five levels [3]. Children aged [6][7][8][9][10][11][12][13][14][15][16][17][18] years in GMFCS level I will be able to run with limited balance, speed and coordination, while twothirds of children in GMFCS level II are able to run [4]. Children classified as GMFCS levels III to V are not able to run independently due to their neurological disorders and motor disturbance [3]. ...
... Several comparisons of barefoot and shod running have been undertaken in typically developing (TD) children [8][9][10][11]. Barefoot running is reported to promote a more midfoot/forefoot strike pattern in TD children, defined as the midfoot or forefoot making contact with the ground first [8,9,12]. ...
... Several comparisons of barefoot and shod running have been undertaken in typically developing (TD) children [8][9][10][11]. Barefoot running is reported to promote a more midfoot/forefoot strike pattern in TD children, defined as the midfoot or forefoot making contact with the ground first [8,9,12]. ...
Article
Background The biomechanics of barefoot and shod running are different for typically developing children but unknown for children with cerebral palsy (CP). Such differences may have implications for injury and performance. Aims The primary aims of this study were to compare the lower limb biomechanics of barefoot and shod running in children with CP, and to determine whether any differences were the same in GMFCS levels I and II. Methods This cross-sectional study examined 38 children with CP (n=24 (GMFCS) level I; n=14 GMFCS II), running overground at 3 speeds (jog, run, sprint) in barefoot and shod conditions. Marker trajectories and force plate data were recorded, and lower limb kinematics, kinetics and spatiotemporal variables were derived. Differences between barefoot and shod running were analysed using linear mixed models. Results For both GMFCS levels, barefoot running resulted in higher loading rates, but smaller impact peaks at all speeds. Barefoot running was associated with greater hip and knee power; less ankle dorsiflexion and hip flexion at initial contact, and less ankle and knee range of motion during stance, compared to shod running, at all speeds. Barefoot stride length was shortened, and cadence increased compared to shod during jogging and running but not sprinting. For GMFCS level I only, barefoot running involved a higher incidence of forefoot strike, greater ankle power generation and less hip range of motion during stance. Significance Running barefoot may facilitate running performance by increasing power generation at the ankle in children with CP, GMFCS level I. Higher barefoot loading rates may have implications for performance and injury.
... Although running routine leads to highly commendable health bene ts, there also remains a high incidence of running-related injuries in youth and adult runners [8,9]. Therefore, some researchers suggested the importance for focusing research on children [10][11][12][13], and potentially elucidate the way children interact with environment during running from a mechanical loading perspective [13,14]. ...
... Through the type of footwear selected, parents buying footwear for their preschool children could indirectly affect their movement pattern [12]. Moreover, underlying kinematic and kinetic differences have been observed in the development of running in comparing preschool and older children running [13,25]. ...
... Eleven children were excluded from this study because they did not meet criteria or did not nish whole procedure (3 children below 15th percentile in MABC-2, 5 children did not complete biomechanical protocol (bad mood or being nervous or shy etc.), 2 children had diagnosed foot or lower limb deformities, 1 child -parent´s time constrain). No strati cation for sex was required because a recent study showed no differences in footstrike pattern between preschool boys and girls [12]. Nevertheless, both sexes in each age group were included in the current study (Table 1). ...
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Full-text available
Background Previous research indicated that running barefoot or in minimalist shoes led to lower impact loading in an adolescent and adult population. Running as fundamental locomotor skill significantly develops during early childhood (preschool age). However, no study has focused on effect of footwear condition on lower limb impact loading during running in this age. Therefore, the purpose of this study was to assess effect of footwear conditions (barefoot, minimalist and standard running shoes) on running impact loading in the preschool years. Methods Fourty-eight habitually shod preschool children were divided into 4 age groups. Children performed simple running game in 3 different footwear conditions (random counter-balanced order), 3-dimensional biomechanical analysis were carried out during overground running. The key dependent variables included vertical ground reaction force (VGRF) and vertical instantaneous loading rate (VILR). Statistical parametric mapping was performed to reveal possible differences in VGRF and one-way repeated measures ANOVA in VILR. Results Three-year-old children displayed significantly lower impact peak of VGRF in barefoot condition compared to minimalist (3-7% stance, P = 0.012) and standard running shoes (7-11% stance, P = 0.009). Furthermore, in 3-year-old in minimalist shoes had higher loading than in standard running shoes (0-4% stance, P = 0.007). There were also differences in VILR, where 3-year-old had lower loading in barefoot than in minimalist (P = 0.010, d = 1.19) or standard running shoes (P = 0.045, d = 0.98). No differences were found in older children. Conclusion Running in minimalist shoes did not imitate barefoot running and did not lower impact forces compared to standard running shoes in 3-year-old children. On the contrary, increased loading was observed in minimalist shoes in early running developmental stages. Professionals who work with children should consider effect of minimalist shoes on impact loading (running on hard surfaces).
