Article

Children’s school footwear: The impact of fit on foot function, comfort and jump performance in children aged 8 to 12 years

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Abstract

Background There is a common perception that poorly fitting footwear will negatively impact a child’s foot, however, there is limited evidence to support this. Aim To determine the effect of shoe size on foot motion, perceived footwear comfort and fit during walking, maximal vertical jump height and maximal standing broad jump distance in children aged 8–12 years. Methods Fourteen participants completed 3D walking gait analysis and jumping tasks in three different sizes of school shoes (one size bigger, fitted for size, one size smaller). In-shoe motion of the hindfoot, midfoot and 1st metatarsophalangeal joint (1st MTPJ) were calculated using a multi-segment kinematic foot model. Physical performance measures were calculated via maximal vertical jump and maximal standing broad jump. Perceived footwear comfort and fit (heel, toes and overall) was assessed using a 100 mm visual analog scale (VAS). Differences were compared between shoe sizes using repeated measures ANOVA, post-hoc tests and effect sizes (Cohen’s d). Results Compared to the fitted footwear, the smaller sizing restricted hindfoot eversion (−2.5°, p = 0.021, d = 0.82), 1st MTPJ dorsiflexion (−3.9°, p = 0.012, d = 0.54), and compared to the bigger footwear, smaller sizing restricted sagittal plane midfoot range-of-motion during walking (−2.5°, p = 0.047, d = 0.59). The fitted footwear was rated as more comfortable overall with the smaller size rated as too tight in both the heel (mean difference 11.5 mm, p = 0.042, d = 0.58) and toes (mean difference 12.1 mm, p = 0.022, d = 0.59), compared to the fitted size. Vertical and standing broad jump distance were not impacted by footwear size (p = 0.218−0.836). Significance Footwear that is too small restricts foot motion during walking in children aged 8–12 years. Jump performance was not affected. Children were able to recognise shoes that were not correctly matched to their foot length, reinforcing that comfort is an important part of the fitting process.

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... Based on previous research, compared with barefoot running kinematics, footwear led to a reduced hip adduction/abduction and knee flexion/extension, increased ankle angle of motion, and increased incidence of rear-foot strike (RFS) rates [3,9,[42][43][44][45][46][47]. In joint kinetics, children running while wearing shoes had greater ground reaction force and lower impact load rate than barefoot running. ...
... The stiffest soles have the lowest plantar pressure; the softest soft-soled shoes had the highest plantar pressure, similar to barefoot shoes [50]. Shoe-wearing children had longer stride length, step length, stance time, double support time during gait cycle, and wider support base; shoe-wearing children also increased stride time and step time, decreased cadence, and increased walking velocity more than barefoot children [3,8,43,[51][52][53][54][55][56]. ...
... Relative to other types of biomechanical variables, the findings of spatiotemporal variables are consistent. Previous research reported that children aged 0-12 years had longer stride length and step length, increased stride time and step time, decreased cadence, wider support base, longer stance time, increased double support time, decreased single support, longer stance time, and increased walking velocity than barefoot children [3,8,43,[51][52][53][54][55][56]. Meanwhile, in studies by Heidner et al. [49] and Wolf et al. [8], there was no change in gait velocity between shod and barefoot. ...
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Children’s footwear plays an important role in the healthy growth of foot and gait development during the growing stage. This review aims to synthesize findings of previous investigations and to explore the biomechanical influences of different types of children’s footwear on foot health and gait development, thus guiding the healthy and safe growth of children’s feet and gait. Online databases were searched for potential eligible articles, including Web of Science, Google Scholar, and PubMed. In total, nineteen articles were identified after searching based on the inclusion requirements. The following five aspects of biomechanical parameters were identified in the literature, including spatiotemporal, kinematics, kinetics, electromyography (EMG), and plantar pressure distribution. Children’s footwear can affect their foot health and gait performance. In addition, children’s shoes with different flexibility and sole hardness have different effects on children’s feet and gait development. Compared to barefoot, the stride length, step length, stride time, and step time were increased, but cadence was decreased with wearing shoes. Furthermore, the support base and toe-off time increased. Double support time and stance time increased, but single support time decreased. The hip, knee, and ankle joints showed increased range of motion in children with the rear-foot strike with larger ground reaction force as well. Future studies may need to evaluate the influence of footwear types on gait performance of children in different age groups. Findings in this study may provide recommendations for suitable footwear types for different ages, achieving the aim of growth and development in a healthy and safe manner.
