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Foot motion in children shoes-A comparison of barefoot walking with shod walking in conventional and flexible shoes
Abstract
The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inadequate footwear in childhood. Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot the objective of this study was to monitor the influence of commercial footwear on children's foot motion during walking. Furthermore, an attempt was made to reduce this influence by changing the physical properties of standard footwear. Children's barefoot motion pattern was monitored by a marker-based optical 3D-tracking method using a multi-segment foot model. In the study's first stage, barefoot walking was compared to walking with a commercial product. In the second stage it was compared to both, the pattern with the commercial product and with the shoe modified on the basis of the findings of the first stage of the study. Eighteen children (8.2+/-0.7 years old) with no foot deformity and with the same shoe size were recruited for this study. It was found that tibio-talar ROM increased in the commercial shoe (26.6 degrees ) compared to the barefoot condition (22.5 degrees , p=0.001) whereas the medial arch changes for push-off were diminished since the variation in arch length was reduced from 9.9% (barefoot) to 5.9% (shoe, p<0.001). Further, ROM in foot torsion along the long foot axis was reduced from 9.8 degrees (bare) to 4.7 degrees (shoe, p<0.001). These parameters could be improved with more flexible footwear. The present study shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended not only for children in this age but for healthy children in general.
... Because the windlass mechanism works more frequently [7], children who are barefoot have more space for the feet and toes to move flexibly. Due to the windlass mechanism, the medial longitudinal arch rises as the contraction of plantar aponeurosis, pulling the calcaneus and extension of the metatarsophalangeal joint during walking and running [8]. Being It was found that Chinese children showed higher ratios of hallux valgus than Mongolian children [33], which may be because the Chinese children wore pointed-toe shoes, which played an important role in contributing to hallux valgus [32]. ...
... 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. ...
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.
... The correct choice of footwear is especially important for children because their growth and development are characterized by the evolutionary dynamics of the locomotor system and by the physical activity to which their lower extremities are subjected. Furthermore, the choices of footwear are often influenced by marketing, economics or aesthetics rather than future health considerations of the feet (Wolf et al., 2008). ...
... The hypothesis is that there will be a significant correlation between more time spent barefoot verses shod, wearing correct fitted footwear verses ill fitted footwear and the incidence of HV in children and adolescence aged between 6-18 years of age. This research is important as poor footwear choices have been shown in the literature to effect physical development of not only the foot but also posture (Wolf et al., 2008;Dai et al., 2015). ...
... It has been suggested in the literature children wearing school shoes where the toes are squished due to a narrow toe box for a prolonged period is often overlooked (Klein et al., 2009;Matsuda et al., 2018). Shoes also significantly influence forefoot movement patterns, foot development and gait (Wolf et al., 2008). It has been reported in the literature when compared to barefoot walking shoes increased the strike patterns in the rearfoot and influenced knee and ankle ranges of motion, as well as longer steps, but reduced foot movements, including the swing phase leg speed and shock absorption have all been observed in children wearing shoes (Wegener et al., 2015). ...
Wearing shoes of insufficient fit can lead to foot development deformities such as hallux valgus (HV). It is defined as a static subluxation of the first metatarsophalangeal joint with lateral deviation of the big toe and medial deviation of the first metatarsal. We surveyed 268 children and adolescence aged between 6 and 18 years old (under 13 age group & over 13 age group) about their footwear and barefoot habits both inside and out their school environment. The association of HV with School Shoe Fit (PCS = 0.002 < 0.05.), Outside School Shoe Fit (PCS = 0.022 < 0.05) and Time Barefoot at Home (PCS = 0.001 < 0.05) was shown to be statistically significant for the Under 13s population. However, this could not be established for the Over 13s population, possibly due to the smaller sample size. For both groups, the association of HV and School Shoe Fit was much stronger than Outside School Shoe Fit. For both age groups, there was no significant association of HV with Participation in Sport, Injury or Activity. For both groups, there was no significant association of HV with School Shoe Type or Outside School Shoe Type. A notable difference between the Under 13s and Over 13s groups was observed in association between HV and Gender. More research is needed in the over 13 age group
... Differences in foot anthropometry, particularly in forefoot width, have been observed between populations habitually walking barefoot and those wearing shoes [9][10][11]. The width of the anterior part of the foot was observed to be greater when walking barefoot compared to walking in shoes [12,13]. Lighter, wider and more flexible barefoot footwear appears to reduce the difference between shoe and barefoot walking in forefoot width [14]. ...
... The aim of this study was to compare the arch index, dynamic foot anthropometry and gait parameters in toddlers who had been habitually wearing barefoot shoes or conventional shoes since their first steps, as the long-term effect of habitual shoe-wearing on children's growth and development is still unclear [17]. The choice of optimal footwear for toddlers and children is also influenced by fashion trends and price, in addition to issues of health and foot protection [13,23]. A previous study by Wolf et al. [13] shows that footwear affects the motion pattern during walking and that a slimmer and more flexible shoe design helps to reduce this effect and makes the motion pattern more similar to the barefoot gait pattern. ...
... The choice of optimal footwear for toddlers and children is also influenced by fashion trends and price, in addition to issues of health and foot protection [13,23]. A previous study by Wolf et al. [13] shows that footwear affects the motion pattern during walking and that a slimmer and more flexible shoe design helps to reduce this effect and makes the motion pattern more similar to the barefoot gait pattern. The results of our study showed statistically significant differences between BF and N-BF groups after seven months of habitual wearing of barefoot shoes or conventional footwear in the maximal force on the medial foot area, which was increased in the N-BF group. ...
Objectives
Barefoot shoes have recently become a popular alternative to conventional shoes among the parents of pre-school children. As the long-term effect of habitual shoe-wearing on the foot is still unclear, the aim of this study was to compare the arch index, dynamic foot anthropometry and gait parameters in toddlers who had been habitually wearing barefoot shoes or conventional shoes since their first steps.
Methods
30 toddlers– 15 habitually wearing barefoot shoes (BF group) and 15 habitually wearing conventional shoes (N-BF group)–participated in this study. Each child was measured twice during the study. The first data collection session occurred within one month after the first five consecutive unsupported steps were performed by the toddler. The second data collection session occurred seven months after this event. At each data collection session, the toddler was instructed to walk barefooted at its natural speed over an Emed ® platform (Novel GmbH, Germany). The Emed ® software generated data regarding the arch index, dynamic foot anthropometry, foot progression angle, contact area, contact time, peak pressure and maximum force. The Wilcoxon signed-rank test was used to compare the differences between the 1 st and 2 nd data collections. The Mann-Whitney U test was used to compare the differences between the BF and N-BF groups.
Results
The results of this study show a higher plantar arch and a smaller foot progression angle in the BF group. The forefoot width in both the BF and N-BF groups remained proportional to the foot length after seven months of independent walking.
Conclusions
These findings may encourage parents and caregivers to introduce barefoot shoes or create a habitual barefoot time for their child.
... Few studies have investigated the differences in foot width in children with different footwear habits and those who wear poorly fitted footwear [50,75,76]. Hollander et al. [50] and Kusumoto [76] investigated populations with different footwear habits, whilst Wolf et al. [75] investigated acute changes when changing footwear conditions. ...
... Few studies have investigated the differences in foot width in children with different footwear habits and those who wear poorly fitted footwear [50,75,76]. Hollander et al. [50] and Kusumoto [76] investigated populations with different footwear habits, whilst Wolf et al. [75] investigated acute changes when changing footwear conditions. Overall, both Hollander et al. [50] and Kusumoto [76] found that foot width was similar in populations with different footwear habits. ...
... The Filipino children did not wear restrictive footwear, 97% wore rubber sandals, and 3% were barefoot, whereas children from Tokyo wore either athletic shoes (87%) or leather shoes (15%) [76]. Wolf et al. [75] found that foot width was acutely reduced in children when wearing shoes. The foot width variability whilst barefoot was almost 10%, whereas, in the two shoe conditions, it was only 6% and 4%, respectively [75]. ...
The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children’s feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.
... In recent years the function and development of the foot have sparked renewed interest [1]. Areas on which studies have focused over the past ten years include foot movement patterns [2][3][4][5][6], the advantages and disadvantages of barefoot locomotion compared to shod walking [6][7][8][9][10][11], shoe development, shoe characteristics, shoe fitting assessment methods [12][13][14][15][16][17], and inter-continental differences in foot morphology and foot function [1,7,[17][18][19]. A few recent studies have focused on the pediatric foot, and specific footwear habits and foot development [2,7,14,20]. ...
... For example, growing up barefoot, compared to growing up shod, influences pediatric foot arch morphology, foot pliability, the hallux valgus angle, rearfoot strike patterns and motor performance [6,7,25]. Shoes have been identified as an external factor that could significantly influence foot development, as well as gait in children [9,11]. ...
... Forefoot movement patterns are also significantly influenced by shoes [9]. Compared to barefoot walking, increased rearfoot strike patterns and knee and ankle range of motion, as well as longer steps, but reduced foot movements, swing phase leg speed and shock absorption, were reported in children wearing shoes [11]. ...
Background
Research shows that ill-fitting shoes can negatively impact the development of the pediatric foot, in a very direct manner. The primary aim of the study was to determine if the dimensions of available prescribed school shoes fit the foot dimensions of habitually barefoot South African children and adolescents.
Methods
A cross-sectional observational study was conducted where static standing foot measurements of children and adolescents from urban and rural schools were obtained with a mobile caliper. The maximum heel-toe-length and foot width with an added 10 mm toe- and width fit allowance to each participant, were compared to the corresponding school shoe length and shoe width available in retail. A mixed model ANOVA was used to compare foot dimensions between gender, age and side.
Results
Six hundred and ninety-eight school children ( N = 698) (431 girls; 267 boys; average age 10.86 years, SD = 2.55) were participants. A total of seventy-seven ( N = 77) black coloured prescribed school shoes currently available in retail ranging from different styles and brands were measured. Results show that, comparing the shoe length and maximum heel-toe-length of participants, as well as taking 10 mm toe allowance into account, fifty-nine percent (59%) of children wore shoes that were not the correct length. With regards to the shoe width and the added 10 mm of width fit allowance, ninety-eight percent (98%) of the shoes worn by participants were too narrow for their feet.
Conclusions
Results confirmed that school shoes currently available in retail, are not suited for the habitually barefoot population studied. It is recommended that the shoe manufacturing industry should consider the shoe width of school shoes for children and adolescents in habitually barefoot populations to avoid the long-term negative effect of ill-fitting shoes on the pediatric foot.