... Nominal classification differentiates runners as rearfoot, midfoot, and forefoot strikers or as rearfoot and non-rearfoot (14,15). Numerous studies have reported strong evidence that the running footstrike pattern is affected by different types of footwear in different ethnic and age populations (16)(17)(18)(19)(20)(21)(22). However, no universal recommendation exists regarding footwear or footstrike and their effect on overall incidence of running-related injuries (15,21,23). ...
... A recent study by Latorre-Román et al. (20) studied the effect of footwear on footstrike pattern during overground running in preschool children. They reported that 54% of preschool children displayed a non-rearfoot strike in the shod condition, which is far greater than in adult runners. ...
... They reported that 54% of preschool children displayed a non-rearfoot strike in the shod condition, which is far greater than in adult runners. The authors explained the higher prevalence of non-rearfoot strike pattern in preschoolers by morphological/biomechanical changes associated with growth or due to habit of wearing shoes (20). However, Latorre-Román et al. (20) did not account for the preschool age-related changes during this important growth period for running skill development. ...
Article
Introduction: Running skill develops during the pre-school age. There is little research evidence as to how footstrike patterns are affected by footwear during this important developmental period. Purpose: The aim of this study was to compare footstrike patterns among different age groups of preschool children running in different footwear conditions. Methods: Three-dimensional kinetics and kinematics were collected while 48 typically developing children age 3-6 years ran overground at self-selected speed in a barefoot condition and in minimalist and standard running shoes. Children were divided into 4 age groups (n=12 per group). The key dependent variables for this study included strike index and sagittal plane ankle angle at footstrike. A two-way mixed ANOVA (3 x 4) was performed to determine possible footwear and age differences in footstrike patterns. Results: An interaction between footwear condition and age group was found in the ankle angle at footstrike (P = 0.030, η2 = 0.145). There was a main effect within the footwear condition across all age groups for strike index (P = 0.001, η2 = 0.337). The ankle was more plantar flexed in the barefoot and minimalist conditions compared to standard running shoes only in six-year old children (P < 0.05, d > 0.8). In addition, six-year old children had a more plantar flexed ankle than 3-year old children when they ran barefoot (P = 0.008, d = 1.24). Conclusions: Footstrike pattern is affected by footwear in preschool children. As children get older, their footstrike pattern becomes more non-rearfoot with a more plantar flexed ankle in barefoot and minimalist shoes. On the contrary, the rearfoot-midfoot strike pattern did not change over preschool age when they wore standard running shoes.
... Through the type of footwear selected, parents buying footwear for their preschool children could indirectly affect their movement pattern (Pedro Á. Latorre-Román et al., 2018;Plesek et al., 2021). Moreover, underlying kinematic and kinetic differences have been observed in the development of running in comparing preschool and older children (P. ...
... As an inclusion criterion, the limit for this study was set for over the 15th percentile for a certain age according to Czech norms of the MABC-2 (15th percentile is considered as a boundary for typically developing children from the motor developmental perspective, for given age; Psotta, 2014). No stratification for sex was required because a recent study showed no differences in footstrike patterns between preschool boys and girls (Pedro Á. Latorre-Román et al., 2018). Nevertheless, both sexes in each age group were included in the current study (Table 1). ...
