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Background: In recent years, minimalist footwear has been increasingly promoted for its use in sportive and recreational activities. These shoes are considered to function naturally like barefoot walking while providing a protective surface. Despite a growing popularity of these shoes in the older population, little is known about the influence of minimalist footwear on gait patterns. This study investigated whether overground walking with minimalist shoes is comparable to barefoot walking regarding gait stability and variability parameters. Methods: In a randomized within-subject study design, 31 healthy younger (29 ± 4 years) and 33 healthy community-dwelling older adults (71 ± 4 years) volunteered. Participants walked on flat ground, once barefoot and once with minimalist shoes. Gait variability of minimum toe clearance (MTC), stride length, stride time, and local dynamic gait stability were analysed. Results: The results for both age groups showed significant condition effects (minimalist shoes vs. barefoot walking) for the outcomes of local dynamic stability (p = .013), MTC variability (p = .018), and stride length variability (p < .001) indicating increased local dynamic stability and decreased gait variability during the minimalist shoe condition. Group effects (young vs. older adults) were detected in all gait outcomes. Conclusion: Walking with minimalist shoes appeared to be associated with better gait performance than walking barefoot in both age groups. Thus, walking with minimalist shoes is not similar to barefoot walking. With respect to reducing the risk of falling, we suggest that minimalist shoes could be an alternative to barefoot walking or a transition option between shoes to barefoot for older adults.
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R E S E A R C H A R T I C L E Open Access
Walking barefoot vs. with minimalist
footwear influence on gait in younger
and older adults
Evi Petersen
1*
, Astrid Zech
2
and Daniel Hamacher
2
Abstract
Background: In recent years, minimalist footwear has been increasingly promoted for its use in sportive and
recreational activities. These shoes are considered to function naturally like barefoot walking while providing a
protective surface. Despite a growing popularity of these shoes in the older population, little is known about the
influence of minimalist footwear on gait patterns. This study investigated whether overground walking with minimalist
shoes is comparable to barefoot walking regarding gait stability and variability parameters.
Methods: In a randomized within-subject study design, 31 healthy younger (29 ± 4 years) and 33 healthy community-
dwelling older adults (71 ± 4 years) volunteered. Participants walked on flat ground, once barefoot and once with
minimalist shoes. Gait variability of minimum toe clearance (MTC), stride length, stride time, and local dynamic gait
stability were analysed.
Results: The results for both age groups showed significant condition effects (minimalist shoes vs. barefoot walking)
for the outcomes of local dynamic stability (p=.013),MTCvariability(p= .018), and stride length variability (p<.001)
indicating increased local dynamic stability and decreased gait variability during the minimalist shoe condition. Group
effects (young vs. older adults) were detected in all gait outcomes.
Conclusion: Walking with minimalist shoes appeared to be associated with better gait performance than walking
barefoot in both age groups. Thus, walking with minimalist shoes is not similar to barefoot walking. With respect to
reducing the risk of falling, we suggest that minimalist shoes could be an alternative to barefoot walking or a transition
option between shoes to barefoot for older adults.
Keywords: Elderly, Community-dwelling, Inertial sensors, Leguano, Minimalist shoes, Barefoot
Background
Bipedal gait is one of the most fundamental sensori-
motor tasks performed every day [1]. Especially in older
adults, a well-functioning gait pattern is recognized to
be essential for autonomous participation in daily life
[2]. With an increase in age, however, deficiencies in gait
frequently evolve while the risk of falling increases [3].
Due to degenerative processes of the neuromuscular sys-
tem and other age-related adaptations, older adults typ-
ically exhibit the following gait characteristics: (i) a
wider stance and extended bipedal ground contact with
shorter steps [4] as well as (ii) a diminished swing phase
[5]. Besides internal factors, evidence reveals that foot-
wear as an external criterion has a significant impact on
the gait pattern [6,7].
Footwear has been implicated as a factor in falls, which
again is a crucial issue affecting health and quality of life
in older adults [8,9]. In relation to this, older adults are
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: evi.petersen@usn.no
1
Institute of Sports, Physical Education and Outdoor Life, University of
South-Eastern Norway, Bø and Telemark, Norway
Full list of author information is available at the end of the article
Petersen et al. BMC Geriatrics (2020) 20:88
https://doi.org/10.1186/s12877-020-1486-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
often advised to wear shoes with low heels and firm slip-
resistant soles [10]. McKeon et al. [11] noted that per-
manent support to the foot might result in degenerative
efficiency in foot muscles and sensitivity, and therefore
carry a potential of adverse effects on the gait pattern.
Accordingly, [11] suggest that walking barefoot is less
restricting for motion control, which increases the sensi-
tivity of the sensory mechanisms and activates the foot
and lower leg muscles. Both sensory feedback sensitivity
[12] and increased foot strength [13] showed to improve
balance in older adults, and are therefore significant pre-
dictors in the prevention of falls. Thus, barefoot walking
might result in beneficial effects on sensorimotor
control.