... Most studies were laboratory-based, repeated measures designs where comfort was measured under different footwear and/or insole conditions [14, 15, 18, 20-23, 25-30, 33, 35-39, 41, 43-48, 50-55, 57, 58, 60-71, 73-79, 81-87, 89, 90, 93, 97, 98, 100-105], but there were also 13 surveys [1, 3, 9-11, 16, 19, 24, 40, 56, 88, 92, 96], eight clinical trials [12,34,42,49,59,94,95,99], three qualitative studies [13,17,91] and three reviews [5,7,72]. Sample size ranged from 5 to 1524, and primarily included healthy young adults [10, 14, 15, 17, 18, 22, 28, 31, 32, 35, 37, 43-46, 48, 50, 53, 54, 56, 58, 60, 64, 67, 74-76, 78, 79, 83, 88, 90, 101-104], but also children [71,91], older people [1,52,63,76], participants with medical conditions (such as diabetes [16,27,68,105], rheumatoid arthritis [29], patellofemoral pain [73], plantar fasciitis [99], hallux valgus [93] and non-specific musculoskeletal disorders/symptoms [25,95]), specific occupational groups (such as military personnel [42,69,85,89], factory workers [9,12], school teachers [11], kitchen staff [13], hospital staff [13], coal miners [40,41] and police officers [94]) and sportspeople (such as runners [26,30,36,39,47,49,65,66,70,77,82,84,86,98], basketball players [61,62,92,100], soccer players [38,87,97], cyclists [20,21], aerobic dancers [34], skiers [51], rugby players [59], people attending gymnasiums [3], badminton players [55] and tennis players [96]). ...
... A wide range of measurement tools have been used to quantify comfort, including simple dichotomous responses [11,12,29,94], ranking footwear conditions in order of preference [14, 31-33, 36, 47, 48, 52, 60, 63-65, 76, 77, 79, 81], 4-point [42,80], 5-point [37,40,45,58,70,76,97], 6-point [59], 7-point [47,64,79,87], 9-point [57] and 12-point [41] Likert scales, 10-point numerical rating scales [43,78], and 100 mm [15, 16, 18-21, 27, 28, 30, 35, 39, 48, 49, 53, 56, 63-65, 67, 68, 71, 73, 74, 77, 79, 82, 85, 89, 90, 93, 99, 104, 105], 150 mm [22,25,26,36,46,50,55,61,62,66,69,75,83,84,98,100] and 170 mm [44] visual analog scales. The anchor statements indicating the lowest possible comfort score included 'not comfortable at all' [19-22, 25, 26, 30, 39, 49, 50, 53, 55, 56, 61-65, 73, 79, 82-85, 89, 93], 'very uncomfortable' [27,28,40,41,45,46,58,68,74,78,79,98], 'least comfortable' [44,76,80,90], 'extremely uncomfortable' [48,59,89], 'not comfortable' [71,75], 'not at all comfortable' [15,18], 'not acceptable' [37,70], 'totally disagree' [10], 'least comfortable imaginable' [35], 'not satisfactory' [42], 'very bad comfort' [43], 'very, very low' [47], 'minimum comfort' [69], 'maximal pain/discomfort' [99], 'not very comfortable' [100], 'completely uncomfortable' [104], 'extremely bad' [57] and 'unbearable discomfort' [87]. The anchor statements indicating the highest possible comfort score included 'most comfortable imaginable' [19-22, 25, 26, 30, 35, 39, 46, 50, 53, 56, 61, 63, 65, 73, 79, 82-84], 'very comfortable' [18,27,28,40,41,49,58,68,71,74,75,78,79,98,100], 'most comfortable' [44,55,62,76,80,85,90], 'extremely comfortable' [48,59,87], 'just right' [37,70], 'totally agree' [10], 'very much' [15], 'excellent' [42], 'very good comfort' [43], 'not at all uncomfortable' [45], 'very, very high' [47], 'maximum comfort' [69], 'maximal comfortable' [64], 'no pain/discomfort' [99], 'completely comfortable' [104], 'most conceivable comfort' [93] and 'extremely good' [57]. ...
... The anchor statements indicating the lowest possible comfort score included 'not comfortable at all' [19-22, 25, 26, 30, 39, 49, 50, 53, 55, 56, 61-65, 73, 79, 82-85, 89, 93], 'very uncomfortable' [27,28,40,41,45,46,58,68,74,78,79,98], 'least comfortable' [44,76,80,90], 'extremely uncomfortable' [48,59,89], 'not comfortable' [71,75], 'not at all comfortable' [15,18], 'not acceptable' [37,70], 'totally disagree' [10], 'least comfortable imaginable' [35], 'not satisfactory' [42], 'very bad comfort' [43], 'very, very low' [47], 'minimum comfort' [69], 'maximal pain/discomfort' [99], 'not very comfortable' [100], 'completely uncomfortable' [104], 'extremely bad' [57] and 'unbearable discomfort' [87]. The anchor statements indicating the highest possible comfort score included 'most comfortable imaginable' [19-22, 25, 26, 30, 35, 39, 46, 50, 53, 56, 61, 63, 65, 73, 79, 82-84], 'very comfortable' [18,27,28,40,41,49,58,68,71,74,75,78,79,98,100], 'most comfortable' [44,55,62,76,80,85,90], 'extremely comfortable' [48,59,87], 'just right' [37,70], 'totally agree' [10], 'very much' [15], 'excellent' [42], 'very good comfort' [43], 'not at all uncomfortable' [45], 'very, very high' [47], 'maximum comfort' [69], 'maximal comfortable' [64], 'no pain/discomfort' [99], 'completely comfortable' [104], 'most conceivable comfort' [93] and 'extremely good' [57]. Most studies documented an overall comfort score for the whole foot/shoe, while others reported separate comfort scores for specific regions of the foot/shoe [19,21,22,36,57,59,64,66,71,73,75,83,87,104]. ...