Article
The aim of this study was to assess acute effects of footwear conditions (barefoot, minimalist and standard running shoes) on running impact loading in the preschool years. Fourty-eight habitually shod preschool children (26 males and 22 females) were divided into four age groups (3-, 4-, 5- and 6-year-old). Children performed a simple running game in three different conditions. Three-dimensional biomechanical analysis was carried out during overground running. Statistical parametric mapping was performed on the vertical ground reaction force profiles during the stance phase and one-way repeated measures ANOVA on the vertical instantaneous loading rate. Three-year-old children displayed significantly lower vertical ground reaction force values in the barefoot condition compared to minimalist (3-7% stance) and standard running shoes (7-11% stance). There were also differences in vertical instantaneous loading rate, where 3-year-olds had lower loading when barefoot than in minimalist (p = 0.010, d = 1.19) or running shoes (p = 0.045, d = 0.98), despite no differences in the footstrike pattern (mostly rearfoot-midfoot strike). No differences were found for the older children. Running in minimalist shoes did not imitate barefoot running in 3-year-old children. On the contrary, increased loading was observed in minimalist shoes in early running developmental stages.
... 15 The few previous studies conducted in children and adolescents report that the foot strike pattern is likely to be influenced by the footwear with the rearfoot pattern being the most common. 16,17 Therefore, this study aimed to investigate the distribution of foot strike patterns in children and adolescents during running, and the association of participants' characteristics with the foot strike patterns identified using an algorithm developed by a supervised machine learning procedure. ...
... The authors found higher prevalence of rearfoot pattern during shod condition (86% shod versus 63% barefoot). Other studies 17,25 investigated the foot strike pattern during running in children and adolescents and also the influence of barefoot and shod conditions on foot strike patterns. The authors found a higher proportion of rearfoot in the shod condition compared to barefoot (85% shod versus 60% barefoot). ...
Article
Background There is a lack of studies describing foot strike patterns in children and adolescents. This raises the question on what the natural foot strike pattern with less extrinsic influence should be and whether or not it is valid to make assumptions on adults based on the knowledge from children. Objectives To investigate the distribution of foot strike patterns in children and adolescents during running, and the association of participants’ characteristics with the foot strike patterns. Methods This is a cross-sectional study. Videos were acquired with a high-speed camera and running speed was measured with a stopwatch. Bayesian analyses were performed to allow foot strike pattern inferences from the sample to the population distribution and a supervised machine learning procedure was implemented to develop an algorithm based on logistic mixed models aimed at classifying the participants in rearfoot, midfoot, or forefoot strike patterns. Results We have included 415 children and adolescents. The distribution of foot strike patterns was predominantly rearfoot for shod and barefoot assessments. Running condition (barefoot versus shod), speed, and footwear (with versus without heel elevation) seemed to influence the foot strike pattern. Those running shod were more likely to present rearfoot pattern compared to barefoot. The classification accuracy of the final algorithm ranged from 80% to 88%. Conclusions The rearfoot pattern was predominant in our sample. Future well-designed prospective studies are needed to understand the influence of foot strike patterns on the incidence and prevalence of running-related injuries in children and adolescents during running, and in adult runners.
... Multiple studies have identified acute changes in running biomechanics in habitually shod children when running barefoot, such as having a higher step frequency, shorter step length and shorter contact times, and shifting their foot strike pattern from a rear-foot strike (RFS) towards mid-foot strike (MFS) or fore-foot strike (FFS) [11,15,16,21]. These biomechanical alterations, especially the use of a more anterior foot strike pattern may lead to chronic changes in sprint technique [16,21] and fast stretch-shortening cycle (SSC) performance as required in sprinting and jumping [21]. ...
... Multiple studies have identified acute changes in running biomechanics in habitually shod children when running barefoot, such as having a higher step frequency, shorter step length and shorter contact times, and shifting their foot strike pattern from a rear-foot strike (RFS) towards mid-foot strike (MFS) or fore-foot strike (FFS) [11,15,16,21]. These biomechanical alterations, especially the use of a more anterior foot strike pattern may lead to chronic changes in sprint technique [16,21] and fast stretch-shortening cycle (SSC) performance as required in sprinting and jumping [21]. Barefoot running programs of 8-12 weeks duration may alter average vertical ground reaction forces, loading rates and stiffness characteristics of the lower limb during running, with less research investigating whether these changes are also found while jumping [10,30]. ...