In recent years, minimalist footwear (characterized by
light weight, high flexibility and absence of cushioning
material) has been increasingly promoted for its use in
sportive and recreational activities. Wear of such foot-
wear has been shown to be closely related to barefoot
running conditions [1416]. Therefore, it considered to
function naturally like barefoot walking while providing
a protective surface. Despite the growing popularity of
these shoes in the older population, little is known about
the influence of minimalist footwear on gait patterns
and performance [17,18]. In relation to this, local dy-
namic gait stability, as well as gait variability measures,
were associated with gait performance and the likelihood
of falling [19,20]. More specifically, measures of local
dynamic gait stability (LDS) are capable of distinguishing
between cohorts of younger and older adults, while
lower levels of LDS are associated with a higher risk of
falling [21]. Furthermore, the minimum foot clearance
(MFC) variability is a promising gait variable that can
predict the risk of falling, with greater variabilities of
MFC indicating a higher risk of falling [22].
In conclusion, walking with minimalist shoes seems
to merge the positive effects of barefoot walking while
providing a protective surface. However, the effects
on the gait pattern were not sufficiently studied yet.
Consequently, the primary aim of our study was to
investigate if overground walking with minimalist
shoes is comparable to barefoot walking regarding
gait stability and variability. A study by Smith et al.
[23] showed that minimalist shoes provided better
overall and anterior-posterior static balance than
walking barefoot. Additionally, [17]suggestedthat
wearing minimalist shoes could provide benefits of
barefoot walking in respect to fall prevention, while
simultaneously offering some protection and support
to the feet. Therefore, we predicted that overground
walking with minimalist shoes is associated with
higher gait stability and lower gait variability. We fur-
thermore analyzed whether this relationship is similar
in young and older adults.
Methods
Participants
In a randomized within-subject study design, gait data of
31 healthy younger (17 female, 14 male, age: 29 ± 4 years;
BMI: 23 ± 2) and 33 healthy community-dwelling older
(20 female, 13 male, age: 71 ± 4 years; BMI: 27 ± 4) par-
ticipants were collected. We advertised in the local
newspaper and at a local sport club to recruit the partic-
ipants of this study.
Inclusion criteria were the age of 35 years for the
younger group and 65 years for the older group. Partic-
ipants had to be able to walk throughout 5 minutes
without the need to pause or the use of assisting equip-
ment. Additionally, participants had to be unfamiliar
with regular barefoot walking or walking with minimalist
shoes. Any self-reported motor-functional impairments
that could affect gait performance, such as acute muscu-
loskeletal disorders or neurological diseases, led to ex-
clusion from the study. All subjects provided their
written informed consent to their voluntary participation
in this study as well as their allowance for publication,
which has been approved by the local ethics committee
(protocol no. FSV 16/13) and followed the principles of
the Helsinki Declaration.
Testing procedure
To capture kinematic data, wireless inertial sensors
(MTw2, Xsens Technologies B.V., Enschede, The
Netherlands, range of measurement of angular velocity: ±
1200 deg/s, sampling rate: 100 Hz) were attached to the
participantsright forefeet using tape. The participants
were block randomized to the different test condition se-
quences by using the computer-based program Research
Randomizer (https://www.randomizer.org/). Further, par-
ticipants were asked to walk at their preferred walking
pace back and forth on a 25 m track inside a sports hall
with flat ground. The following test conditions were per-
formed in a randomized and balanced order: 1) barefoot
walking and 2) walking with minimalist shoes (leguano
classic, leguano GmbH, Buchholz, Germany; material:
53% polyamide, 38% lyocell, 7% polypropylene, 2% elas-
tane, Sole: 100% LIFOLIT®). Participants walked for 3 mi-
nutes under each condition. The resting time between the
test conditions was 5 minutes. Prior to each of the testing
conditions, participants walked for approximately 1 mi-
nute back and forth the track to familiarize themselves
with the corresponding test condition and to improve reli-
ability [24].
Data analysis and statistics
The data analysis included gait variability measures as
well as the local dynamic gait stability for which the lar-
gest Lyapunov exponent (λ) was calculated. We removed
the first strides (from the start to the first turn after 25
Petersen et al. BMC Geriatrics (2020) 20:88 Page 2 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
m) of each trial as well as the last strides (from the last
turn to the stop) to avoid possible transients, e.g. to
analyze steady-state gait [25]. Furthermore, we removed
the first 2.5 m of each section between two successive
turns to exclude the acceleration periods after turning
[26]. To account for possible deceleration periods before
turning, the last 2.5 m were excluded from the subse-
quent analysis as well. At least 50 strides should be ana-
lyzed for gait variability measures [27]. In this study, the
first 80 valid strides within each trial were analyzed.
To calculate the gait measures a) stride length, b)
stride time and c) minimum toe clearance (MTC), we
used a published algorithm [25]. As gait variability mea-
sures, the intraindividual standard deviations of each gait
measure were analysed. To quantify λ,we time-
normalized the three-dimensional angular velocity data
of the 80 valid strides to 8000 samples. To reconstruct
the state space, we applied the embedding approach.
The time delay (9 samples) and the embedded dimen-
sion (dE = 6) were determined, using the first minimum
mutual information [28] and the global false nearest
neighbors method, respectively [29]. The λwas deter-
mined using the Rosensteins algorithm [30], which we
implemented in MATLAB (version 2016a, TheMath-
Works BV, Natrick, USA). The Euclidean distance of
each nearest neighbor state space was tracked while the
mean of the logarithm of the divergence curve was
calculated. λis defined as the slope (linear fit) through
00.5 strides. The implementation was validated previ-
ously [25]. Using IBM SPSS Statistics (V 21.0) for all
statistical procedures, a two factor (condition: barefoot
and minimalist footwear; age: younger and older adults)
variance analysis with repeated measures was applied to
identify differences across the two conditions.