... Footwear offers protection from the elements, as well as from harmful objects or terrain [1]. Adult footwear research is extensive [2], however the impact of children's footwear design on musculoskeletal structure and function is poorly understood [3]. ...
... However, the evidence suggests that a predominantly barefoot childhood results in higher foot arches [4] and hallux angles [5]; as well as improved balance and standing long jump ability [6]. Furthermore, there is some evidence of the negative influences of conventional shoes (casual and sports) on children's foot and gait biomechanics in laboratory studies, compared to more flexible shoes and barefoot [1,7,8]. The splinting effect of shoes is substantial, limiting the first metatarsophalangeal joint range of motion (36.0 • barefoot vs 10.7 • shod), which is essential for propulsion; and midfoot sagittal plane motion (22.5 • barefoot vs 6.2 • shod) [8]. ...
... The long-term consequences of these restrictions are not known. These studies suggest that shoe flexibility may affect movements that require midfoot power development, as well as the muscles involved in creating this movement [1,9]. Increased shoe flexibility may facilitate intrinsic foot muscle development and strength, as it has been shown to do in adults [10]. ...
Background
From retrospective research, it is believed that children who predominantly spend their time shod have poorer foot strength and performance than those who are predominantly barefoot. Children’s foot motion has been shown to be adversely affected by standard school shoes; however, the long-term effect of moderate minimalist shoes on foot strength, muscle structure and balance in children is unknown.
Research question
Does wearing moderate minimalist shoes, compared to stiff shoes, benefit a child’s foot strength, muscle structure and performance over time?
Methods
Seventy healthy children (9-12 yr) were randomly assigned to wear standard (control), or minimalist shoes (experimental) at school, for nine months. Cross-sectional areas (CSA) of Abductor Hallucis (AH) and Flexor Digitorum Brevis (FDB) muscles, and toe flexor strength (TFS) of hallux and lesser toes separately, were primary outcome measures. Single leg balance (SLB), Y-balance test (YBT) and standing long jump (SLJ) were secondary outcome measures. Pre- and post-intervention measurements were analysed for between group differences with ANCOVA.
Results
Minimalist shoes resulted in moderate but statistically non-significant increases in muscle CSA (AH η²p =.04, FDB η²p =.05) and TFS (hallux η²p =.05, lesser toes η²p =.04). Significant moderate to large improvements in YBT in the experimental group were found in the postero-medial (P =.04, η²p =.07) and postero-lateral (P =.01, η²p =.10) directions. YBT (anterior, postero-medial and postero-lateral) was correlated with hallux TFS (R =.29,.27 and.33 respectively), lesser toes TFS (R =.28,.35 and.38 respectively) and SLJ (R =.30,.39 and.57 respectively). CSA of FDB was correlated with SLJ (R =.34) and SLB (R =.42).
Significance
Wearing moderate minimalist shoes long-term improves balance in children. TFS is correlated with better balance and SLJ. Moderate minimalist school shoes are recommended for children.
... Recent research has demonstrated that wearing athletic footwear (designed to increase sole thickness, providing cushioning against impacts) interferes with the functional ability of the human foot during walking. Walking barefoot compared to shod results in a reduced step and/or stride length [14][15][16][17][18], increased cadency [14,16,17], decreased double support time [14], decreased stance time [14,16,19], increased swing time [16], and decreased stride time [14,17]. Gait velocity differences between barefoot and footwear conditions revealed a decrease in velocity when barefoot [14,16]. ...
... Recent research has demonstrated that wearing athletic footwear (designed to increase sole thickness, providing cushioning against impacts) interferes with the functional ability of the human foot during walking. Walking barefoot compared to shod results in a reduced step and/or stride length [14][15][16][17][18], increased cadency [14,16,17], decreased double support time [14], decreased stance time [14,16,19], increased swing time [16], and decreased stride time [14,17]. Gait velocity differences between barefoot and footwear conditions revealed a decrease in velocity when barefoot [14,16]. ...
... Recent research has demonstrated that wearing athletic footwear (designed to increase sole thickness, providing cushioning against impacts) interferes with the functional ability of the human foot during walking. Walking barefoot compared to shod results in a reduced step and/or stride length [14][15][16][17][18], increased cadency [14,16,17], decreased double support time [14], decreased stance time [14,16,19], increased swing time [16], and decreased stride time [14,17]. Gait velocity differences between barefoot and footwear conditions revealed a decrease in velocity when barefoot [14,16]. ...
The forefoot plays an important role in providing body support and propulsion during walking. We investigated the effect of forefoot dysfunction on the gait pattern of a young adult with partial bilateral amputation of the toes. We measured our participant's gait kinematics during barefoot and shod overground walking and analysed time-distance and joint range of motion (RoM) parameters against a group of healthy adults. Forefoot dysfunction gait is improved by footwear and walking experience; however, this improvement was still remarkably different (exceeded 95% CI) when compared to healthy gait at matching walking speed. Compared to healthy gait, walking barefoot had a slower speed and a 30% reduction in ankle and knee joint RoM, but a larger hip RoM. Shod gait resulted in a remarkable increase in ankle RoM and walking speed compared to barefoot gait. These results are consistent with the important role of the forefoot (tarsals and metatarsophalangeal joints) and suggest that footwear can facilitate gait function following toe amputation.
... The impact of different types of footwear on immediate spatiotemporal variables, kinematics, kinetics, plantar loading and muscle activity have had limited investigation in children under 6 years old [14][15][16][17][18][19]. In toddlers, there has been a variable effect noted dependent on the walk experience and flexibility of footwear sole. ...
... There were no differences observed across measured spatiotemporal variables in walking and running in all footwear types, other than the shorter stride length in the hard-soled sandals. It is unknown if the observed differences in step length were due to immaturity in gait, as these changes differ to those observed in older children [13,17,33]. It is possible that as a child develops gait maturity and gait is less variable, they may be more sensitive to external factors such as footwear. ...
... While all of children within the study were independently walking for longer than 12 months, J o u r n a l P r e -p r o o f it is possible that they adapted to differing sole hardness with less changes to the gait parameters compared to the earlier walkers [13] and the older children [17,33]. Similarly, the differences that were observed may be related to the individual weight of the child and their ability to push through a sole that is harder. ...
Background
It is unknown what the impact of sole hardness is on young children’s gait. Yet, this feature is commonly marketed as having differing benefits for young children’s walking and development.
Research question
What are the differences in spatiotemporal measures of gait during walking and running in three common types of young children’s footwear with a soft sole, compared to a hard sole?
Methods
The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (aged 2 - 4 years). Participants walked or ran the length of a GAITRite mat in a randomized order in a soft (Shore 48-53) or hard soled (Shore 60-65) sneaker, boot and sandal condition. Linear regression analyses were used to investigate the difference between footwear for the different gait parameters including velocity, cadence, step time, swing percentage, stance percentage, double support time and the toe in/out angle.
Results
Children walked with a shorter stride length in the hard-soled sandals compared to the soft- soled sandals (p < 0.05). There were no other differences in spatiotemporal variables in the soft versus hard soled sandals during walking or running (p > 0.05). There were no differences in any spatiotemporal gait variables during walking or running in soft versus hard- soled runners and no differences in walking or running in soft versus hard-soled boots (p > 0.05).
Significance
There were few differences in spatiotemporal parameters between soft and hard-soled footwear in both walking and running in three different types of footwear. This may be a positive finding for footwear designers and manufacturers, as a harder sole appeared to have limited impact on spatiotemporal gait parameters.
... Más aún, Lythgo et al. (2009) elevan la edad de maduración de la marcha a los 13 años. Si a estas diferencias en la maduración de la marcha se les añade la modificación de la misma asociada a la utilización de calzado (Keenan, Franz, Dicharry, Della Croce & Kerrigan, 2011;Lythgo et al., 2009;Oeffinger, Brauch, Cranfill, Hisle, Wynn & Hicks, 1999;Wolf, Simon, Patikas, Schuster, Armbrust & Döderlein, 2008) el análisis se complica aún más. Oeffinger et al. (1999) y Wolf et al. (2008 encuentran diferencias en la marcha en niños calzados y descalzos, sin que estos cambios estuvieran asociados al sexo, con una velocidad de la marcha estable al aumentar la longitud del paso y disminuir la cadencia. ...
... la utilización de calzado cerrado por parte de los alemanes, mientras que los niños australianos caminan descalzos con mayor frecuencia o utilizan calzados abiertos. Wolf et al. (2008) observan mayor movimiento en la articulación tibio-astragalina con calzado respecto a descalzo, y lo justifican como una posible compensación de la disminución del movimiento en el plano sagital del mediopié y antepié, ya que el calzado inhibiría los movimientos del antepié afectando al mecanismo de «windlass». Morio et al. (2009) en un estudio en adultos, coinciden en que el calzado no solo limita la movilidad natural del pie descalzo, sino que también impone patrones de movimiento en la fase de impulsión. ...
... El resultado más notable y consistente es que el calzado reduce considerablemente la flexión en la articulación metatarsofalángica, en torno a 20º, por igual en marcha y en carrera en ambos géneros. Wolf et al. (2008) encuentran un valor medio de flexión del hallux de 37.1º descalzo frente a 25.7º y 27.8º según dos modelos de calzado, en este caso también se observa una reducción en los grados de flexión en la articulación metatarsofalángica aunque menores que en nuestro estudio. 19º/s FlexMax-ángulo de máxima flexión de la articulación metatarsofalángica. ...