Article
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Objective To provide a narrative synthesis of the research literature pertaining to footwear comfort, including definitions, measurement scales, footwear design features, and physiological and psychological factors. Methods A systematic search was conducted which yielded 101 manuscripts. The most relevant manuscripts were selected based on the predetermined subheadings of the review (definitions, measurement scales, footwear design features, and physiological and psychological factors). A narrative synthesis of the findings of the included studies was undertaken. Results The available evidence is highly fragmented and incorporates a wide range of study designs, participants, and assessment approaches, making it challenging to draw strong conclusions or implications for clinical practice. However, it can be broadly concluded that (i) simple visual analog scales may provide a reliable overall assessment of comfort, (ii) well-fitted, lightweight shoes with soft midsoles and curved rocker-soles are generally perceived to be most comfortable, and (iii) the influence of sole flexibility, shoe microclimate and insoles is less clear and likely to be more specific to the population, setting and task being performed. Conclusion Footwear comfort is a complex and multifaceted concept that is influenced not only by structural and functional aspects of shoe design, but also task requirements and anatomical and physiological differences between individuals. Further research is required to delineate the contribution of specific shoe features more clearly, and to better understand the interaction between footwear features and individual physiological attributes.
... Thirty-six studies designated the country or countries where the study was conducted. Seven studies were completed in Australia (Davis et al., 2013;Dobson et al., 2017Dobson et al., , 2018aDobson et al., , 2018bHennessy et al., 2007;Matthias et al., 2021;Mills et al., 2018), seven from the USA (Cornwall & McPoil, 2017;Day & Hahn, 2020;Grier et al., 2011;Kong & Bagdon, 2010;Luczak et al., 2020;Pace et al., 2020;Saxton et al., 2020), seven from the UK (Anderson et al., 2021;Chuter et al., 2016;Clinghan et al., 2008;Hurst et al., 2017;Janson et al., 2021;Jordan & Bartlett, 1995;Melvin et al., 2019), three from the Netherlands (Arts et al., 2014;Zwaferink et al., 2020Zwaferink et al., , 2021, two each from Italy (Colonna et al., 2017;Franciosa et al., 2013), and Spain (Llana et al., 2002;L opez-Moral et al., 2020), one each from Denmark (Jensen & Laursen 2011), New Zealand (Frecklington et al., 2019), Hong Kong (Au & Goonetilleke, 2007), Malaysia (Chee-Kidd & Vivek, 2009), India (Govindasamy et al., 2020), Ethiopia (Getie et al., 2021) and Brazil (Dinato et al., 2015). One study completed investigations in two primary locations (Liverpool, England and Greater Beijing Area, China) (Apps et al., 2015). ...
... Only nine studies did not report on the gender ratio of the participants. Two studies investigated children (aged less than 13 years) (Herbaut et al., 2019;Matthias et al., 2021), three studies investigated adolescents (13-18 years) (Lam et al., 2019;Muniz & Bini, 2017;Park et al., 2017), 90 studies investigated adult populations (age 19þ years) (Anderson et al., 2021;Apps et al., 2015;Arezes et al., 2013;Arts et al., 2014;Au & Goonetilleke, 2007;Bergstra et al., 2015;Bishop et al., 2020;Branthwaite et al., 2014;Burke, 2012;Bus et al., 2009;Cha, 2020;Chan et al., 2020;Che et al., 1994;Chee-Kidd & Vivek, 2009;Chu et al., 2014;Chuter et al., 2016;Clinghan et al., 2008;Colonna et al., 2015;Cornwall & McPoil, 2017;Crews & Candela, 2018;Davis et al., 2013;Day & Hahn, 2020;Dinato et al., 2015;Dobson et al., 2017Dobson et al., , 2018bDobson et al., , 2018a2020;Franciosa et al., 2013;Frecklington et al., 2019;Fuchs et al., 2020;Gao & Abeysekera, 2000;Getie et al., 2021;Govindasamy et al., 2020;Grier et al., 2011;Haene et al., 2012;Hennessy et al., 2007;Herbaut et al., 2016;Hintzy et al., 2015;Hoerzer et al., 2016;Hofer et al., 2014;Hollawell & Baione, 2015;Hong et al., 2005Hong et al., , 2016Hurst et al., 2017;Isherwood et al., 2021;Janson et al., 2021;Jensen & Laursen 2011;Jerosch et al., 1995;Jiang et al., 2016;Jordan & Bartlett, 1995;Kong & Bagdon, 2010;Koska & Maiwald, 2020;Lam et al., 2011Lam et al., , 2017Lane et al., 2014;Lindorfer et al., 2019aLindorfer et al., , 2019bLindorfer et al., , 2020Liu et al., 2021;Llana et al., 2002;L opez-Moral et al., 2020;Luczak et al., 2020;Luo et al., 2009;Melia et al., 2021;Melvin et al., 2019;Meyer et al., 2018; Mills et al., 2010Mills et al., , 2018Mo et al., 2020;M€ undermann et al., 2001Nigg et al., 1986;Okholm Kryger et al. 2017Pace et al., 2020;Peng et al., 2020;Saxton et al., 2020;Schuh et al., 2011;Sinclair et al., 2016;Sterzing et al., 2013;Thordarson et al., 2001;Thordarson, Ebramzadeh, Moorthy, et al., 2005;Van Alsenoy et al., 2019;West et al., 2020;Witana et al., 2009;Zhang et al., 2019;Zwaferink et al., 2020Zwaferink et al., , 2021. Four studies did not describe the age range or average ages of their participants. ...