Article
Background The acute changes of running biomechanics in habitually shod children when running barefoot have been demonstrated. However, the long-term effects of barefoot running on sprinting biomechanics in children is not well understood. Research question How does four years of participation in a daily school barefoot running program influence sprint biomechanics and stretch-shortening cycle jump ability in children? Methods One hundred and one children from barefoot education school (age, 11.2 ± 0.7 years-old) and 93 children from a control school (age, 11.1 ± 0.7 years-old) performed 50 m maximal shod and barefoot sprints and counter movement jump and five repeated-rebound jumping. To analyse sprint kinematics, a high-speed camera (240 fps) was used. In addition, foot strike patterns were evaluated by using three high-speed cameras (300 fps). Jump heights for both jump types and the contact times for the rebound jump were measured using a contact mat system. Two-way mixed ANOVA was used to examine the effect of school factor (barefoot education school vs control school) and footwear factor (barefoot vs shod) on the sprinting biomechanics. Results Sprinting biomechanics in barefoot education school children was characterised by significantly shorter contact times (p = 0.003) and longer flight times (p = 0.005) compared to control school children regardless of footwear condition. In shod sprinting, a greater proportion of barefoot education school children sprinted with a fore-foot or mid-foot strike compared to control school children (p < 0.001). Barefoot education school children also had a significantly higher rebound jump height (p = 0.002) and shorter contact time than control school children (p = 0.001). Significance The results suggest that school-based barefoot running programs may improve aspects of sprint biomechanics and develop the fast stretch-shortening cycle ability in children. In order to confirm this viewpoint, adequately powered randomised controlled trials should be conducted.
... Angles greater than 8.0° were represented as RFS, angles from 8.0° to −1.6° were midfoot strikes and angles less than −1.6° as FFS. 27 Secondly, the foot strike pattern was determined using two cameras within the Simi Motion Capture System, which were placed 4 meters perpendicular to the center of the treadmill using the methods described by Latorre-Román et al. 29 The classification of RFS or non-RFS using these techniques has been shown to have a greater accuracy in determining a RFS (interrater accordance: 0.981), than in deciding between RFS, midfoot strike, and FFS (0.893). 30 Spatiotemporal parameters were recorded using a floorbased photocell system (Optogait; Microgate), mounted on a professional treadmill (Woodway Pro XL) at a sampling frequency of 1000 Hz, over a 120 s period (with more than 330 steps). ...
Article
Full-text available
The aim of this study was to compare the effects of two 10-week non-laboratory based running retraining programs on foot kinematics and spatiotemporal parameters in recreational runners. One hundred and three recreational runners (30 ± 7.2 years old, 39% females) were randomly assigned to either: a barefoot retraining group (BAR) with 3 sessions/week over 10 weeks, a cadence retraining group (CAD) who increased cadence by 10% again with 3 sessions/week over 10 weeks and a control group (CON) who did not perform any retraining. The footstrike pattern, footstrike angle (FSA) and spatial-temporal variables at comfortable and high speeds were measured using 2D/3D photogrammetry and a floor-based photocell system. A 3x2 ANOVA was used to compare between the groups and 2 time points. The FSA significantly reduced at the comfortable speed by 5.81° for BAR (p < 0.001; Cohen’s d = 0.749) and 4.81° for CAD (p = 0.002; Cohen’s d = 0.638), and at high speed by 6.54° for BAR (p < 0.001; Cohen’s d = 0.753) and by 4.71° for CAD (p = 0.001; Cohen’s d = 0.623). The cadence significantly increased by 2% in the CAD group (p = 0.015; Cohen’s d = 0.344) at comfortable speed and the BAR group showed a 1.7% increase at high speed. BAR and CAD retraining programs showed a moderate effect for reducing FSA and rearfoot prevalence, and a small effect for increasing cadence. Both offer low-cost and feasible tools for gait modification within recreational runners in clinical scenarios.