Results
As Fig. 1illustrates, the results show significant condi-
tion effects (minimalist shoes vs. barefoot walking) for
the outcomes of local dynamic stability (p= .013, partial
η
2
= 0.10), MTC variability (p= .018, partial η
2
= 0.09),
and stride length variability (p< .001, partial η
2
= 0.26).
These outcomes indicate increased local dynamic stabil-
ity (lower largest Lyapunov exponent) and decreased gait
variability during the minimalist shoe condition. There
was no condition effect on stride time variability. Group
effects (young vs. older adults) in all gait outcomes
(LDS: p< .001, partial η
2
= 0.30; MTC variability:
p= .006, partial η
2
= 0.12; stride length variability:
p= .004, partial η
2
= 0.13; stride time variability:
p= <.001, partial η
2
= 0.26) were found. These effects in-
dicate better LDS in younger participants and, surpris-
ingly, better (lower) gait variability in older participants.
There was no significant interaction effect between the
walking condition and the group condition.
Fig. 1 Gait stability and variability in younger and older adults barefoot vs. minimalist shoes
Petersen et al. BMC Geriatrics (2020) 20:88 Page 3 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Discussion
To the best of our knowledge, this is the first study that
investigated whether overground walking with minimal-
ist shoes is comparable to barefoot walking regarding
gait stability and variability parameters in both younger
and older adults. Current research discussed the use of
minimalist shoes as an alternative to barefoot running or
a method of transitioning between shod and barefoot
running for athletes [23]. Overall and valid for both age
groups, our results suggest that walking with minimalist
shoes is associated with better gait stability and variabil-
ity measures, thus, with a lower risk of falling [21,22].
Consequently, walking with minimalist shoes is not simi-
lar to barefoot walking, and the positive effects of bare-
foot walking [11] are not necessarily generalizable to
walking with minimalist shoes.
In order to reduce the risk of falling, we suggest that
walking training with minimalist shoes could be an alter-
native to barefoot walking or a transition option between
shoes to barefoot for older adults. Our proposition is in
line with [17], who state that wearing minimalist shoes
could provide benefits of barefoot walking in respect of
fall prevention, while simultaneously offering some pro-
tection and support to the feet. Further, wearing minim-
alist shoes might help older adults to overcome different
barriers, which are associated with walking barefoot.
Often reported barriers are being ashamed of ones own
feet, fear of falling or fear of instability as well as the
sense of having cold feet [10,31].
Research on younger adults and children [15] showed
that barefoot training can result in long-term outcomes,
such as reduced ankle dorsiflexion at foot strike. That
points to the prospect that wearing minimalist footwear
regularly could have a positive impact on reducing the
risk of falling. In one of their recent studies, Franklin
et al. [32] investigated whether wearing minimalist shoes
daily for 4 months could lead to improvements in bal-
ance and foot strength, which are both critical variables
concerning a functional gait pattern. Preliminary results
show that training with minimalist shoes can improve
both parameters and thereby emphasize the potential of
minimalist shoe use to reduce the risk of falling. That is
in line with our results, which show that the use of min-
imalist shoes improved gait stability compared to bare-
foot walking.
We found less LDS in older adults compared to youn-
ger adults. This outcome has been frequently reported
[1921]. In contrast, it is surprising that older adults
showed better (lower) gait variability than younger
adults. A recent study by Hamacher et al. [33] reported
similar outcomes. In their study, younger and older par-
ticipants walked in their own shoes; however, the same
system and algorithms were applied [33]. In the current
study, younger adults show a much higher MTC, stride
length and stride time variability during barefoot walking
and walking with minimalist shoes compared to the
younger participants of [33], walking in their own shoes.
The older adults of the current study, on the other hand,
show only a minor increase in gait variability compared
to the older participants of the other study. We conclude
that the group effect of the gait variability measures
could be the result of younger adults adapting more
quickly to an unfamiliar walking condition (walking
barefoot / walking with minimalist shoes) to maintain
local dynamic stability. This effect seems to be less pro-
nounced in older adults. Since this is speculative, more
research is needed to investigate the issue.
Study limitations and future research implications
We want to acknowledge four main study limitations.
First, this research involved healthy community-dwelling
older adults. Therefore, our current findings may not
apply to older adults with health issues or already exist-
ing impairments. Most older adults have a higher risk of
falling when confronted with existing dysfunctions con-
cerning the gait pattern [34]. This fact points to the po-
tential of future research within clinical settings.
Second, the participants of this study did not walk in their
own shoes. Implementing this third condition to the testing
procedure could have revealed more knowledge of how
minimalist shoes influence gait in comparison to normal
shoes, which are worn in daily life. Additionally, it would
have made our results even more comparable to other stud-
ies. However, this question was not subject of our current
study. We also ran our tests for only one type of minimalist
shoe. Considering the growth of diversity in products, we
encourage future research to compare the influence of dif-
ferent minimalist footwear as well as to include aspects of
practicability regarding minimalist shoes for older adults.