... Six studies investigated shoes used for rehabilitation purposes including customized or semicustomized footwear for diabetes-related foot care (Arts et al., 2014), forefoot offloading shoes or rocker shoes (Bus et al., 2009;Fuchs et al., 2020;L opez-Moral et al., 2020), standard MCR shoes (Govindasamy et al., 2020), and post-operative shoes (Schuh et al., 2011). The remaining studies investigated multiple shoe conditions consisting of ballet pumps (Branthwaite et al., 2014), washable walker shoes (Davis et al., 2013), orthopaedic footwear (Hennessy et al., 2007), new shoe designs (Gao & Abeysekera, 2000;Grier et al., 2011), ski boots (Colonna et al., 2015(Colonna et al., , 2017Hofer et al., 2014), soccer cleats (Okholm Kryger et al., 2021), school shoes (Matthias et al., 2021), experimental shoes (Chuter et al., 2016;Hurst et al., 2017;Lindorfer et al., 2020;Melvin et al., 2019;Mills et al., 2010;Sterzing et al., 2013;Zwaferink et al., 2020Zwaferink et al., , 2021, commercially available shoes (Mills et al., 2018;Sinclair et al., 2016), boots (Dobson et al., 2020;Muniz & Bini, 2017;Okholm Kryger et al. 2017), shoes with differing heel heights (Hong et al., 2005;Luo et al., 2020;Witana et al., 2009), stability models (Kong & Bagdon, 2010), varying sole hardness (Lane et al., 2014) and a combination of design factors (Jiang et al., 2016). A further 14 studies investigated only a single condition of footwear (i.e. ...
Article
Perceived footwear comfort influences wearability and can impact on physical mobility, performance and foot-related complaints. To date, there has been no comprehensive review of the characteristics or methods for measuring perceived footwear comfort. The aims of this systematic review were to identify, appraise and synthesise the literature on methods used to assess perceived footwear comfort, and report their validity and reliability. Electronic databases were systematically searched and the articles screened and appraised for methodological risk of bias using a modified Quality Index checklist. Data on footwear comfort assessment tools (methods, populations, footwear types, reliability/validity) was extracted by two reviewers. A narrative synthesis was undertaken to describe the findings. Ninety-nine articles involving 6980 participants were assessed as eligible for review. Perceived footwear comfort has been assessed by a variety of methods including the visual analogue scale (VAS), Likert-type scales, ranking scales and questionnaires. The studies have covered a range of populations, both healthy and pathological, ranging between ages 8 and 75 years, most commonly adults. Investigations into reliability of perceived footwear comfort scales were limited, and whilst some tools had evidence of moderate to high reliability, findings were population dependent. Developmental or independent validity testing was typically not undertaken. Risk of bias was variable across studies. Perceived footwear comfort assessment has been performed across a wide range of populations and footwear types. Whilst select measures had evidence for their reliability, the results were variable and population dependent. There is scope for further research into the reliability and validity of perceived footwear comfort assessment tools in different populations.
... School shoes are often designed with stiff, inflexible midsoles, a closed toe and elevated heel heights [6]. Recent evidence has suggested that some of these footwear characteristics increase knee joint loads, reduce tactile feedback during walking and running, and reduce dynamic balance when compared to being barefoot [7][8][9][10]. Cross-sectional studies have identified changes in paediatric gait characteristics including step length, velocity, and cadence when children go from being barefoot to shod in school and/ or sport shoes [11][12][13][14]. ...
... Footwear comfort is highly valued by students and parents when selecting the shoes, they, or their children, choose to wear to school. These findings are consistent with studies performed in primary school aged children [8,25], as well as adult runners [15,18] and adults with inflammatory arthropathies [17,33]. Parents of secondary school students consider their child's opinion very important when selecting shoes. ...