La elección del calzado infantil durante el desarrollo del niño/a puede ser determinante en la aparición o prevención de problemas asociados con el pie por las diferentes características intrínsecas de los niños. Por ello, el objetivo del presente trabajo fue evaluar los movimientos del pie durante el apoyo en marcha y carrera con y sin calzado. Participaron 12 niños y 12 niñas de primaria. El sistema de captura del movimiento Vicon fue utilizado para obtener variables cinemáticas del movimiento del pie. Los resultados mostraron una reducción significativa en la flexión en la articulación metatarsofalángica con calzado en ambos géneros y en ambas habilidades de en torno a 20º (p < .05 y tamaño del efecto alto), pudiendo asociarse a un mecanismo de protección. Así mismo se constató un aumento de la velocidad de caída del pie en carrera con calzado, especialmente en chicas, al contrario de la marcha, posiblemente por cambios en la técnica de pisada y/o características propias del calzado según el género. Por último, se encontró un desajuste en el eje de flexión de los metatarsos de aproximadamente 1 cm hacia la parte anterior del pie con calzado (p < .05 y tamaño del efecto alto), lo que lleva a recomendar que el diseño del calzado se ajuste con más precisión a la población que lo utiliza.Abstract. The choice of children's shoes can be decisive in the appearance or prevention of problems associated with children’s feet individual characteristics. Therefore, the aim of this study was to evaluate foot movements during the support phase of walking and running gait, with and without shoes. Twenty-four primary school students (12 boys and 12 girls) participated in the study. Vicon 3D motion analysis system was used to obtain foot kinematic variables. Results showed a significant decrease in the flexion of metatarsophalangeal joint with shoes in both genders in walking and running around 20º (p < .05 and high effect size), which can be associated with a protection mechanism. We also found an increased foot fall speed when running with shoes, especially in girls, but not in walking gait, probably due to changes in the technique and/or characteristics of the shoes according to gender. Finally, data show a 1-cm forward displacement of the metatarsal flexion axis with shoes (p < .05 and high effect size), which suggests that shoes design should be more accurately adapted to children population.
... There have been a number of studies investigating different types of footwear and the gait impact of footwear in children. These studies have limited exploration to the spatiotemporal, kinematics and kinetics, plantar loading and muscle activity of either very young children during walking acquisition while barefoot, or children over the ages of six [3][4][5][6][7][8]. Spatiotemporal variables in older children have shown to change with increasing age, and wearing footwear increases velocity, step and stride length [8], and decreases their cadence and swing percentage [6] compared to barefoot. ...
... In particular, there were no differences in children's velocity regardless of whether they were walking or running in the sneakers, boots or sandals. Older children (aged between 5-11 years) have demonstrated increasing their velocity while wearing footwear compared to barefoot conditions [3,7]. Yet the velocity increase was not observed in this younger age group, which may be due to less confidence and adaptability in unfamiliar surroundings, or less conditioning to wearing footwear. ...
... This results from having a shorter leg length, therefore requiring an increased number of steps to cover any distance. This is consistent with what is known in older children [3,[6][7][8]. ...
Background
Clinicians and footwear manufacturers often advise young children to wear soft-soled footwear when they are first learning to walk. There is limited evidence as to why this advice is given, and if soft-soled shoes are as close to barefoot as thought.
Research Question
What are the differences in spatiotemporal measures of gait during walking and running in three common types of children’s footwear with a soft-soled compared to barefoot in young children?
Methods
The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (2 - 4 years). Participants walked or ran the length of a GAITrite mat in a randomized order for barefoot and soft-soled sneaker, boot and sandal conditions. Linear regression analyses were used to investigate the main effect of each soft-soled footwear compared to bare feet in the different gait parameters.
Results
For walking and running trials, cadence decreased whereas step time and stride length increased in all footwear types compared to the barefoot condition. While wearing sneakers and sandals increased the stance percentage for walking and running trials, compared to barefoot, this difference was only apparent during the running trial for the boots. Likewise, although double support time increased for both the boots and sneakers in walking and running, compared to barefoot, this difference was only observed in the sandals during walking.
Significance
This research found that various types of soft-soled footwear impacted gait compared to the barefoot condition, with some differences seen between walking and running trials.
These findings challenge the assumption that soft-soled footwear facilitate a similar gait to barefoot walking and running, although the clinical significance of these differences is unknown.
... Earlier research in this grouping focused on skeletal foot development (n = 35) inclusive of the medial longitudinal arch and digital deformity [42][43][44][45][46][47]. However the recent focus of this research grouping has considered the potential effects on neuromuscular development in terms of gait and other motor tasks (n = 45) [6,25,[48][49][50][51][52]. The remaining articles (n = 35) were in relation to the ideal attributes of footwear design and application for the child in both typical and atypical development, with a broad range study design including opinion base, cross-sectional survey through to systematic review [22,[53][54][55]. ...
... Like the anthropometrics grouping, this grouping was in relation to the methods used in the research. These studies involved the mechanical effects of footwear on the child's locomotory system, including gait (running, walking), and motor tasks (jumping, balance) [48,[113][114][115]. These studies utilised, kinetic, kinematic, electromyography, and spatio-temporal assessments [6,48,49,116]. ...
... These studies involved the mechanical effects of footwear on the child's locomotory system, including gait (running, walking), and motor tasks (jumping, balance) [48,[113][114][115]. These studies utilised, kinetic, kinematic, electromyography, and spatio-temporal assessments [6,48,49,116]. Footwear designs studied included "school footwear," athletic footwear, therapeutic footwear, and thong style flip-flops [6,25,117]. ...
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.
... For example, growing up barefoot, compared to growing up shod, in uences pediatric foot arch morphology, foot pliability, the hallux valgus angle, rearfoot strike patterns and motor performance (6,7,25). Shoes have been identi ed as an external factor that could signi cantly in uence foot development, as well as gait in children (9,11). ...
... Forefoot movement patterns are also signi cantly in uenced by shoes (9). Compared to barefoot walking, longer steps, increased knee and ankle range of motion, reduced foot movement, swing phase leg speed and shock absorption, as well as increased rearfoot strike patterns, were reported in children wearing shoes (11). ...
Background
Research shows that ill-fitting shoes can negatively impact the development of the pediatric foot, in a very direct manner. The primary aim of the study was to determine if the dimensions of available prescribed school shoes fit the foot dimensions of habitually barefoot South African children and adolescents.
Methods
A cross-sectional observational study was conducted where static standing foot measurements of children and adolescents from urban and rural schools were obtained with a mobile caliper. The maximum heel-toe-length (HTL) and foot width (FW) with an added 10 mm (millimetres) toe and width fit allowance to each participant, were compared to the corresponding school shoe length and shoe width available in retail. A mixed model ANOVA was used to compare foot dimensions between gender, age and side.
Results
Six hundred and ninety-eight school children (N=698) (431 girls; 267 boys; average age 10.86 years, SD=2.55) were participants. A total of seventy-seven (N=77) black coloured prescribed school shoes currently available in retail ranging from different styles and brands were measured. Results show that, comparing the shoe length (SL) and HTL of participants, as well as taking a10 mm toe allowance into account, fifty-nine percent (59%) of children wore shoes that were not the correct length. With regards to the shoe width (SW) and the added 10 mm of width fit allowance, ninety-eight percent (98%) of the shoes worn by participants were too narrow for their feet.
Conclusions
Results confirmed that school shoes currently available in retail, are not suited for the habitually barefoot population studied. It is recommended that the shoe manufacturing industry should consider the shoe width of school shoes for children and adolescents in habitually barefoot populations to avoid the long-term negative effect of ill-fitting shoes on the pediatric foot.
... Minimal footwear has been associated with the ability to mimic some of the barefoot walking characteristics in children (38,39). For example, Hillstrom, Buckland (38) compared the gait of toddlers with only a few months of walking experience as they walked barefoot, and in minimal and structured shoes. ...
... They noted that walking kinematics in minimal footwear were closer to the barefoot condition than in structured footwear in 12 out of 15 parameters tested. They also noted that minimal footwear allowed the medial longitudinal arch to deform more naturally than in traditional, stiff footwear (39). ...
Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 years, most footwear has become increasingly more cushioned and supportive. Here we review evidence that minimal shoes are a better match to our feet which may result in a lower risk of musculoskeletal injury.
... In contrast, it is well established that wearing shoes changes the walking patterns of older children [7]. In older children, walking in shoes often results in longer steps [8,9], a faster walking speed [8][9][10], increased knee sagittal plane range of motion [11], and reduced first metatarsophalangeal joint and three-dimensional motion of the midfoot [12], when compared to walking barefoot. Understanding whether similar changes occur in early walkers is needed to help inform footwear choices for parents and clinicians. ...
... In contrast, it is well established that wearing shoes changes the walking patterns of older children [7]. In older children, walking in shoes often results in longer steps [8,9], a faster walking speed [8][9][10], increased knee sagittal plane range of motion [11], and reduced first metatarsophalangeal joint and three-dimensional motion of the midfoot [12], when compared to walking barefoot. Understanding whether similar changes occur in early walkers is needed to help inform footwear choices for parents and clinicians. ...
The development of walking in young toddlers is an important motor milestone. Walking patterns can differ widely amongst toddlers, and are characterised by unique biomechanical strategies. This makes comparisons between newly walking toddler’s and older children’s walking difficult. Little is currently understood regarding the effects of footwear on the gait in newly walking toddlers. A quasi-experimental pre-post study design was used to assess whether spatiotemporal parameters of gait, and in-shoe foot and lower limb kinematics, differed when walking barefoot and in soft-soled footwear in newly walking toddlers. There were 18 toddlers recruited, with 14 undergoing testing. The GAITRite system collected spatial and temporal data. The Vicon camera system collected kinematic data. The testing conditions included barefoot and footwear. Footwear tested was a commercially available soft soled shoe (Bobux XPLORER). Data was extracted directly from the GAITRite system and analysed. Walking in footwear did not change spatial or temporal data, however there were small but significant decreases in hip adduction/abduction range of motion (mean difference (MD) = 1.79°, 95% CI = -3.51 to -0.07, p = 0.04), knee flexion (MD = -7.63°, 95% CI = 2.70 to 12.55, p = 0.01), and knee flexion/extension range of movement (MD = 6.25°, 95% CI = -10.49 to -2.01, p = 0.01), and an increase in subtalar joint eversion (MD = 2.85°, 95% CI = 5.29 to -0.41, p = 0.03). Effect sizes were small for hip and ankle range, peak knee extension, and subtalar joint ranges ( d <0.49), medium for knee flexion/extension range ( d = 0.75) and large for peak knee flexion ( d = 0.87). The magnitude of kinematic changes with soft-soled footwear were small thus the clinical importance of these findings is uncertain. Future longitudinal studies are needed to develop recommendations regarding footwear for newly walking toddlers.
... Children walked faster with shoes compared to barefoot walking. This is consistent with earlier studies [21][22][23][24] however in this study, the increase in gait speed was achieved primarily by increasing stride length, rather than maintaining a fixed ratio between cadence and stride length to increase speed [22,23,25]. ...
... This was a similar finding to a past study on toe walking gait [26]. The addition of shoes led to stride length and velocity parameters reaching age appropriate values, which is again similar to other studies investigating the impact of footwear on ITW gait [22,25]. ...
... The human foot is shaped throughout all life in a way that is individual for every human being. The variability of its shape is a result of various factors, including genetic, environmental, socio-economic, lifestyle and type of footwear worn [1][2][3][4][5][6][7][8]. According to Kinz et al. [9] 96-99% of children are born with healthy feet, however, 40% suffer from health problems related to feet in their adult life. ...