Third, the application side in this study was a gym,
proving a flat ground. Thus, our findings are limited to
overground walking on an even surface. According to
Zurales et al. [35], however, uneven surfaces are strong
predictors of falls among older adults. Additionally and
in line with Li et al. [36], falls occurred more often out-
doors than indoors among older adults. Thus, future re-
search should consider testing on an uneven surface, for
instance, outdoors.
Last, this study focused on short-term effects. We sug-
gest that future research should target long-term effects
of fall prevention training with minimalist shoes or ex-
tended periods of wearing minimalist shoes during daily
activity. Certainly, a systematic overview of the existing
literature would enrich this scope of research.
Conclusion
This study demonstrates for walking in a straight line on
flat ground that minimalist shoes, as compared to
Petersen et al. BMC Geriatrics (2020) 20:88 Page 4 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
walking barefoot, have significantly different effects on
gait and fall predicting parameters such as gait stability
(LDS) and variability (MTC). Effects were observed for
the group of younger as well as older adults. Walking
with minimalist shoes was overall associated with better
gait performance than walking barefoot. This finding
hence demonstrates the potential of minimalist shoes as
a means to prevent falls. We conclude that there is a
need for future research to investigate the benefits of
minimalist shoes for more complex walking tasks such
as walking on uneven ground. Further, the long-term ef-
fects of minimalist usage need to be explored, particulary
in relation to standard footwear. Simultaneously, we
make a call for a systematic review of the literature con-
cerned with minimalist footwear and the risk of falling.
Abbreviations
LDS: Local dynamic gait stability; MFC: Minimum foot clearance;
MTC: Minimum toe clearance; λ: Lyapunov exponent
Acknowledgments
We thank all participants of this study and the two reviewer.
Authorscontributions
EP, DH and AZ were all fully involved in the planning of the study and
preparation of the manuscript. EP collected the data for this study. EP and
DH wrote the first draft of the manuscript and AZ advised. Each of the
authors has read and concurs with the content in the final manuscript. The
author(s) read and approved the final manuscript.
Funding
This research did not receive any grant from funding agencies in the public,
commercial, or not-for-profit sectors.
Availability of data and materials
The dataset for this manuscript is not publicly available, however, requests to
access the datasets can be directed to Evi Petersen (evi.petersen@usn.no).
Ethics approval and consent to participate
All subjects provided their written informed consent to their voluntary
participation in this study and for the publication of their data. The study has
been approved by the local ethics committee of Faculty of Social and Behavioural
Sciences, Friedrich Schiller University Jena (protocol number: FSV 16/13) and
followed the principles of the Helsinki Declaration.
Consent for publication
Not applicable.
Competing interests
None. The authors declare that the research was conducted in the absence
of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Author details
1
Institute of Sports, Physical Education and Outdoor Life, University of
South-Eastern Norway, Bø and Telemark, Norway.
2
Institute of Sports Science,
Friedrich-Schiller University of Jena, Jena, Thuringia, Germany.
Received: 13 May 2019 Accepted: 20 February 2020
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... Schuhe mit minimaler Sohle ohne Dämpfung, hoher Flexibilität und fehlendem "heel-to-toe drop" werden allgemein als minimalistische Schuhe oder auch Barfußschuhe bezeichnet [37]. In Wechselwirkung mit der zunehmenden Popularität der minimalistischen Schuhe wurden in den letzten Jahren eine Reihe von Studien publiziert, die die Möglichkeiten und Grenzen der Simulation des Barfußlaufens untersucht haben [31,38,39]. Tatsächlich führen Schuhe mit den oben beschriebenen minimalistischen Eigenschaften zu einem Laufstil, der hinsichtlich der biomechanischen Eigenschaften dem Barfußlaufen am ähnlichsten ist. ...
... Anpassung der Schuhbedingungen aktuell auch zu den zentralen Bestandteilen evidenzbasierter Guidelines zur Prävention von Stürzen im Alter [48]. Eine Reihe jüngerer Studien [30,39,49] hat zudem die Auswirkungen eines abrupten Wechsels zum Barfußgehen bzw. -laufen oder zur Nutzung von minimalistischen Schuhen bei Senioren untersucht. ...
... Die Ergebnisse zeigen, dass beide Bedingungen zunächst zu Unsicherheiten in der Gleichgewichtskontrolle führen [49]. Das Barfußgehen kann zudem akut die Gangstabilität limitieren, wohingegen die minimalistischen Schuhe hier eher weniger Nachteile aufzeigen [39]. Somit sollten Senioren einen möglichen Wechsel zu eher ungewohnten Schuhbedingungen bzw. ...