Article
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Background: Adolescents are often required to wear footwear that adheres to uniform guidelines at secondary school. There is a paucity of literature on factors influencing school footwear choice and what drives the development of school footwear guidelines. The aims of this study were to describe (i) current school footwear guidelines in secondary schools across Australia, (ii) factors that influence footwear choice in secondary school students and their parents, and (iii) principals, parents, and students' beliefs on factors which contribute to school footwear guidelines. Methods: An online survey was distributed to principals, secondary school students (aged 14-19 years) and their parents across Australia. The survey included questions on current school footwear guidelines, factors influencing footwear choice (for students and parents), participants beliefs on the effect footwear has on musculoskeletal health, current and previous lower limb pain, and beliefs on factors that contribute to school footwear guidelines. Parent and student responses to factors that influence their footwear choice were compared using proportional odds logistic regression. Students and parents' responses to factors influencing footwear guidelines were compared to principal responses using proportional odds logistic regression. Significance was set at an alpha of < 0.05. Results: Eighty principals, 153 parents and 120 secondary school students responded to the survey. 96% (77/80) of principals reported that their schools have set guidelines for school footwear. 88% of principals considered comfort to be important when developing school footwear guidelines. Proportional odds logistics regression showed that parents and students were 3.4 and 4.9 times more likely, respectively, than principals to rate comfort as being important when schools develop footwear guidelines. More than 40% of students reported experiencing musculoskeletal pain, and 70% of these students reported the pain to be exacerbated when in their school shoes. Less than a third of participants considered healthcare recommendations important to the development of footwear guidelines. Conclusions: Nearly all principals that participated in this survey had set guidelines for school footwear. There is a discord between parents, students, and principals on the importance that factors such as comfort, play in the development of school footwear guidelines.
... The quality of the product, from the consumer's perspective, is emphasised even before acquisition, highlighting that the customer's expectations regarding the product's performance are essential and significantly impact their purchasing decision (Engler et al., 2015). Therefore, the comfort of footwear is a crucial consideration for consumers, as shoes that fit perfectly and allow walking without causing discomfort can significantly reduce discomfort, while incorrect fit can have negative health repercussions (Matthias et al., 2021). Similarly, comfort is a key factor in boosting footwear sales, particularly for sports shoes, where the design should minimise injuries and improve performance (Peng et al., 2020). ...
Article
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This study investigates how customer satisfaction influences loyalty within the Peruvian footwear sector. A mixed-methods approach of the Dexplis type was employed, combining the collection of quantitative data through a questionnaire administered to 350 consumers, and qualitative data obtained from 25 interviews, to explore how satisfaction affects emotions, intentions, and behaviours of consumers in this specific context. The findings reveal a significant association between satisfaction and loyalty, supported by a Rho coefficient of 0.872, and a multiple regression model showing 80.1% of the variability in loyalty decisions. Additionally, other factors such as innovation, shopping experience, and after-sales service were identified as having a substantial impact on customer loyalty. In summary, this article not only contributes to the theoretical understanding of the association between customer satisfaction and loyalty, but also offers practical implications for improving customer retention strategies in the Peruvian footwear industry, providing key insights for professionals in the sector in strategic decision-making and in designing more satisfactory and engaging shopping experiences.
... The importance of foot measurement for footwear fit and design, as well as clinical applications is evident [1,[7][8][9][10][11][12][13][14]. Although knowledge of the high heterogeneity in foot shape in children is evident [1,4,6,13,14], the footwear industry still bases the last as well as the shoe development predominantly just on the foot length and ball width [15]. ...
Article
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Background In infants and young children, a wide heterogeneity of foot shape is typical. Therefore, children, who are additionally influenced by rapid growth and maturation, are a very special cohort for foot measurements and the footwear industry. The importance of foot measurements for footwear fit, design, as well as clinical applications has been sufficiently described. New measurement techniques (3D foot scanning) allow the assessment of the individual foot shape. However, the validity in comparison to conventional methods remains unclear. Therefore, the purpose of this study was to compare 3D foot scanning with two established measurement methods (2D digital scanning/manual foot measurements). Methods Two hundred seventy seven children (125 m / 152 f; mean ± SD: 8.0 ± 1.5yrs; 130.2 ± 10.7cm; 28.0 ± 7.3kg) were included into the study. After collection of basic data (sex, age (yrs), body height (cm), body weight (kg)) geometry of the right foot was measured in static condition (stance) with three different measurement systems (fixed order): manual foot measurement, 2D foot scanning (2D desk scanner) and 3D foot scanning (hand-held 3D scanner). Main outcomes were foot length, foot width (projected; anatomical; instep), heel width and anatomical foot ball breadth. Analysis of variances for dependent samples was applied to test for differences between foot measurement methods (Post-hoc analysis: Tukey-Kramer-Test; α=0.05). Results Significant differences were found for all outcome measures comparing the three methods ( p <0.0001). The span of foot length differences ranged from 3 to 6mm with 2D scans showing the smallest and 3D scans the largest deviations. Foot width measurements in comparison of 3D and 2D scans showed consistently higher values for 3D measurements with the differences ranging from 1mm to 3mm. Conclusions The findings suggests that when comparing foot data, it is important to consider the differences caused by new measurement methods. Differences of about 0.6cm are relevant when measuring foot length, as this is the difference of a complete shoe size (Parisian point). Hence, correction factors may be required to compare the results of different measurements appropriately. The presented results may have relevance in the field of ergonomics (shoe industry) as well as clinical practice.