... Mauch et al. [2] emphasized that the wrong size of the shoe causes foot injuries and deformities as well as pain. Wolf et al. [1] showed that most of the deformities arise as a result of wearing improperly fitted boots, less often due to the use of wrongly fitted sandals or slippers. The measure of the degree of footwear fitting to the foot is a functional excess, which on the one hand is a reserve for growing feet, on the other it secures the free space in the footwear needed to lengthen the longitudinal arch (the so-called apparent increase in the length of the foot) during movement or load. ...
Background:
The human foot is shaped throughout all life in a way that is individual for every human being. Footwear fitting in the process of foot development is the issue covered by a limited range of empirical studies. This prompted the authors to undertake this subject of the study aimed at the influence of fitting of regularly worn inside the school footwear on feet morphology in primary schoolgirls.
Methods:
The study group comprised 100 girls aged 9. Feet characteristics were recorded by CQ-ST podoscope. The footwear fitting to the feet of the examined girls was tested using the Clevermess device. The data were analyzed based on the Student's t test, Wilcoxon test and regression analysis.
Results:
Appropriately fitted right indoor footwear was worn by 48% of the subjects while the left one by 43% of the group. Appropriate fitting in relation to the left and right foot width was noted in 23% of the group. The statistically significant combined effect of predictors characterizing footwear on the value of Wejsflog index of the right (p < 0.001) and left (p < 0.001) foot and influence of the length excess on the heel angle of the left foot (p = 0.006) were found.
Conclusions:
Most examined girls wear poorly fitted indoor footwear. The length excess of the indoor footwear has connections with the Wejsflog index of the right and left foot and the heel angle of the left foot. The larger the length excess, the lower the transverse arch. In the production of indoor footwear the differences in the feet width should be taken into account.
... A set of 36 markers (9 mm) were placed bilaterally on bony landmarks to model the tibia, hindfoot, forefoot, and hallux (Wang, Thur, Gutierrez-Farewik, Wretenberg, & Brostr€ om, 2010). Holes of 20 mm were cut in the shoe upper material to obtain inshoe foot kinematics, the position of each hole was referenced to the underlying anatomical landmarks based on the OFM (Wolf et al., 2008). Good consistency in kinematic waveform estimation and good intrarater reliability of the in-shoe multi-segment foot kinematics were approved as noted in previous studies. ...
... The windlass mechanism of the foot is dependent on the dorsiflexion of the MTP joint at initial contact to increase plantar aponeurosis tension and in turn inverts the hindfoot. Wolf et al. (2008) demonstrated significantly reduced medial longitudinal arch length in shod walking compared to barefoot walking, which suggested that shoes inhibit the windlass mechanism. While this study failed to find any difference in foot torsion ROM between BF/SH conditions. ...
Backward walking (BW) has been extensively used in athletic training and orthopedic rehabilitation as it may have value for enhancing balance. This study identified the differences in foot intersegment kinematics (forward walking (FW) vs. time-reversed BW) and plantar pressure parameters of 16 healthy habitually shod individuals walking FW and BW using flexible shoes (SH) and under barefoot conditions (BF). BW was found to have shorter stride length (SL) and higher stride frequency (SF) under BF conditions compared with SH, which indicates a better BW gait stability under BF conditions. Decreased HX/FF dorsiflexion at HO in BW induces less plantar aponeurosis tension which may inhibit the windlass mechanism compared to FW walking. Increased forefoot relative to hindfoot (FF/HF) pronation and sequentially hindfoot relative to tibia (HF/TB) eversion combined with medially distributed plantar pressure and a higher plantar contact area in the medial side in BW-BF maybe beneficial in maintaining balance. These results indicate that BW training may be more reliable under BF conditions compared to the SH conditions based on greater sensory information feedback from the plantar area resulting in better biomechanical behavior.
... 3,5,6 Hallux angle deformities are frequently observed in cases where individuals wear shoes that are either too narrow or too short for their feet. [7][8][9] A study conducted in South Africa reported that 80% of participants experienced foot pathologies as a result of wearing ill-fitting footwear. 10 However, it is important to note that the study had a limited sample size, consisting of only 60 women. ...
... 65 The gait pattern in MF has been reported to be more similar to that of BF walking. 10,68,69 Only 2 studies have compared walking in MF versus BF. 29,70 One study found a significant effect on kinematic gait parameters (cadence, step length, foot progression angle, and center of pressure length) and kinetic gait parameters (vGRF) between both conditions. 29 The other study reported no significant differences in kinematic knee parameters (angles) and kinetic knee parameters (net joint moments) in any planes between MF and BF, but the investigators suggested that MF might be an optimal compromise for healthy adults, considering the gait symmetry parameters. ...
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.
... However, the bone-mounted marker approach is not widely accepted because of its invasive preparation procedures [15]. Attaching markers directly to the skin by drilling holes in the shoes is an alternative approach for studying multi-segment foot motion [25,26]. Furthermore, to accurately assess the actual foot motion, Sterzing et al. [27] removed the original shoe upper and modified the upper with custom-made sock technology, which was thin and made of neoprene material for stretch boots. ...
We investigated how midfoot stiffness of running shoes influences foot segment kinemat-ics and ground reaction force (GRF) during heel-toe running. Nineteen male rearfoot strike runners performed overground heel-toe running at 3.3 m/s when wearing shoes with different midfoot bending stiffnesses (low, medium, and high) in a randomized order. A synchronized motion capture system (200 Hz) and force plate (1000 Hz) were used to collect the foot-marker trajectories and GRF data. Foot kinematics, including rearfoot-lab, midfoot-rearfoot, forefoot-rearfoot, and forefoot-midfoot interactions, and kinetics, including GRF characteristics, were analyzed. Our results indicated that high midfoot stiffness shoes reduced the forefoot-rearfoot range of motion (mean ± SD; high stiffness, 7.8 ± 2.0°, low stiffness, 8.7 ± 2.1°; p < 0.05) and forefoot-midfoot range of motion (mean ± SD; high stiffness, 4.2 ± 1.1°, medium stiffness, 4.6 ± 0.9°; p < 0.05) in the frontal plane. No differences were found in the GRF characteristics among the shoe conditions. These findings suggest that an increase in midsole stiffness only in the midfoot region can reduce intersegmental foot medial-lateral movements during the stance phase of running. This may further decrease the tension of the foot muscles and tendons during prolonged exercises.
... Shoes are primarily used to protect the foot from injuries and improve running performance (Wolf et al., 2008;Fuller et al., 2015;Kakouris et al., 2021). In the shod condition, the foot and shoe act together to modulate the mechanical function of the first metatarsophalangeal joint (MTPJ) (Day and Hahn, 2019). ...
The biomechanics of the first metatarsophalangeal joint (MTPJ) is affected by different shoe conditions. In the biomechanical research field, traditional skin marker motion capture cannot easily acquire the in vivo joint kinematics of the first MTPJ in shoes. Thus, the present study aims to investigate the differences of the first MTPJ’s six-degree-of-freedom (6DOF) kinematics between shod and barefoot running by using a high-speed dual fluoroscopic imaging system (DFIS). In total, 15 healthy male runners were recruited. Computed tomography scans were taken from each participant’s right foot for the construction of 3D models and local coordinate systems. Radiographic images were acquired at 100 Hz while the participants ran at a speed of 3 m/s ± 5% in shod and barefoot conditions along an elevated runway, and 6DOF kinematics of the first MTPJ were calculated by 3D–2D registration. Paired sample t-tests were used to compare the kinematic characteristics of the first MTPJ 6DOF kinematics during the stance phase between shod and barefoot conditions. Compared with barefoot, wearing shoes showed significant changes (p < 0.05): 1) the first MTPJ moved less inferior at 50% but moved less superior at 90 and 100% of the stance phase; 2) the peak medial, posterior, and superior translation of the first MTPJ significantly decreased in the shod condition; 3) the extension angle of the first MTPJ was larger at 30–60% but smaller at 90 and 100% of the stance phase; 4) the maximum extension angle and flexion/extension range of motion of the first MTPJ were reduced; and 5) the minimum extension and adduction angle of the first MTPJ was increased in the shod condition. On the basis of the high-speed DFIS, the aforementioned results indicated that wearing shoes limited the first MTPJ flexion and extension movement and increased the adduction angle, suggesting that shoes may affect the propulsion of the first MTPJ and increase the risk of hallux valgus.
... (Rao and Joseph, 1992;MacKenzie et al., 2012). Flexible lat foot is the consequences of a dynamic functional transition of the lower extremity and not a matter of static ankle and foot complex alignment (Wolf et al., 2008). ...
Flat foot is also called Plano-valgus foot, and it is a term, that is commonly used in describing flat foot. Some studies have suggested, that certain foot-specific exercises and barefoot weight bear walking can change foot function like flat foot, and also confirm that shoed walking children are more likely to get a flat foot. An Assessor blinded, Randomized controlled trial with thirty-eight children with flat foot aged 6 – 14 years, both male and female were randomised to the control group (n= 19) and intervention group (n=19). The control group had performed barefoot walking for 45 minutes a day for eight weeks, and the intervention group had received foot-specific exercises with barefoot walking for eight weeks. Foot posture was evaluated by the arch index, while the Oxford foot and ankle questionnaire was used to measure the subjective well-being of children. Measurements were taken before and after the eight weeks of intervention. The outcome of the randomised control trial showed that the barefoot walking group faired far better than that which didn't (p-value <0.05). The intervention group outcomes measure Arch Index, and Oxford Foot and Ankle Questionnaire were p-values is <0.05 from seventh and eight weeks. This study results suggest that barefoot walking and specific foot exercises are effective in improving the flat foot in school-going children.
... While at birth just 1% of the participants had a foot problem, by age five, it was already 41%, and by age 20, it was the incredible number of 80% (Rossi, 1999). Observations of habitual barefoot walkers show that they anatomically have wider feet (D'aout et al., 2009), a reduced step/stride length (Lythgo et al., 2009;Oeffinger et al., 1999;Wolf et al. 2008), flatter foot placement (D'aout et al., 2009), and many more benefits. A systematic review of this topic has been analysed in 466 articles (Franklin, 2015). ...