Article
Full-text available
Rearfoot strike (RFS) in children running produces impact forces that give rise to a transient stress wave traveling through the body. It could contribute to the development of injuries. The purpose of this study was to determine RFS prevalence during childhood while running at a self-selected velocity in a prospective longitudinal cohort study. A total of 175 children (68 girls), aged 6 to 14 years, participated in this study. The sample was divided into three age groups (age in 2016): 6-8 years, 9-11 years, and 12-14 years which were analysed three years later (2019). 2D video-based was used to record the RFS Taking into account all samples, in the jogging trial the prevalence of RFS (an average of both feet) was 86.9% in 2016 and 94.7% three years later; in the running trial the prevalence was 82.6 and 94.4%, respectively. In all samples a significant increase of RFS prevalence was found in both the jogging and running trials for both feet over three years (jogging, left foot, p=.011, right foot, p=.023; running, left foot, p=.001, right foot, p<.001). In girls, there were no significant differences in any conditions. In boys, a significant increase of RFS prevalence was found after three years in both feet (p<.01) in the running trial. This study shows that RFS prevalence in children increases with age and the results may be used to characterize typical running development in children population.
Article
Background The purpose of this study was to analyse the effects of ten weeks of different running-retraining programmes on rearfoot strike (RFS) prevalence in adolescents. Research question it is possible to change foot strike pattern in adolescents? Methods A total of 180 children (45.3% girls), aged 13–16 years, participated in this intervention study. The children were randomly assigned to one of three experimental groups (EGs) that each carried out a different retraining programme, based on running technique (n = 39), a 15% increased step frequency (SF) (n = 37) and barefoot training (n = 30), performed for three days each week. A control group (CG) (n = 43) did not perform any retraining. A 2D video-based analysis (240 Hz) was used to determine the RFS. Results At baseline, no significant differences in RFS prevalence were found between the EGs and the CG in either the left (χ² = 2.048; p = 0.559) or the right foot (χ² = 0.898; p = 0.825). In the post-test, no significant differences were found for the left foot (χ² = 7.102; p = 0.069), but there were significant differences for the right foot (χ² = 9.239; p = 0.025) were observed. In the re-test, no significant differences were found for either the left foot (χ² = 2.665; p = 0.273) or the right foot (χ² = 2.182; p = 0.325). In addition, no group displayed significant changes in RFS prevalence from the pre-test to the re-test. There was a trend towards a reduction in the RFS prevalence in both the increased SF group and the barefoot group. Meaning The main finding of this study was that certain running-retraining programmes performed three times per week for ten weeks are not enough to modify the adolescent foot strike pattern (FSP).
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The development of the human foot is crucial for motor learning in children and adolescents as it ensures the basic requirements for bipedal locomotion and stable standing. Although there is an ongoing debate of the advantages and disadvantages of early and permanent footwear use, the influence of regular barefootness on foot characteristics in different stages of child development has not been extensively evaluated. A multicenter epidemiological study was conducted to compare the foot morphology between habitually barefoot children and adolescents (N = 810) to age-, sex-and ethnicity-matched counterparts that are used to wearing shoes. While controlling for confounders, we found that habitual footwear use has significant effects on foot-related outcomes in all age groups, such as a reduction in foot arch and hallux angles. The results indicate an impact of habitual footwear use on the development of the feet of children and adolescents. Therefore, growing up barefoot or shod may play an important role for childhood foot development, implying long-term consequences for motor learning and health later in life.
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Background Barefoot locomotion has evoked an increasing scientific interest with a controversial debate about benefits and limitations of barefoot and simulated barefoot walking and running. While most current knowledge comes from cross sectional laboratory studies, the evolutionary perspective suggests the importance of investigating the long-term effects. Observing habitually barefoot populations could fill the current gap of missing high quality longitudinal studies. Therefore, the study described in this design paper aims to investigate the effects of being habitually barefoot on foot mechanics and motor performance of children and adolescents. Methods This study has a cross-sectional, binational design and is part of the “Barefoot Locomotion for Individual Foot- and health Enhancement (Barefoot LIFE)” project. Two large cohorts (n(total) = 520) of healthy children and adolescents between 6 and 18 years of age will be included respectively in Germany and South Africa. A barefoot questionnaire will be used to determine habitually barefoot individuals. The testing will be school-based and include foot mechanical (static arch height index, dynamic arch index, foot pliability) and motor performance (coordination, speed, leg power) outcomes. Gender, BMI and level of physical activity will be considered for confounding. DiscussionThe strength of this study is the comparison of two large cohorts with different footwear habits to determine long-term effects of being habitually barefoot on foot mechanics and motor performance.