Article
In diesem Beitrag-Einfluss von Schuhen auf die anatomische Fußstruktur-Einfluss von Schuhen auf die Gang-und Laufbiomechanik-Praktische Relevanz Leistungsfähigkeit · Verletzungs-und Sturzprävention QR-Code scannen & Beitrag online lesen Zusammenfassung Individuelle Gang-und Laufmuster entwickeln sich in Abhängigkeit von internen (u. a. anatomischen, anthropometrischen) und externen (aktivitätsbedingten, umweltbedingten) Einflüssen. So wird der am häufigsten genutzte Laufstil mit einem Rückfußaufsatz vor allem auf die vermehrte Schuhdämpfung zurückgeführt, obwohl aus anthropologischer Perspektive das Barfuß-und somit Vorfußlaufen als das natürliche Laufen gilt. Eine Reihe von Forschungsarbeiten konnte Einflüsse langfristiger gewohnter Schuhnutzung auf die Fußmorphologie, Laufbiomechanik, motorische Kompetenz und Laufleistung aufzeigen. Aber auch ein sofortiger Wechsel der Schuhbedingung durch z. B. Barfußlaufen führt zu unmittelbaren Veränderungen der Laufkinematik und der Vertikalbelastung. Bisher liegen allerdings keine belastbaren wissenschaftlichen Nachweise für einen Zusammenhang zwischen der Schuhnutzung bzw. den fußaufsatzbedingten Aufprallkräften und der Prävalenz von Verletzungen oder Überlastungsschäden vor. Schlüsselwörter Fuß · Vorfuß, menschlicher · Kinematik · Laufen · Schuhe Aus anthropologischer Perspektive gilt das Barfußlaufen als die natürlichere Form des Laufens [1]. Ca. 99% der Ent-wicklungshistorie des aufrechten (bi-pedalen) Ganges erfolgte unter unbe-schuhten Bedingungen [2]. In der Kon-sequenz stellt sich die Frage, welchen Einfluss die heute weit verbreitete Nut-zung von Schuhen auf fußmorphologi-sche Strukturen, die Biomechanik des Gehens und Laufens und somit auch auf die Fußgesundheit und Bewegungsge-wohnheiten hat.
... An elevated heel of only 4.5 cm height significantly impairs balance in older adults whereas a high heel collar and a hard sole showed trends towards being beneficial [18]. Minimalist shoes improve dynamic stability in older adults better than barefoot [19], while it remains to be investigated whether it is superior to conventional footwear [20]. A recent study highlights barefoot walking has clinical potential based on gait stability and variability outcomes in both young and older adults [12]. ...
... Thus, gait patterns included both normal and perturbed gait as well as footwear conditions including shod and barefoot walking in this study. An adequate break (approximately 5 min) was given between each trial until the participant felt ready to continue with the next test [19]. A safety rope system was used throughout the test to prevent potential falls of participants. ...
... The Wilcoxon signed rank test and paired t-test were performed to analyze the statistical differences in normal gait speed and perturbed recovery gait speed in shod and barefoot walking, respectively. A two-way repeated-measures ANOVA with gait pattern and footwear condition as factors, based on a General Linear Model, was applied to identify differences in gait variability [19]. When a significant main effect or factor interaction effect was found, a Tukey's post hoc analysis with individual variances was performed to correct for multiple comparison tests. ...
Article
Full-text available
Background Perturbation-based balance training on a treadmill is an emerging method of gait stability training with a characteristic task nature that has had positive and sustained effects on balance recovery strategies and fall reduction. Little is known about the effects produced by shod and barefoot walking. We aimed to investigate which is more appropriate, shod or barefoot walking, for perturbation-based balance training in older adults. Methods Fourteen healthy older adults (age: 68.29 ± 3.41 years; body height: 1.76 ± 0.10 m; body mass: 81.14 ± 14.52 kg) performed normal and trip-like perturbed walking trials, shod and barefoot, on a treadmill of the Gait Real-time Analysis Interactive Lab. The marker trajectories data were processed by Human Body Model software embedded in the Gait Offline Analysis Tool. The outcomes of stride length variability, stride time variability, step width variability, and swing time variability were computed and statistically analyzed by a two-way repeated-measures analysis of variance (ANOVA) based on gait pattern (normal gait versus perturbed recovery gait) and footwear condition (shod versus barefoot). Results Footwear condition effect ( p = 0.0310) and gait pattern by footwear condition interaction effect ( p = 0.0055) were only observed in swing time variability. Gait pattern effects were detected in all four outcomes of gait variability. Conclusions Swing time variability, independent of gait speed, could be a valid indicator to differentiate between footwear conditions. The lower swing time variability in perturbed recovery gait suggests that barefoot walking may be superior to shod walking for perturbation-based balance training in older adults.
... However, it has also been suggested that because somatosensory feedback from the plantar surface of the foot plays an important role in balance, older people should wear shoes that mimic barefoot walking as closely as possible [17]. Indeed, using various types of balance testing apparatus, balance has been found to be better barefoot than wearing shoes [18,19], with minimalist shoes being better for balance than barefoot [20] or conventional, supportive footwear [21]. ...
... The findings of this study need to be interpreted in the context of several limitations and highlight that these data represent only a preliminary evaluation of the footwear given the relatively small sample. First, although previous research has shown that 5 weeks of habituation to new shoes does not significantly affect standing balance or gait patterns in older women [44], previous studies have used a habituation period of between 1 min [19, 20] and a few days [45]. In our study, participants were only provided with a brief period of time to acclimatise to the different footwear conditions before undertaking the balance tests. ...
Article
Full-text available
Background: Footwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants' perceptions in relation to comfort, ease of use and fit. Methods: Older women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires. Results: There were no statistically significant differences in balance performance between the supportive and minimalist footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling. Conclusion: Balance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people. Trial registration: Australian New Zealand Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered).
... However, it has also been suggested that because somatosensory feedback from the plantar surface of the foot plays an important role in balance, older people should wear shoes that mimic barefoot walking as closely as possible [17]. Indeed, using various types of balance testing apparatus, balance has been found to be better barefoot than wearing shoes [18,19], with minimalist shoes being better for balance than barefoot [20] or conventional, supportive footwear [21]. ...