The aim of this article is to point out the potential of urban spaces that have not been primarily meant to be barefoot parks. The stimulation of bare feet is used as a part of therapy or for the prevention of plantar problems. The high number of research papers or blogs available about bare feet shows the interest in this topic among scientists, doctors and the broader population. People are usually shod in a city environment. An analysis of some existing barefoot/sensomotoric spaces compares 3 different projects located in Italy, Germany, and Colombia. The paper shows the common and different approaches in information systems and the amount, variability, and spatial arrangement of stimulation surfaces of these projects. The same method of categorization is used in the analysis of a newly reconstructed park in Slovakia, which was built without a request for a barefoot space. A comparison of these analyses shows the high potential for a regular park having a barefoot area. This research proves that barefoot places in urban areas could be instituted without any significant financial or construction interventions.
... A child's foot undergoes continuous developmental changes throughout childhood that include -a diminution of the plantar fat pad [1], arch development and stabilisation of the medial longitudinal arch [2], and an increase in size and strength of the foot [3]. There is a growing understanding of the developmental influences of external and internal factors on children's foot health and performance outcomes; including footwear choices [4], demographics [5], barefoot versus shod childhood [6], and the influence of toe flexor strength on physical performance [7]. Due to extensive changes during childhood, and the large range of growth and development, it can be challenging measuring strength in smaller foot muscles [8]. ...
Background
Stronger toe flexor muscles improve performance outcomes in children, including balance, sprinting, jumping and side stepping. Toe flexor strength (TFS) is recommended as part of the clinical assessment of foot function in children. Fixed dynamometry, rather than handheld, is the gold standard of measurement; however, it can be prohibitively costly. No fixed dynamometer reliability studies on toe flexion have been conducted in children to date.
Research questions
Does the novel fixed hand-held dynamometer (HHD) protocol provide reliable intra-rater and test-retest measurements of toe flexor strength in children aged 10 to 12?
Methods
Two trials were recorded from 14 healthy children (10–12 years), 7–14 days apart by the same rater. A Lafayette HHD (model 01163) measured peak force. The HHD was secured in a mobile custom mould below a step with a strap, which secured the foot of the participant. The receptor pads of the HHD were level with the upper surface of the step, maintaining neutral toe joints at rest. The participant was seated on an adjustable stool to ensure the hip, knee and ankle were each at 90° flexion, with the testing foot flat on the upper surface of the step. The averages of three maximal five second efforts were used for data analysis using a two-way mixed effects model with repeated measures ANOVA (intraclass correlation coefficient ICC 3,3). Standard error of measurement (SEM) was calculated to determine the absolute between trial variability.
Results
The novel fixed HHD protocol provided excellent test-retest reliability with small measurement error for hallux (ICC 3,3 = 0.93, 95 % CI 0.78−0.98, SEM = 4.31 N) and lesser toe flexor strength testing (ICC 3,3 = 0.96, 95 % CI 0.87−0.99, SEM = 1.86 N).
Significance
The fixed HHD protocol described in this study has excellent reliability for the test-retest evaluation of children’s toe flexor strength.
... Reliable measurements describing these internal bio-mechanical effects are necessary but difficult to achieve; for example, individual bone movements and deformation of the ligaments of the foot under load are poorly characterized because they are difficult to observe directly. The effect of the shoe has therefore been studied using different types of measurements, including movements of the foot segments, plantar pressures, the user's oxygen demand, associated injuries, and many others (Zipfel and Berger, 2007;Wolf et al., 2008;Hagen and Hennig, 2009;Morio et al., 2009;Fuller et al., 2015;Ferber and Hettinga, 2016); but the impact of the shoe on the internal biomechanical behavior is poorly characterized as there is no available methodology to obtain such measurement. It is likely that the effect of footwear is mainly observed in dynamic and active situations, however understanding the passive and static effect of a shoe on internal structures is a first step toward a better comprehension of the different mechanisms involved. ...
The mechanical behavior of the foot is often studied through the movement of the segments composing it and not through the movement of each individual bone, preventing an accurate and unambiguous study of soft tissue strains and foot posture. In order to describe the internal behavior of the foot under static load, we present here an original methodology that automatically tracks bone positions and ligament deformations through a series of CT acquisitions for a foot under load. This methodology was evaluated in a limited clinical study based on three cadaveric feet in different static load cases, first performed with bare feet and then with a sports shoe to get first insights on how the shoe influences the foot's behavior in different configurations. A model-based tracking technique using hierarchical distance minimization was implemented to track the position of 28 foot bones for each subject, while a mesh-morphing technique mapped the ligaments from a generic model to the patient-specific model in order to obtain their deformations. Comparison of these measurements between the ex vivo loaded bare foot and the shod foot showed evidence that wearing a shoe affects the deformation of specific ligaments, has a significant impact on the relative movement of the bones and alters the posture of the foot skeleton (plantar-dorsal flexion, arch sagging, and forefoot abduction-adduction on the midfoot). The developed method may provide new clinical indicators to guide shoe design and valuable data for detailed foot model validation.
... Footwear intended for therapeutic purposes in children consists of a broad range of designs and clinical applications including pes planus, talipes equino varus, toe walking, cerebral palsy and developmental delay [9,[11][12][13][14][15][16]. Footwear appears to be widely prescribed as an assistive device by some healthcare professionals [17], and a number of studies demonstrate that conventional footwear has significant effects on typically developing children's gait [18,19]. However, in contrast to other assistive aids such as ankle-foot orthoses which have seen an increase in research [20][21][22][23], there appears to be a lack of understanding on the design, effects and purpose of therapeutic footwear on children living with a mobility impairment [24][25][26]. ...
Background
It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children.
Methods
A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers.
Results
Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled “corrective and “functional” based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited.
Conclusion
Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.
... Generally, it seems that children are able to take longer steps and consequently increase their speed. However, the reason that the velocity in our experiment and those of Wolf et al. (2008) and Chen et al. (2015) were not significant different might be due to the use of commercial and experimental shoes in comparison to athletic or running shoes in the experiments of Lythgo et al. (2009) andWegener et al. (2015). ...
Progression or impediment of fundamental motor skills performance (FMSP) in children depends on internal and environmental factors. Shoes as an environmental constraint are believed to affect these movements as children showed to perform qualitatively better with sports shoes than flip-flop sandals. However, locomotor performance assessments based on biomechanical variables are limited. Therefore, the objective of this experiment was to assess the biomechanical effects of wearing shoes while performing fundamental motor skills in children. Barefoot and shod conditions were tested in healthy children between the age of 4 and 7 years. They were asked to perform basic and advanced motor skills including double-leg stance, horizontal jumps, walking as well as counter-movement jumps, single-leg stance and sprinting. Postural control and ground reaction data were measured with two embedded force plates. A 3D motion capture system was used to analyse the spatiotemporal parameters of walking and sprinting. Findings showed that the parameters of single- and double-leg stance, horizontal and counter-movement jump did not differ between barefoot and shod conditions. Most of the spatiotemporal variables including cadence, stride length, stride time, and contact time of walking and sprinting were statistically different between the barefoot and shod conditions. Consequently, tested shoes did not change performance and biomechanics of postural control and jumping tasks; however, the spatiotemporal gait parameters indicate changes in walking and sprinting characteristics with shoes in children.
... There has also been an observation of changes in lower limb kinetics with shoes changing tibialis anterior activity (compared to barefoot in children with a mean age of 7.7 years (range 2-15 years) [6]. In another study, shoes were also noted to decrease the intrinsic motion of the foot, which could indicate possible splinting effect of shoes on foot joints, a study undertaken with children aged above six years [7]. ...
Background:
There is limited evidence of shoe impact in younger children, particularly in the context of immature gait patterns. It is unclear if the impact from shoes in younger children is similar to what has been seen in older children. This systematic review aims to identify any impact of shoe features on younger children's gait, and if there are any differences between shoe sole flexibility compared to barefoot.
Methods:
Study inclusion criteria included: typically developing children aged ≤6 years; comparison of barefoot and shod conditions (walking and/or running) with shoe features or style of shoe described; sample size > 1. Novelty types of footwear were excluded, as was any mention of in shoe support or modifications. Studies were located from six databases. Study methodology was assessed using the McMasters critical review form. Sample size weighted standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.
Results:
Four studies were included. Participant age ranged from 15.2 to 78.7 months, with 262 participants across all studies. All studies had limited methodological bias based on their design type. Compared to barefoot walking, shoes increased velocity, step time and step length. Shod walking decreased cadence. Peak plantar pressure was generally lower in the stiff shoe design and there was a higher peak plantar pressure in the Ultraflex shoes. No studies were found investigating muscle activation.
Conclusions:
Shoes affect younger children's gait in spatiotemporal gait aspects, similar to those seen in older children. There is limited evidence on effects of particular shoe features such as sole hardness, on gait, and no evidence of any changes in muscle activation patterns. Further research is required to evaluate the impact of different types of shoe and shoe features in this population to provide clinical advice on the type of shoe that is appropriate in this age group.
... We did not find any differences in postural and dynamic stability nor in physical function between barefoot and minimal shoes. Previous research has shown that minimal footwear is similar to barefoot in kinematics and kinetics (Wirth et al., 2011;Wolf et al., 2008) and in lower-leg muscle activity during walking (Franklin et al., 2018). Our findings further strengthen the claim that minimal footwear is similar to barefoot by showing no differences in movement of the CoP during standing and walking, nor in performance-based physical function. ...
Background:
Effects of minimal shoes on stability and physical function in older people are under-researched. No studies have systematically explored effects of a range of minimal footwear features on these factors in older people.
Methods:
A within-participant repeated-measures design was used. Participants were subjected to thirteen footwear conditions: (i) barefoot, (ii) a conventional shoe, (iii) a control minimal shoe, (iv-xiii) minimal shoes differing from the control minimal shoe by one design feature. The outcomes were: (i) postural stability expressed with movement of the center of pressure (CoP) during standing (ii) dynamic stability expressed with the CoP movement during walking, (iv) physical function assessed with the Timed Up and Go test (TUG), and (iv) perceptions of footwear assessed with the Monitor Orthopaedic Shoes questionnaire. Linear Mixed Models were applied for statistical analyses.
Findings:
Twenty-two people participated in the study. Compared to the conventional shoe, participants: (i) were more stable during standing and walking in the majority of minimal shoes, and (ii) completed the TUG test faster when wearing the minimal shoe with wider sole. Compared to the control minimal shoe, participants: (i) completed the TUG test faster when wearing the minimal shoe with wider sole; and (ii) perceived features such as a split toe and a higher ankle collar as less fashionable and wearable.