... In most cases, styling and fit do not always correspond with foot health related issues which cause foot pain and may lead to development of foot deformity [22,23]. This suggests that to maintain good foot health, the use of any shoes must fit someone socially, fashionably and also functionally [13,24]. Furthermore, this shows that correct shoe fitting plays an important role in foot pathology and this aspect is highly necessary to identify the current size and shape distribution of a given population [10,23]. ...
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Background Adolescents are often required to wear footwear that adheres to uniform guidelines at secondary school. There is a paucity of literature on factors influencing school footwear choice and what drives the development of school footwear guidelines. The aims of this study were to describe (i) current school footwear guidelines in secondary schools across Australia, (ii) factors that influence footwear choice in secondary school students and their parents, and (iii) principals, parents, and students’ beliefs on factors which contribute to school footwear guidelines. Methods An online survey was distributed to principals, secondary school students (aged 14–19 years) and their parents across Australia. The survey included questions on current school footwear guidelines, factors influencing footwear choice (for students and parents), participants beliefs on the effect footwear has on musculoskeletal health, current and previous lower limb pain, and beliefs on factors that contribute to school footwear guidelines. Parent and student responses to factors that influence their footwear choice were compared using proportional odds logistic regression. Students and parents’ responses to factors influencing footwear guidelines were compared to principal responses using proportional odds logistic regression. Significance was set at an alpha of < 0.05. Results 80 principals, 153 parents and 120 secondary school students responded to the survey. 96% (77/80) of principals reported that their schools have set guidelines for school footwear. 88% of principals considered comfort to be important when developing school footwear guidelines, though parents and students were 3.4 and 4.9 times more likely than principals to rate comfort as having lower importance in the development of guidelines. More than 40% of students reported experiencing musculoskeletal pain, and 70% of these students reported the pain to be exacerbated when in their school shoes. Less than a third of participants considered healthcare recommendations important to the development of footwear guidelines. Conclusions Nearly all principals that participated in this survey had set guidelines for school footwear. There is a discord between parents, students, and principals on the importance that factors such as comfort, play in the development of school footwear guidelines.
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Comfort is important for running shoe prescription in athletes to enhance performance and potentially decrease injury risk. A three-stage process was used to develop a new running footwear comfort assessment tool (RUN-CAT): (i) a survey of 282 runners to identify meaningful items of comfort, (ii-a) field testing of 100 runners who assessed the comfort of different shoes, (ii-b) item reduction using bootstrap aggregation and weightings using multiple regressions to identify a final set of items, and (iii) defining test-retest reliability, standard error of measurement (SEM), minimal detectable difference (MDD90) and minimal important difference (MID) values for the final tool. Of the 19 initial items, after item reduction, four were included in the final tool: heel cushioning, shoe stability, forefoot cushioning and forefoot flexibility. Reliability of the overall comfort score was good to excellent (within-day ICC 0.88, between-day 0.70) with all four components displaying good reliability (ICC >0.70). The SEM of the comfort score was 2.8 points and the MDD90 was 6.5 mm. Subject nominated MID values ranged from 9.3 to 9.9 mm. The RUN-CAT demonstrates excellent reliability, acceptable measurement error and can discriminate between footwear models. Clinicians and researchers can incorporate the RUN-CAT to optimise running shoe comfort in athletes.
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Good foot health throughout childhood is important but remains poorly understood with few studies exploring this topic. The aim of this study was to define parents' knowledge, practices and health-related perceptions of children's feet. A qualitative design was adopted. Semi-structured, one-to-one interviews were carried out with parents of children aged five years and under, recruited from South East and North West of England. Interviews explored parents' views, beliefs and understanding of foot health in infancy and early childhood. Transcripts of the interviews were analysed using thematic analysis. Eighteen interviews were conducted. Seven themes were identified relating to (1) parents belief and knowledge about children's foot health; (2) how parents use and share foot health information; (3) activities for supporting foot health and development; (4) footwear choices, beliefs and influences; (5) the way they access health professionals; (6) the way they search for foot health information and (7) developing practice(s) to support parents. The study provides the first insight into how parents view foot health in early infancy and childhood. The findings highlight the key foot health beliefs important to parents, how they learn about and what influences their decision-making about caring for children's feet, the way parents receive and seek information, and how they access support for foot health concerns. The findings highlight the need for accurate, clear and consistent foot health messages, and the important role health professionals have in signposting parents towards reliable and informative sources on foot health.
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Background Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children’s gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children’s footwear and to establish the range of studies that considered therapeutic footwear. Methods A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children’s footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies. Results The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional). Conclusion Children’s footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children’s therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children’s therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role. Electronic supplementary material The online version of this article (10.1186/s13047-019-0336-z) contains supplementary material, which is available to authorized users.