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Study Design Systematic review with meta-analysis. Objective To determine the biomechanical differences between foot strike patterns using when running. Background Strike patterns during running has received attention in the recent literature due to the mechanical differences and associated injury risks between them. Methods Electronic databases (Medline, Embase, Lilacs, Scielo, and SPORTDiscus) were searched through July 2014. Studies (cross-sectional, case control, prospective, and retrospective) comparing biomechanical characteristics between foot strike patterns during running of distance runners with at least 18 years of age were included in this review. Two independent reviewers evaluated the risk of bias. A meta-analysis with a random-effects model was used to combine the data from the included studies. Results Sixteen studies were included in the final analysis. In the meta-analyses of kinematic variables, significant differences between forefoot and rearfoot strikers were found for foot and knee angle at initial contact and knee flexion range of motion. A forefoot strike pattern resulted in a plantar flexed ankle position and a more flexed knee position, compared to a dorsiflexed ankle position and a more extended knee position for the rearfoot strikers, at initial contact with ground. In the comparison of rearfoot and midfoot strikers, midfoot strikers demonstrated greater ankle dorsiflexion range of motion and decreased knee flexion range of motion compared to rearfoot strikers. For kinetic variables, the meta-analysis revealed that rearfoot strikers had higher vertical loading rates compared to forefoot strikers. Conclusion There are differences in kinematic and kinetic characteristics between foot strike patterns when running. Clinicians should be aware of these characteristics to help in the management of running injuries and advice on training. J Orthop Sports Phys Ther, Epub 24 Aug 2015. doi:10.2519/jospt.2015.6019.
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Barefoot running has been proposed to reduce vertical loading rates, which is a risk factor of running injuries. Most of the previous studies evaluated runners on level surfaces. This study examined the effect of surface inclination on vertical loading rates and landing pattern during the first attempt of barefoot running among habitual shod runners. Twenty habitual shod runners were asked to run on treadmill at 8.0 km/h at three inclination angles (0°; +10°; −10°) with and without their usual running shoes. Vertical average rate (VALR) and instantaneous loading rate (VILR) were obtained by established methods. Landing pattern was decided using high-speed camera. VALR and VILR in shod condition were significantly higher ( p < 0.001 ) in declined than in level or inclined treadmill running, but not in barefoot condition ( p > 0.382 ). There was no difference ( p > 0.413 ) in the landing pattern among all surface inclinations. Only one runner demonstrated complete transition to non-heel strike landing in all slope conditions. Reducing heel strike ratio in barefoot running did not ensure a decrease in loading rates ( p > 0.15 ). Conversely, non-heel strike landing, regardless of footwear condition, would result in a softer landing ( p < 0.011 ).
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The purpose of this study was to determine the foot strike patterns, inversion and kinematics variables in recreational runners during a long-distance road competition, determining an association between foot strike pattern's classification, inversion and kinematics variables with athletic performance and sex. Five hundred and forty-two athletes who participated in a half marathon passed through the 15 km data collection point. Photogrammetric techniques (2D) were used to measure contact time and flight time. A high prevalence of rearfoot and high rearfoot strikes was found among the most recreational distance runners. No significant differences between sexes in foot strike pattern were found, whilst significant differences between level groups in the asymmetry (first level = 96.5%, second level = 10.6% and third level = 0.4%) were found. Additionally, forefoot and high forefoot strike exhibit greater percentage for inversion. Moreover, athletes with high rearfoot and rearfoot strike showed a greater contact time and lower flight time. Foot strike patterns were influenced by running speed; thus, athletes with higher performance exhibit lower frequency of rearfoot and high rearfoot strikes. Further research could clarify the causes and consequences (performance and injury) of the current findings.