... The ndings of this study need to be interpreted in the context of several limitations. First, although previous research has shown that ve weeks of habituation to new shoes does not signi cantly affect standing balance or gait patterns in older women [43], previous studies have used a habituation period of between 25 metres [19], one minute [20] and a few days [44]. In our study, participants were only provided with a brief period of time to acclimatise to the different footwear conditions before undertaking the balance tests. ...
Preprint
Full-text available
Background Footwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants’ perceptions in relation to comfort, ease of use and fit. Methods Older women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires. Results There were no statistically significant differences in balance performance between the supportive and minimalist footwear. However, trends were observed which indicated that standing balance was better in the minimalist footwear, while walking stability was better in the supportive footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling. Conclusion Balance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people. Trial registration: Australian New Zeland Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384670&isReview=true
... This is in line with prior studies. Petersen, et al. 13 , for example, report an increased local dynamic stability in younger and older adults when walking in MS (measured via motion capture system). Cudejko,et al. 18 found that elderly participants with a history of falls were more stable (reduced CoP range in mm) during standing and walking in MS. ...
... Cudejko,et al. 18 found that elderly participants with a history of falls were more stable (reduced CoP range in mm) during standing and walking in MS. In general, walking or running barefoot or in MS seems to be positively correlated with balance skills and consequently lowers the risk of falls 5,8,10,13,18 . This improvement in stability is reported to be associated with an increase in IFM strength 8, 10 . ...
Preprint
Full-text available
Research suggests that running in minimalist shoes (MS) positively influences local and non-directly adjacent areas of the dorsal chain (DC). This study investigates the effects of 4-week MS walking in non‑runners. 28 healthy participants (15f, 13m; 25.3 ± 5.3 yrs; 70.2 ± 11.9 kg; 175.0 ± 7.8 cm) were randomly assigned to a control or intervention group. The intervention group undertook a 4‑week incremental walking program in MS, which included a daily step count of 3,000 steps/day in the first week increasing to 5,000 steps/day for the remaining 3 weeks. The control group walked in their preferred shoe (no MS). We assessed the following parameters in a laboratory at baseline [M1], and after the 4-week intervention [M2]: Foot parameters (e.g. FPI‑6), lower limb ROM, balance during single-leg stance, and muscle strength of the DC. For statistical analysis, stepwise linear regression models in forward selection were calculated. In the MS group, the FPI-6 (b = -3.72, t(51) = -6.05, p < .001, [-4.94, 2.51]) and balance (b = -17.96, t(49) = -2.56, p = .01, [-31.54, 4.37]) significantly improved from M1 to M2, but not all other parameters (all p >.05). Walking with MS might be an advantageous intervention for non-runners.
... Approximately 90% of children are born with healthy feet, but with age they become affected by various factors, which account for a diversity of subsequent complaints, notably those of structural character. European studies indicate that only 3% of individuals over the age of 60 have structurally sound feet [16]. ...
... The fact that so few adults boast functionally efficient feet nowadays is not only attributable to various ailments and physical injuries sustained throughout one's lifetime, but also to wearing ill-fitting footwear. Children are especially prone to be affected by many environmental factors in their adolescence, most of them of lifestyle origin [14,[16][17][18]. ...
... Taking a greater number of shorter steps over a defined distance, points to an inefficient gait pattern. This finding aligns with previous work that demonstrates wearing footwear can enhance gait performance over and above walking barefoot in young and older populations [48,49]. Notably, the current findings largely concur with our preliminary work [23], and those of Kalron et al. [24], which report no immediate effects of textured insoles on spatiotemporal gait measures during level ground walking in pwMS. ...
... There are several possible explanations for these findings. Evidence has shown that wearing footwear (with or without insoles) can help to stabilise, cushion, and support the foot during walking, leading to greater dynamic stability, compared to unshod conditions [49,50]. Individuals with existing balance problems, specifically older people, also adopt a more conservative (cautious) gait pattern when walking over irregular (versus regular/level) surfaces [35] -this could also be true for pwMS who commonly demonstrate impaired upright stability. ...
Article
Purpose To investigate the immediate effects of wearing novel sensory-stimulating textured insoles on balance and gait in 41 people with multiple sclerosis (pwMS). Materials and methods Assessments of balance (firm/foam surface; eyes open/closed) and walking (when negotiating even/uneven surfaces) were performed wearing textured insoles, smooth insoles, shoes only, and barefoot. Outcome measures were centre of pressure (CoP) movement during standing (elliptical area, sway path velocity) and spatiotemporal gait patterns (stride/step width, stride time, double-limb support time, stride length, velocity). Results Wearing textured insoles led to reductions in CoP velocity measures when standing on foam with eyes open and closed when compared to barefoot (p values ≤0.02). Textured insoles did not appear to be consistently superior to smooth insoles or shoes only for improving gait. Relative to the insole/shoe conditions, walking barefoot led to poorer gait performance for the even and uneven surface tasks (p values ≤0.03). Conclusions For pwMS, stimulating the foot with “texture” appears to provide enhanced sensory input with the capacity to improve CoP movement control during standing; offering a potential new treatment option for balance rehabilitation. Further research is needed to identify which individuals may benefit most from textured insoles. • Implications for rehabilitation • Textured shoe insoles, designed to stimulate plantar mechanoreceptors, are a novel approach to improve standing balance and walking patterns in people with multiple sclerosis (pwMS). • Wearing textured insoles for the first time can lead to improvements in centre of pressure movement control when standing on an unstable compliant supporting surface. • Textured insoles offer a potential new treatment technique for balance rehabilitation in pwMS who show early signs of diminished foot sensation.