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Background Correct footwear fitting is acknowledged as being vitally important, as incorrectly fitted footwear has been linked to foot pathology. The aim of this narrative review was to determine the prevalence of incorrectly fitted footwear and to examine the association between incorrectly fitted footwear, foot pain and foot disorders. Methods A database search of Ovid MEDLINE and CINAHL yielded 1,681 citations for title and abstract review. Eighteen articles were included. Findings were summarised under the categories of (i) children, (ii) adults, (ii) older people, (iii) people with diabetes and (iii) occupation- or activity-specific footwear. Differences in footwear fitting between sexes were also explored. Results Between 63 and 72% of participants were wearing shoes that did not accommodate either width or length dimensions of their feet. There was also evidence that incorrect footwear fitting was associated with foot pain and foot disorders such as lesser toe deformity, corns and calluses. Specific participant groups, such as children with Down syndrome and older people and people with diabetes were more likely to wear shoes that were too narrow (between 46 and 81%). Conclusion A large proportion of the population wear incorrectly sized footwear, which is associated with foot pain and foot disorders. Greater emphasis should be placed on both footwear fitting education and the provision of an appropriately large selection of shoes that can accommodate the variation in foot morphology among the population, particularly in relation to foot width.
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The effects of footwear on the development of children's feet has been debated for many years and recent work from the developmental and biomechanical literature has challenged long-held views about footwear and the impact on foot development. This narrative review draws upon existing studies from developmental, biomechanical and clinical literature to explore the effects of footwear on the development of the foot. The emerging findings from this support the need for progress in [children's] footwear science and advance understanding of the interaction between the foot and shoe. Ensuring clear and credible messages inform practice requires a progressive evidence base but this remains big issue in children's footwear research.
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Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of > 0.61. Inter-rater reliability was investigated separately in a second sample of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.
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One of the goals of a pilot study is to identify unforeseen problems, such as ambiguous inclusion or exclusion criteria or misinterpretations of questionnaire items. Although sample size calculation methods for pilot studies have been proposed, none of them are directed at the goal of problem detection. In this article, we present a simple formula to calculate the sample size needed to be able to identify, with a chosen level of confidence, problems that may arise with a given probability. If a problem exists with 5% probability in a potential study participant, the problem will almost certainly be identified (with 95% confidence) in a pilot study including 59 participants. Copyright © 2015 Elsevier Inc. All rights reserved.
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The purpose of this study was to analyze the reliability and the criterion-related validity of several lower body muscular power tests (i.e. standing long jump, squat jump, countermovement jump and Abalakov jump), in children aged 6-12 years. Three hundred and sixty three healthy children (168 girls) agreed to participate in this study. All the lower body muscular power tests were performed twice (7 days apart) whereas the 1 repetition maximum (1RM) leg extension test was performed 2 days after the first session of testing. All the tests showed a high reliability (inter-trial difference close to 0 and no significant differences between trials, all p > 0.05). The association between the lower body muscular power tests and 1RM leg extension test was high (all p<0.001). The standing long jump and the Abalakov jump tests showed the highest association with 1RM leg extension test (R = 0.700, test result, weight, height, sex and age were added in the model). The standing long jump test can be a useful tool to assess lower body muscular power in children when laboratory methods are not feasible because is practical, time efficient, and low in cost and equipment requirements.
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To investigate in-shoe foot kinematics, holes are often cut in the shoe upper to allow markers to be placed on the skin surface. However, there is currently a lack of understanding as to what is an appropriate size. This study aimed to demonstrate a method to assess whether different diameter holes were large enough to allow free motion of marker wands mounted on the skin surface during walking using a multi-segment foot model. Eighteen participants underwent an analysis of foot kinematics whilst walking barefoot and wearing shoes with different size holes (15 mm, 20 mm and 25 mm). The analysis was conducted in two parts; firstly the trajectory of the individual skin-mounted markers were analysed in a 2D ellipse to investigate total displacement of each marker during stance. Secondly, a geometrical analysis was conducted to assess cluster deformation of the hindfoot and midfoot-forefoot segments. Where movement of the markers in the 15 and 20 mm conditions were restricted, the marker movement in the 25 mm condition did not exceed the radius at any anatomical location. Despite significant differences in the isotropy index of the medial and lateral calcaneus markers between the 25 mm and barefoot conditions, the differences were due to the effect of footwear on the foot and not a result of the marker wands hitting the shoe upper. In conclusion, the method proposed and results can be used to increase confidence in the representativeness of joint kinematics with respect to in-shoe multi-segment foot motion during walking.
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The conventional analysis of variance applied to designs in which each subject is measured repeatedly requires stringent assumptions regarding the variance covariance (i.e. correlations among repeated measures) structure of the data. Violation of these assumptions results in too many rejections of the null hypothesis for the stated significance level. This paper considers several alternatives when heterogeneity of covariance exists, including nonparametric tests, randomization and matching procedures, Box and Greenhouse Geisser corrections, and multivariate analysis. The presentation is from an applied rather than theoretical standpoint. Multivariate techniques that make no covariance assumptions and provide exact probability statements represent the most versatile solution.