Interpretation:
Wearing minimal shoes might be more beneficial for stability and physical function in older adults than wearing conventional shoes. The results will be highly valuable for the design of minimal footwear for older adults.
... Since the shoe can affect the gait parameters, the subjects used the same shoes at the baseline and intervention phases during kinematic measurements. 21 One pair of the novel type of custom-molded insoles was made for each subject by a certified orthotist ( Figure 1). ...
The medial longitudinal arch of the foot is a dynamic structure while walking. The mobility of this structure in people with flexible flatfoot is partially or completely absent. The aim of this study was to investigate the efficacy of an insole that was designed to retrieve the medial longitudinal arch mobility in people with flatfoot. The study was a case series using a single-subject design. This single-subject design study was based on three subjects with flexible flatfoot. This study was designed in two phases: the baseline phase and the intervention phase. Each phase included five measurement sessions that were done in 5 consecutive weeks. We used the celeration-line method to detect the significant differences between the phases. Significant differences were recorded in the walking velocity, step length, and medial longitudinal arch mobility parameters when using the hydrodynamic insole. The results of this study showed that using the hydrodynamic insole may have a positive effect on the foot kinematics and gait parameters in people with flexible flatfoot.
... In the thigh and leg segments, rigid clusters were also used according to the Lowerbody Vincon Model (Plug-in Gait) (39,40). To avoid marker displacement between the BL and both TS conditions, and to reduce the influence of the footwear on the gait pattern, all participants used the same model of commercially available sneakers during the test protocol (41). The markers were placed in anatomical landmarks equivalent to those reported in the literature (42). 1 II III III I I I I I II 2 II III III II II I I II II 3 I III III III III III I II II 4 I II II I I I I I II 5 I II II II II I I II II 6 II III III II II II I II II 7 I II II I I I I I For the hallux and heel, the markers were placed on the shoe in positions that best reproduced the reported barefoot anatomical references (42). ...
This study analyzes the immediate effects of wearing a Therasuit on sagittal plane lower limb angular displacements during gait in children with unilateral spastic cerebral palsy (US-CP). Seven participants (median age = 7.00 years; ranging from 5.83 to 9.00 years) with US-CP, levels I and II of the Gross Motor Function Classification System, were assessed with kinematic gait analysis in three different conditions: (A) Baseline; (B) Therasuit without elastics and (C) Therasuit with elastics. Significant improvements were observed at the hip joint of both lower limbs during most of the gait cycle in participants wearing a Therasuit, including a decrease in the flexion pattern at the initial contact and swing phase in both lower limbs, and an increase in the extension pattern in the paretic lower limb during the stance phase. At the knee joint in the paretic lower limb, significant differences were found between the baseline and Therasuit with elastics conditions on the knee angle at initial contact, and between baseline and both Therasuit conditions on the flexion angle at swing phase. However, the inter-individual variability in kinematic patterns at the knee joint was high. At the ankle joint, decreased plantar flexion at initial contact and increased dorsiflexion during stance and swing phases were observed at the Therasuit with elastics condition, helping to correct the equinus-foot in the paretic lower limb during the whole gait cycle. The Z-values showed large effect sizes particularly for most of the angular hip variables in both lower limbs and for the angular ankle variables in the paretic lower limb. The Therasuit seems to have some positive immediate effects on gait kinematics in children with spastic unilateral cerebral palsy by providing a more functional and safer gait pattern. Future investigations with larger samples are recommended to further support these findings.
Деформитети стопала код дјеце, као и деформитети читавог локомоторног апарата, постају глобални проблем данашњице усљед седентарног начина живота, лоше исхране и смањења тјелесне активности. Важност превенције појаве деформитета стопала код дјеце је непроцјенљива. Циљ овог истраживања јесте приказати преглед досадашњих истраживања деформитета стопала код дјеце узраста од 6. до 11. година живота. Истраживање је вршено мета- анализом 50 научно-истраживачких страних радова. На основу анализираних радова долази се до закључка да је присутност деформитета стопала подједнако заступљена и код дјечака и код дјевојчица. Највећи утицај на појаву деформитета стопала код дјеце млађег школског узраста има обућа коју дијете носи, а први знаци постојања деформитета су болови у стопалима.
Minimalist shoes are proposed to promote walking gait patterns more similar to natural bare-
foot gait. While there is already considerable research evaluating the effects of minimalist shoes
on running biomechanics, little has been reported about the effects of minimalist shoes on kine-
matic and kinetic parameters during normal gait. Therefore, the purpose of this study was to
compare biomechanical gait parameters between walking in non-cushioned minimalist shoes, in
conventional cushioned shoes and barefoot. Kinematic (cadence, step length, foot progression
angle, length of CoP) and kinetic (vGRF) parameters of 32 healthy adults were collected at pre-
ferred walking speed on an instrumented treadmill. ANOVA or Friedman- Tests were applied for
between condition comparisons. In case of significant (p < 0.05) main effects, post-hoc analyses
were implemented for pairwise comparisons. Significant main effects of footwear conditions
were found for all parameters (p < .001). Post-hoc analyses revealed that increased cushioning
properties of the applied footwear are associated with increased step lengths, lengths of CoP
trajectory and foot progression angle as well as a reduced cadence. Additionally, decreased
cushioning resulted in increased vGRF, especially of the forefoot and rearfoot. Results indicate
that footwear significantly affects biomechanical gait parameters in a group of healthy adults.
The findings have implications on the use of footwear during walking gait, with special
emphasis on the cushioning properties of the different conditions.
This study aimed to compare the foot muscle morphology and foot posture between healthy adults and lifesavers in sandy beach sports. The participants included 15 lifesaver athletes and 15 healthy adults. Using a non-contact three-dimensional foot measurement device, the foot length, width, and arch height of the right foot were measured while standing and sitting without back support, and the transverse arch length ratio and arch height index were subsequently calculated. Muscle cross-sectional area was measured using an ultrasound imaging device. Muscle cross-sectional areas, arch height, foot width, arch height index, and transverse arch length ratio were larger in the lifesaver than in the healthy adult group. Lifesavers had higher arches and more developed intrinsic and extrinsic muscles than healthy adults. Performing physical activity while barefoot on sandy beaches may effectively develop the foot intrinsic and extrinsic muscles and raise the arch.
Persons with ankle osteoarthritis (AOA) often seek surgical intervention to alleviate pain and restore function; however, recent research has yielded no superior choice between the two primary options: fusion and replacement. One factor yet to be considered is the effect of footwear on biomechanical outcomes. Comparisons of AOA biomechanics to a normative population are also sparse. The objectives of this study were to 1) determine how footwear uniquely affected gait in persons with ankle fusion and replacement, and 2) provide context for AOA biomechanics via comparisons to a healthy adult sample. Thirty‐four persons with AOA performed overground walking trials barefoot and shod prior to surgical intervention, and then received either an ankle fusion (n=14) or replacement (n=20). Two and/or three years post‐surgery, patients returned for gait analysis. Nineteen controls performed the same gait procedures during a single study visit. Spatiotemporal variables and peak angles, internal moments, powers, and forces were calculated to quantify gait behavior. Overall, the two surgical groups performed similarly to each other, but demonstrated marked differences from controls both pre‐ and post‐surgery. No significant differences were detected when examining the effect of footwear. The motion of the midfoot with respect to the hindfoot and forefoot may be instrumental in gait biomechanics following an ankle fusion or replacement, and should be considered in future investigations.
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Wearing shoes of insufficient length leads to the development of bunions (hallux valgus). We inspected the feet and the fit of shoes worn by pre-school-aged children in Japan and compared the results with those of children who went only barefoot at pre-school. The hallux angles of 1238 feet were recorded. Only 12.3% of the children presented with a straight position of the great toe and 19.1% of the children’s feet presented with a valgus angle of over 10°. 75.5% of 620 children were wearing outdoor shoes of insufficient length, 84.6% of 381 children had indoor shoes that were too short. A significant correlation between the fit of the shoes and the hallux angle was observed: the shorter the shoe, relative to foot length, the greater the hallux angle. The relative risk of a lateral hallux deviation, higher than the background risk, increases up to 30% if outdoor shoes are two sizes too short. The hallux angle in children who went barefoot was significantly smaller compared to those who habitually wore indoor shoes. Going barefoot can possibly help to counteract the increased hallux angle caused by regularly wearing shoes of insufficient length.