... Previous studies showed that MF positively affects musculoskeletal structures of the body by strengthening the arch of the foot, 7,28,37,42 enlarging intrinsic foot muscles, 7,42 and improving overall gait stability. 50 However, the results of previous studies [4][5][6]18,38 indicate that greater vGRF could also increase the risk of early onset of knee OA. Our study results point out that an acute effect of using MF for walking in adults is similar to the effect of walking in NF. ...
Article
Full-text available
Background Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA). Purpose To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions. Study Design Controlled laboratory study. Methods A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used. Results Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase ( P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF ( P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal ( P = .038) and frontal planes ( P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane ( P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [ P = .008]; absorption, ↑BF, MF, ↓NF [ P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [ P = .005]; absorption, ↑NF, MF, ↓BF [ P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [ P = .001]; absorption, ↑MF, BF, ↓NF [ P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [ P = .015]; propulsion, ↑MF, NF, ↓BF [ P = .039]). Conclusion Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.
... All kinematic variables were observed between the three environments that participants were asked to execute: (1) barefoot, (2) standard insole, and (3) innovative insole. The insole likely causes stabilization to the foot, but it is necessary to understand whether the magnitude of stabilization is significantly different in the three environments (1, 2, and 3) and whether this stabilization does not compromise functional and individual mobility [31]. ...
Article
Full-text available
Knowledge of ergonomics/human factors plays an important role in the creation and design of safety shoes and insoles, contributing to worker protection, comfort, and stability. The purpose of this study is to compare previous insole designs and analyze the plantar pressure and gait pattern kinematics using the Oxford foot model protocol. The tests were performed comparing the environments on the three rockers of the gait, represented by the heel, midfoot, and forefoot, according to the classification of foot type. The analysis of plantar pressure, regarding its total and maximum distribution, showed that the innovative insole presents a better load distribution in terms of the maximum plantar pressure exerted in the hindfoot and forefoot regions. In the biomechanical analysis of gait, the five variables studied did not show variation in the normal mechanics of the foot in any of the three environments considered. The hallux joint was the one that presented the greatest divergences with the barefoot in terms of amplitude and variability, as expected.
Article
Growth of the aging population is a systemic, social-technological challenge facing the world. Typical ways of designing and developing products for older adults have been disrupted by this demographic shift and the introduction of new technologies. This study focuses on indoor footwear design for an aging population to help designers consider aspects of user experience, service, and technology. We investigated older adults’ use and purchasing behavior through surveys and semi-structured interviews. We presented ten smart footwear concepts and ideas around internet-of-things (IoT) wearable devices, data privacy, and security issues to help identify their unmet desires and pain points. We conclude that, for older adults, wearing shoes represents their independence in life, that their foot healthcare problems vary widely, and that they are not equipped with the proper/optimal knowledge to choose the right footwear. Designers need to consider their physical limitations and cognitive load while conducting such research.
Article
Full-text available
Introduction: Barefoot locomotion is widely believed to be beneficial for motor development and biomechanics but are implied to be responsible for foot pathologies and running-related injuries. While most of available studies focused on acute effects of barefoot running and walking little is known regarding the effects of long-term barefoot vs. shod locomotion. The purpose of this study was to systematically review the literature to evaluate current evidence of habitual barefoot (HB) vs. habitual shod locomotion on foot anthropometrics, biomechanics, motor performance and pathologies. Methods: Four electronic databases were searched using terms related to habitually barefoot locomotion. Relevant studies were identified based on title, abstract and full text and a forward (citation tracking) and backward (references) search was performed. Risk of bias was assessed, data pooling and meta-analysis (random effects model) performed and finally levels of evidence determined. Results: Fifteen studies with 8399 participants were included. Limited evidence was found for a reduced ankle dorsiflexion at footstrike (pooled effect size -3.47 (95% CI -5.18 to -1.76)) and a lower pedobarographically measured hallux angle (-1.16 (95% CI -1.64 to -0.68)). HB populations had wider (0.55 (95% CI 0.06 to 1.05) but no shorter (-0.22 (95% CI -0.51 to 0.08)) feet compared to habitual shod populations. No differences in relative injury rates were found, with limited evidence for a different body part distribution of musculoskeletal injuries and more foot pathologies and less foot deformities and defects in HB runners. Conclusions: Only limited or very limited evidence is found for long-term effects of HB locomotion regarding biomechanics or health-related outcomes. Moreover, no evidence exists on any beneficial effects for motor performance. Future research should include prospective study designs.