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In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain. Pain was graded 4 times using a paper VAS (0-100mm): T(0), T(3), T(6), and T(≥ 36)minutes. After T(6), patients were asked if their pain had changed since T(0)minute. The primary analysis was the repeatability coefficient of the VAS, determined according to the Bland-Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T(0), T(3), and T(6). In order to appropriately estimate the within-subject SD, 96 patients were required if we obtained 3 measurements for each patient. A total of 151 patients with a mean age of 12.2 ± 2.5 years were enrolled. Among them, 100 mentioned that their pain was the same for T(0), T(3), and T(6)minutes. The repeatability coefficient of the VAS for these children was 12 mm when the pain did not change. This implies that, for a child, all pain intensity measurements within 12 mm should be considered the same pain intensity on a paper VAS. This measure should also be evaluated on other types of VAS.
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The purpose of the present study was to examine the association among different measures of lower body muscular strength in children, and the association between measures of lower- and upper-body muscular strength. The study population comprises 94 (45 girls) healthy Caucasian children aged 6-17 years. Children performed several lower body explosive muscular strength tests (i.e., standing long jump [SLJ], vertical jump, squat jump, and countermovement jump) and upper body muscular strength tests (i.e., throw basketball, push-ups, and isometric strength exercises). The association among the study tests was analyzed by multiple regression. The SLJ was strongly associated with other lower body muscular strength tests (R = 0.829-0.864), and with upper body muscular strength tests (R = 0.694-0.851). The SLJ test might be therefore considered a general index of muscular fitness in youth. The SLJ test is practical, time efficient, and low in cost and equipment requirements.
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1. Optimum foot development occurs in the barefoot environment. 2. The primary role of shoes is to protect the foot from injury and infection. 3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility. 4. The term "corrective shoes" is a misnomer. 5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications. 6. Shoe selection for children should be based on the barefoot model. 7. Physicians should avoid and discourage the commercialization and "media"-ization of footwear. Merchandizing of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession.
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The purposes of this study were (a) to determine lower extremity anthropometric and sensory factors that are related to differences in comfort perception of shoe inserts with varying shape and material and (b) to investigate whether shoe inserts that improve comfort decrease injury frequency in a military population. 206 military personnel volunteered for this study. The shoe inserts varied in arch and heel cup shape, hardness, and elasticity in the heel and forefoot regions. A no insert condition was included as the control condition. Measured subject characteristics included foot shape, foot and leg alignment, and tactile and vibration sensitivity of the plantar surface of the foot. Footwear comfort was assessed using a visual analog scale. Injury frequency was evaluated with a questionnaire. The statistical analyses included Student's t-tests for repeated measures, ANOVA (within subjects), MANOVA (within insert combinations), and chi-square tests. The average comfort ratings for all shoe inserts were significantly higher than the average comfort rating for the control condition. The incidence of stress fractures and pain at different locations was reduced by 1.5-13.4% for the insert compared with the control group. Foot arch height, foot and leg alignment, and foot sensitivity were significantly related to differences in comfort ratings for the hard/soft, the viscous/elastic, and the high arch/low arch insert combinations. Shoe inserts of different shape and material that are comfortable are able to decrease injury frequency. The results of this study showed that subject specific characteristics influence comfort perception of shoe inserts.
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The limitations of clinical methods for appraising foot posture are well documented. A new measure, the Foot Posture Index is proposed, and its development and validation described. A four-phase development process was used: (i) to derive a series of candidate measures, (ii) to define an appropriate scoring system, (iii) to evaluate the validity of components and modify the instrument as appropriate, and (iv) to investigate the predictive validity of the finalised instrument relative to static and dynamic kinematic models. Methods included initial concurrent validation using Rose's Valgus Index, determination of inter-item reliability, factor analysis, and benchmarking against three dimensional kinematic models derived from electromagnetic motion tracking of the lower limb. Thirty-six candidate components were reduced to six in the final instrument. The draft version of the instrument predicted 59% of the variance in concurrent Valgus Index scores and demonstrated good inter item reliability (Cronbach's alpha = 0.83). The relevant variables from the motion tracking lower limb model predicted 58-80% of the variance in the six components retained in the final instrument. The finalised instrument predicted 64% of the variance in static standing posture, and 41% of the variance in midstance posture during normal walking. The Foot Posture Index has been subjected to thorough evaluation in the course of its development and a final version is proposed comprising six component measures that performed satisfactorily during the validation process. The Foot Posture Index assessment is quick and simple to perform and allows a multiple segment, multiple plane evaluation that offers some advantages over existing clinical measures of foot posture.
Effects of oversized footwear on gait parameters in children
  • K Imaizumi
K. Imaizumi, et al., Effects of oversized footwear on gait parameters in children, Footwear Sci. (2015) S16-S18.
How too big shoes affect to the joint kinematics of kids gait pattern
  • Y Kobayashi
Y. Kobayashi, et al., How too big shoes affect to the joint kinematics of kids gait pattern, Footwear Sci. (2015) S53-S55.