1 ﺻﺪري اﻣﯿﺮﺣﺴﯿﻦ ، 2 ﭼﮑﯿﺪه ﻫﺪف و ﺳﺎﺑﻘﻪ : ﺑﻬﯿﻨﻪ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي وﺟﻮد ﺑﻪ ﻧﯿﺎز رﻓﺘﻦ راه روي ﺑﺮ ﭘﺎ ارﺗﺰﻫﺎي اﺛﺮات ﺑﺎ ارﺗﺒﺎط در دارد. ﻣﻔﺼﻞ ﭼﻨﺪﯾﻦ ﺑﯿﻦ در ﻫﻤﺎﻫﻨﮕﯽ اي دارد. وﺟﻮد اﻧﺪﮐﯽ اﻃﻼﻋﺎت رﻓﺘﻦ راه ﻃﯽ ﺻﺎف ﭘﺎي ﮐﻒ داراي ﮐﻮدﮐﺎن در ﺗﺤﺘﺎﻧﯽ اﻧﺪام ﻣﻔﺎﺻﻞ ﺑﯿﻦ ﻫﻤﺎﻫﻨﮕﯽ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي اﯾﻦ از ﻫﺪف آﻧﯽ اﺳﺘﻔﺎده اﺛﺮ ﺑﺮرﺳﯽ ﻣﻄﺎﻟﻌﻪ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي روي ﺑﺮ ﭘﺎ ارﺗﺰ ﻫﻤﺎﻫﻨﮕ اﻟﮕﻮي ﯽ ﺻﺎف ﭘﺎي ﮐﻒ داراي ﮐﻮدﮐﺎن در ﺗﺤﺘﺎﻧﯽ اﻧﺪام ﻣﻔﺎﺻﻞ ﺑﯿﻦ ﻣﻨﻌﻄﻒ ﺑﻮد. روش و ﻣﻮاد ﻫﺎ : 15 ﺷﺪﻧﺪ. داوﻃﻠﺐ ﻣﻄﺎﻟﻌﻪ اﯾﻦ در ﺷﺮﮐﺖ ﺟﻬﺖ ﻣﻨﻌﻄﻒ ﺻﺎف ﭘﺎي ﮐﻒ ﺑﺎ ﭘﺴﺮ ﮐﻮدك داده ﮐﯿﻨﻤﺎﺗﯿﮑ ﻫﺎي دو ﻃﯽ ﯽ ارﺗﺰ ﺑﺪون و ﺑﺎ رﻓﺘﻦ راه ﺷﺮاﯾﻂ ﺗ ﺳﯿﺴﺘﻢ وﺳﯿﻠﻪ ﺑﻪ دورﺑﯿﻦ ﭼﻬﺎر ﺷﺎﻣﻞ ﺣﺮﮐﺖ ﺤﻠﯿﻞ Vicon ﻫﻤﺎﻫﻨﮕﯽ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ﻣﻘﺎدﯾﺮ اداﻣﻪ در ﺷﺪ. ﺛﺒﺖ ﭘﺎ ﻣﭻ ﻣﻔﺎﺻﻞ ﺑﯿﻦ-ﭘﺎ ﻣﭻ زاﻧﻮ،-زاﻧﻮ و ران،-ﺷﺪ. ﻣﺤﺎﺳﺒﻪ ﺑﻌﺪ ﺳﻪ در ران ﯾﺎﻓﺘﻪ ﻫﺎ : ﻣﯿﺰ ﭘﺎ ﻣﭻ ﻣﻔﺎﺻﻞ ﺑﯿﻦ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ان-ﮐﺎﻫﺶ اﺳﺘﻘﺮار ﻣﯿﺎﻧﻪ ﻓﺎز ﻃﯽ ﺳﺠﯿﺘﺎل ﺻﻔﺤﻪ در زاﻧﻮ) 011 / 0 = P (در و دو ﻓﺮوﻧﺘﺎل ﺻﻔﺤﻪ) 023 / 0 = P ﻫﻮر و (ﯾ ﺰﻧﺘﺎل) 001 / 0 = P ﻣﻘﺎ در ارﺗﺰ از اﺳﺘﻔﺎده ﻫﻨﮕﺎم (ﯾ ﺴﻪ ﺷﺮا ﺑﺎ ﯾ ﻂ اﻓﺰا ارﺗﺰ ﺑﺪون ﯾ ﺶ ﻣﻌﻨﺎدار ي داد ﻧﺸﺎن. ﻣﻔﺎﺻﻞ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي زاﻧﻮ-ﭘﺎﺳﺦ ﻓﺎز ﻃﯽ ﻓﺮوﻧﺘﺎل ﺳﻄﺢ در ران ﺑﺎرﮔﯿﺮي) 015 / 0 = P ﻣﭻ ﻣﻔﺎﺻﻞ ﺑﯿﻦ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ﻫﻤﭽﻨﯿﻦ و (ﭘﺎ-ﻫﻞ ﻓﺎز ﻃﯽ ﻓﺮوﻧﺘﺎل ﺳﻄﺢ در ران دادن) 01 / 0 = P (راه ﺷﺮاﯾﻂ در رﻓﺘﻦ ﻣﻌﻨﺎ ﮐﺎﻫﺶ ارﺗﺰ ﺑﺎ ﻣﯽ دارا ارﺗﺰ ﺑﺪون رﻓﺘﻦ راه ﺷﺮاﯾﻂ ﺑﺎ ﻣﻘﺎﯾﺴﻪ در را داري ﺑﺎﺷﺪ. ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ﻣﯿﺎﻧﮕﯿﻦ زاﻧﻮ ﻣﻔﺎﺻﻞ ﻫﻤﺎﻫﻨﮕﯽ-ﻫﻮرﯾﺰ ﺳﻄﺢ در ران در ارﺗﺰ از اﺳﺘﻔﺎده ﺷﺮاﯾﻂ ﻃﯽ ﻧﺘﺎل را ﻣﻌﻨﺎداري اﻓﺰاﯾﺶ ارﺗﺰ از اﺳﺘﻔﺎده ﺑﺪون ﺷﺮاﯾﻂ ﺑﺎ ﻣﻘﺎﯾﺴﻪ) دادن ﻫﻞ ﻓﺎز ﻃﯽ در 0001 / 0 = P د ﻧﺸﺎن (اد. ﻧﺘﯿﺠﻪ ﮔﯿﺮي : ﭘﺎ ﻣﭻ ﺑﯿﻦ را ﻫﻤﺎﻫﻨﮕﯽ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ﻣﻘﺎدﯾﺮ ﺗﻐﯿﯿﺮ ﻗﺎﺑﻠﯿﺖ ﭘﺎ ارﺗﺰ از اﺳﺘﻔﺎده ﻣﺠﻤﻮع در-زاﻧﻮ در ران ﭘﺎ ﻣﭻ و ﺳﺠﯿﺘﺎل ﺻﻔﺤﻪ در داد. ﮐﺎﻫﺶ ﻓﺮوﻧﺘﺎل ﺻﻔﺤﻪ ﯾﺎﻓﺘﻪ ﻣﻘ ﺑﺮ ارﺗﺰ ﺗﺎﺛﯿﺮات ﺑﯿﺸﺘﺮﯾﻦ ﮐﻪ داد ﻧﺸﺎن ﻫﺎ ﺻﻔﺤﻪ در ﻫﻤﺎﻫﻨﮕﯽ ﺗﻐﯿﯿﺮﭘﺬﯾﺮي ﺎدﯾﺮ ﻣﯽ ﻓﺮوﻧﺘﺎل ﺑﺎﺷﺪ. ﮐﻠﻤﺎت ﮐﻠﯿﺪي : ﺗﻐﯿﯿﺮﭘﺬﯾﺮي، ﭘﺎ ﮐﻒ ﭘﺎ ارﺗﺰ ﺻﺎف، ي. 1. اﯾﺮان. اردﺑﯿﻞ، اردﺑﯿﻠﯽ، ﻣﺤﻘﻖ داﻧﺸﮕﺎه ﺗﺮﺑﯿﺘﯽ، ﻋﻠﻮم و رواﻧﺸﻨﺎﺳﯽ داﻧﺸﮑﺪه ورزﺷﯽ، ﺑﯿﻮﻣﮑﺎﻧﯿﮏ اﺳﺘﺎدﯾﺎر ﻣﺴﺌﻮل، ﻧﻮﯾﺴﻨﺪه amiralijafarnezgad@gmail.com 2. ورزﺷﯽ ﺑﯿﻮﻣﮑﺎﻧﯿﮏ ارﺷﺪ ﮐﺎرﺷﻨﺎﺳﯽ داﻧﺸﺠﻮي اﯾﺮان اردﺑﯿﻞ، اردﺑﯿﻠﯽ، ﻣﺤﻘﻖ داﻧﺸﮕﺎه ﺗﺮﺑﯿﺘﯽ، ﻋﻠﻮم و رواﻧﺸﻨﺎﺳﯽ داﻧﺸﮑﺪه
Background
The variability of center of pressure (COP) is a measure of stability commonly examined during quiet standing. While more recent research has examined the variability of COP during walking, an adequate comparison between shod and unshod walking conditions has yet to be made.
Research Question
What is the influence of athletic footwear on the variability of COP displacement during walking?
Methods
In this intervention study, twenty healthy women (age 18-30 years) completed 2, 10-min walking trials, 1 shod and 1 unshod, during which ground reaction forces (GRF) and COP movement were collected by an instrumental treadmill. COP displacement was examined in the medial-lateral (ML) and anterior-posterior (AP) directions after being divided into quadrants based on the peaks and trough of each steps associated vertical GRF. A single MANOVA was used to determine effects of footwear and limb for each quadrant with the probability of a Type I error set at 0.05.
Results
Significant differences in variability were seen between footwear conditions in all quadrants in the AP direction and quadrants one and four in the ML directionThese results may be due to the structure of footwear, including midsole cushioning, altering the dynamics of the foot during walking.
Significance
The results of this study suggest that on average, athletic footwear reduces the variability of COP displacement in ML and AP directions. This may have implications for populations for whom variability of COP is determined to be undesirable.
This study examines the relationship between floating toes and plantar arch among 416 preschool children (boys: 208; girls: 208; age range: 4–6 years). Contact surface area of the feet in each participant was pictured 5 times while they were standing barefoot on a pedoscope. Untouched toes are the toes that did not show up in more than 4 of the 5 recorded pictures. Plantar arch ratio was used to evaluate the size of the plantar arch. No significant differences were observed in the plantar arch ratio between the children with floating toe and those without floating toe. Furthermore, no difference was observed in the number of floating toes (0 floating toe, 1 floating toe, >2 floating toes). The correlation coefficient between the number of floating toes and plantar arch ratio was not found to be significant. Therefore, this study clarifies the lack of relationship between the floating toes and plantar arch among preschool children.
Background and Aims: The aim of the present study was to investigate the effect of semi-rigid foot orthoses on lower limb joints (ankle, knee, and hip) stiffness during loading response, mid stance, push off, and entire of stance phase in male children with flexible flatfoot while walking. Materials and Methods: A semi-experimental study was conducted on 14 male children with flexible flat foot selected from available community. Data were collected under two specific test conditions including walking in shoes and shoes which were embedded with foot orthoses using semi rigid orthoses. Six Vicon cameras with a frequency of 100 Hz were used to quantify gait kinematic and also two force plates were used to record the ground reaction force components. Three-dimensional lower limb stiffness values during walking were calculated. Results: Foot orthoses reduced ankle joint stiffness during loading response in sagittal plane (p=0.003) and increased it during push off phase in horizontal plane (p=0.001). Also, during the entire stance phase, foot orthoses reduced ankle joint stiffness in sagittal plane (p=0.033) and increased it in horizontal plane (p=0.039). In the knee joint, stiffness values during mid-stance in sagittal plane (p=0.014) decreased after using foot orthoses. Furthermore foot orthoses increased knee joint stiffness values in horizontal plane during mid stance (p=0.000), push off (p=0.001), and stance phases (p=0.001). Hip joint stiffness was increased in frontal plane (p=0.044) during loading response by foot orthoses. Conclusion: Generally, semi rigid orthoses improved the ankle joint stiffness values in sagittal plane and it increased the ankle and knee joints stiffness values in horizontal plane.
Introduction/aim:
Flip-flops are a popular choice of footwear for children. However, their inherent design provides minimal support to the foot and ankle and has been suggested to increase the work performed by muscle and tendon structures, potentially predisposing them to injury. Therefore, the aim of this study was to compare the length change behaviour of the medial gastrocnemius (MG) muscle fascicles and muscle tendon unit (MTU) and their mechanical function at the ankle and subtalar joints in children during walking with and without flip-flop.