Article
Full-text available
Habitual footwear use has been reported to influence foot structure with an acute exposure being shown to alter foot position and mechanics. The foot is highly specialised thus these changes in structure/position could influence functionality. This review aims to investigate the effect of footwear on gait, specifically focussing on studies that have assessed kinematics, kinetics and muscle activity between walking barefoot and in common footwear. In line with PRISMA and published guidelines, a literature search was completed across six databases comprising Medline, EMBASE, Scopus, AMED, Cochrane Library and Web of Science. Fifteen of 466 articles met the predetermined inclusion criteria and were included in the review. All articles were assessed for methodological quality using a modified assessment tool based on the STROBE statement for reporting observational studies and the CASP appraisal tool. Walking barefoot enables increased forefoot spreading under load and habitual barefoot walkers have anatomically wider feet. Spatial-temporal differences including, reduced step/stride length and increased cadence, are observed when barefoot. Flatter foot placement, increased knee flexion and a reduced peak vertical ground reaction force at initial contact are also reported. Habitual barefoot walkers exhibit lower peak plantar pressures and pressure impulses, whereas peak plantar pressures are increased in the habitually shod wearer walking barefoot. Footwear particularly affects the kinematics and kinetics of gait acutely and chronically. Little research has been completed in older age populations (50+ years) and thus further research is required to better understand the effect of footwear on walking across the lifespan. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
Article
Background and purpose: Falls in older adults is a major issue for health care organisations. Footwear is often reported as a contributing factor to falls in older adults; however, the reporting of footwear styles that are proposed to increase falls and falls risk is confusing. Moreover, these reports have been used to inform falls guidelines and recommendations by health practitioners. A systematic review was performed to identify and synthesize the available evidence examining whether there was support of a causal or correlational relationship between different styles of footwear and falls in older adults in real-life settings. Method: The databases included in the search were Ovid MEDLINE, PubMed, Scopus and Web of Science. The inclusion criteria were papers with falls outcomes, healthy adults that were 65 years or older. The footwear styles included slippers, Oxford/lace ups, high heels, boots and sandals. The exclusion criteria were laboratory studies and papers with primary focus on gait issues that increased falls likelihood. Results and discussion: Nine studies met the inclusion criteria and were included in the review from a total of 363 papers identified in the database search. The results of this review suggest that there is inadequate evidence to link any particular footwear style with falls. However, it may be possible that it was not the style of footwear, rather how accustomed the individual was to wear that particular style of footwear. Conclusion: There is limited evidence supporting footwear recommendations as a discrete falls prevention strategy. Clinicians should be pragmatic in their advice to healthy older adults about footwear styles and their potential to reduce falls or falls risk.
Article
The aim of the current study was to evaluate the effect of a cognitive dual task on minimum toe clearance (MTC) variability while walking. In a randomized cross-over design, gait kinematics of 25 older (70 ± 6 years) and 45 younger adults (25 ± 2 years) were captured during normal walking and dual-task walking. Variability of stride time, stride length, and MTC were calculated. Differences between normal versus dual-task walking were assessed using Wilcoxon tests. Compared with normal walking, dual-task walking caused an increase in stride time variability (older adults: p < .001 and younger adults: p < .001), while the variability of MTC decreased (older adults: p = .032 and younger adults: p = .012). MTC seems to be a task-relevant gait parameter that is controlled with high priority to preserve its variability under challenging conditions.
Article
Gait variability is an important measure in clinical settings to diagnose older individuals with fall risk. This study examines whether a familiarization trial improves test-retest reliability of gait variability. Twenty-two older participants walked twice at 1 day and twice 7 days later. The standard deviations of stride length, swing time, stance time, stride time and minimum foot clearance were calculated. The test-retest reliability of (1) between-day comparison of the first trials and (2) between-day comparison of the second trials of all gait variability measures was quantified with the intraclass-correlation coefficient (ICC), the smallest detectable differences (SDD) and the bias and the limits of agreement (LoA). The between-day comparison of the second trials per day showed higher ICC values, lower LoA values and lower SDD values in all analyzed parameters. Our data suggest that the reliability of gait variability in an older population can be considerably improved just with the aid of one familiarization trial.
Article
Since the first edition of this very successful book was written to synthesise and review the enormous body of work covering falls in older people, there has been an even greater wealth of informative and promising studies designed to increase our understanding of risk factors and prevention strategies. This new edition is written in three parts: epidemiology, strategies for prevention, and future research directions. New material includes the most recent studies covering: balance studies using tripping, slipping and stepping paradigms; sensitivity and depth perception visual risk factors; neurophysiological research on automatic or reflex balance activities; and the roles of syncope, vitamin D, cataract surgery, health and safety education, and exercise programs. This new edition will be an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Article
Local dynamic stability is a critical aspect of stable gait but its assessment for use in clinical settings has not yet been sufficiently evaluated, particularly with respect to inertial sensors applied on the feet and/or trunk. Furthermore, key questions remain as to which state-space reconstruction is most reliable and valid. In this study, we evaluated the reliability as well as the ability of different sensor placement and state-spaces to distinguish between local dynamic stability in young and older adults. Gait data of 19 older and 20 young subjects were captured with inertial sensors twice within the first day as well as after seven days. 21 different signals (and combinations of signals) were used to span the system's state-space to calculate different measures of local dynamic stability. Our data revealed moderate or high effect sizes in 12 of the 21 old vs. young comparisons. We also observed considerable differences in the reliability of these 12 results, with intra-class correlation coefficients ranging from 0.09 to 0.81. Our results demonstrate that in order to obtain reliable and valid estimates of gait stability λ of walking time series is best evaluated using trunk data or 1-dimensional data from foot sensors.