Methods:
Eight healthy children walked barefoot and with flip-flops whilst 3D gait analysis and simultaneous B-mode ultrasound images of the MG fascicles during level walking were collected. Joint kinematics, kinetics and MTU lengths were analysed using musculoskeletal modelling and fascicle lengths using a semi-automated tracking algorithm.
Results:
The muscles and tendons across the ankle absorbed greater amounts of power during barefoot walking compared to flip-flop walking. The muscle activations of the lateral gastrocnemius, soleus and tibialis anterior remained invariant across the conditions as did the activation, and fascicle length change behaviour of the medial gastrocnemius. In the barefoot condition, there was a trend of greater MTU lengthening, to potentially absorb greater amounts of power, although no differences in shortening was observed during late stance.
Conclusion:
Walking with flip-flops does not increase the mechanical work performed by the MG muscle at the ankle and subtalar joints, suggesting that flip-flops do not increase the stresses and strains of the Achilles tendon and hence its predisposition to strain induced injury. Instead, our results suggest that flip-flops, act as a compliant surface and absorb energy during contact and hence the strain experienced by the Achilles tendon.
Background & Purpose: Foot orthoses are often used to correct altered gait patterns. The purpose of this study was to investigate how foot orthoses can modify the magnitude of three dimensional ankle, knee, and hip joints kinematics during stance phase of walking in children with flexible flat feet.
Methodology: Three dimensional kinematic data were collected from 15 male children (age: 10.3 ± 1.5 years) suffering from flexible flat feet. In order to obtain the kinematics data, a Vicon motion capture system was used. Arch support foot orthoses were used as an intervention. ANOVA repeated measure test was used for statistical analysis (α =0.05).
Results: The results of data analysis showed that shoe insole can decrease the peak knee (P0.05).
Conclusion: The foot orthoses used in this study were observed to have positive systematic effects on kinematic data during stance phase of walking. Therefore, using of this orthoses was recommended for male children with flexible flat feet. Moreover, the findings of this study may be used as a guidance for future researches in this field
Background:
While wearing shoes is common in daily activities, most foot kinematic models report results on barefoot conditions. It is difficult to describe foot position inside shoes. This study used fluoroscopic images to determine talocrural and subtalar motion.
Research question:
What are the differences in sagittal talocrual and subtalar kinematics between walking barefoot and while wearing athletic walking shoes?
Methods:
Thirteen male subjects (mean age 22.9 ± 2.9 years, mean weight 77.2 ± 6.9 kg, mean height 178.2 ± 3.7 cm) screened for normal gait were tested. A fluoroscopy unit was used to collect images during stance. Sagittal motion of the talocrural and subtalar joints of the right foot were analyzed barefoot and in an athletic walking shoe.
Results:
Shod talocrural position at heel strike was 6.0° of dorsiflexion and shod peak talocrural plantarflexion was 4.2°. Barefoot talocrural plantarflexion at heel strike was 4.2° and barefoot peak talocrural plantarflexion was 10.9°. Shod subtalar position at heel strike was 2.6° of plantarflexion and peak subtalar dorsiflexion was 1.5°. The barefoot subtalar joint at heel strike was in 0.4° dorsiflexion and barefoot peak subtalar dorsiflexion was 3.5°. As the result of wearing shoes, average walking speed and stride length increased and average cadence decreased. Comparing barefoot to shod walking there was a statistical significance in talocrural dorsiflexion and at heel strike and peak talocrural dorsiflexion, subtalar plantarflexion at heel strike and peak subtalar dorsiflexion, walking speed, stride length, and cadence.
Significance:
This work demonstrates the ability to directly measure talocrural and subtalar kinematics of shod walking using fluoroscopy. Future work using this methodology can be used to increase understanding of hindfoot kinematics during a variety of non-barefoot activities.
Background & Purpose: Walking requires optimal coordination variability among multiple joints. Little is known about the effects of foot orthoses on lower limb intra-joint coordination variability during walking in children with flexible flat foot. The aim of this study was to evaluate the immediate effects of foot orthoses on lower limb intra joint coordination variability in children with flexible flat foot during walking.
Methodology: Fifteen male children with flexible flat foot volunteered to participate in this study. Kinematic data during walking with and without foot orthoses was recorded by a motion analysis system (including 4 Vicon cameras). Then, three-dimensional coordination variability between ankle-knee, ankle-hip, and knee-hip joints were calculated.
Results: The value of sagittal ankle-knee coordination variability during mid-stance was reduced in walking with foot orthoses compared to walking without it(P=0.011). While the value of ankle-knee coordination variability in both frontal(P=0.023) and horizontal(P=0.001) planes in walking with foot orthoses were higher than that in walking without it. The value of frontal knee-hip coordination variability during loading response phase (P=0.015) and the magnitude of frontal knee-hip coordination variability during push off phase (P=0.010) decreased in walking with foot orthoses compared to walking without it. Average horizontal knee-hip coordination variability during push off phase increased in walking with foot orthoses compared to walking without it(P=0.000).
Conclusion: Using foot orthoses could decrease coordination variability values between ankle-knee and ankle-hip joints in sagittal and frontal planes, respectively. Our results demonstrated that the effects of foot orthoses on coordination variability were highest in frontal plane.
The purpose of this study was to examine the acute effects of different stretching techniques on performance and lower limb kinematics, kinetics and muscle activities during vertical jump in female aerobics athletes. 10 female college aerobics athletes participated in this study. Three-dimensional kinematic and kinetic data, as well as electromyography of rectus femoris, biceps femoris and gastrocnemius medialis were collected using Vicon motion analysis system, Kistler force plate and Wireless surface electromyographic system respectively during the test. No significant differences in jump height had been determined among these 3 warm-up methods. Hip peak flexion and internal rotation angles decreased significantly after BSM and peak adduction angle decreased significantly after SSM and BSM during landing. Knee peak flexion and internal rotation angles increased significantly after SSM and BSM during take-off. Also, BSM showed significantly greater peak flexion compared with SSM. Ankle peak plantarflexion angle increased significantly after BSM. In addition, BSM showed significantly greater improvement in the variation range than SSM except for the ankle int-external rotation. Existence of no significant differences in the peak value of vertical ground reaction force during take-off and landing phase had been determined among these 3 warm-up methods, and muscle activities of rectus femoris, biceps femoris and gastrocnemius medialis were likewise not significantly different. The results of this study suggest that it would be suitable for female aerobics athletes to perform ballistic stretching in warm-up in order to improve flexibility without decreasing the following vertical jumping event and may also reduce the risk of ankle sprain injury.
One hundred fifty-three subjects between the ages of 18 and 41 years (mean age, 26.2 years) with no history of congenital or traumatic deformity or foot problems walked along a 6-m walkway while the angular and linear displacement of the tibia, calcaneus, navicular, and first metatarsal was measured by means of an electromagnetic motion analysis system. Three-dimensional movement of the calcaneus relative to the tibia, of the navicular relative to the calcaneus, and of the first metatarsal relative to the navicular during the stance phase of gait was calculated. The results of this study provide information on, and an understanding of, how the calcaneus, navicular, and first metatarsal function during the stance phase of normal human walking.
One hundred fifty-three subjects between the ages of 18 and 41 years (mean age, 26.2 years) with no history of congenital or traumatic deformity or foot problems walked along a 6-m walkway while the angular and linear displacement of the tibia, calcaneus, navicular, and first metatarsal was measured by means of an electromagnetic motion analysis system. Three-dimensional movement of the calcaneus relative to the tibia, of the navicular relative to the calcaneus, and of the first metatarsal relative to the navicular during the stance phase of gait was calculated. The results of this study provide information on, and an understanding of, how the calcaneus, navicular, and first metatarsal function during the stance phase of normal human walking.
This paper reports the development, accuracy, reliability, and validation protocol of a four-segment pediatric foot and ankle model. The four rigid body segments include: 1) tibia and fibula; 2) hindfoot--talus, navicular, and calcaneus; 3) forefoot--cuboid, cuneiforms, and metatarsals; and 4) hallux. A series of Euler rotations compute relative angles between segments. Validation protocol incorporates linear and angular testing for accuracy and reliability. Linear static system resolution is greatest in the Y orientation at 0.10 +/- 0.14 mm and 0.05 level of significance and 99.96% accuracy. Dynamic linear resolution and accuracy are 0.43 +/- 0.39 mm and 99.8%, respectively. Angular dynamic resolution computes to 0.52 +/- 3.36 degrees at 99.6% accuracy. These calculations are comparable to the Milwaukee adult foot and ankle model.
This paper quantifies the system characteristics for a pediatric foot and ankle biomechanical model. While orientated along the Z-axis the static system resolution is computed at 0.32 ± 0.29 mm with 99.9% accuracy. Dynamic resolution and accuracy are 0.43 ± 0.39 mm and 99.8%, respectively. Angular dynamic resolution computes to 0.52 ± 3.36 degrees at 99.6% accuracy. These calculations are comparable to the Milwaukee adult foot and ankle model.
Fragestellung: Das Ziel der vorliegenden Untersuchung war es, Fußbefunde bei Kindern zu dokumentieren und auf mögliche Probleme aufmerksam zu machen.
Material und Methode: In einer Feldstudie wurden die Füße und die Beinachsen von 345 Gymnasialschülern der 5. und 6. Jahrgangsstufe im Alter von 10-13 Jahren unter standardisierten Bedingungen untersucht.
Ergebnisse: Nur in 36,5% konnte bei den Kindern unauffällige Fußbefunde dokumentiert werden. Nahezu ⅔ der Schüler hatten Fußfehlhaltungen und -fehlformen. Am häufigsten fand sich mit 39.4% ein Knickfuß. Ein Senkfuß lag in 19.1% der Fälle vor. Bei den Zehendeformitäten fand sich ein Hallux valgus bereits in 17.1%.
Es konnte kein Zusammenhang zwischen Körpergewicht, Körpergröße und Beinachse einerseits und Fußdeformität andererseits dokumentiert werden. Statistisch gesichert war jedoch der Zusammenhang zwischen Spreizfuß und Hallux valgus.
Fazit: Die vorliegenden Zahlen unterstreichen die Notwendigkeit einer zunehmenden Beachtung des Problems Kinderfuß. In den schulischen Sportunterricht sollten gezielte Fußtrainingskonzepte integriert werden.
Thesis (M.S.)--Marquette University, 2001. Includes bibliographical references.
We analysed static footprints of 2300 children between the ages of four and 13 years to establish the influence of footwear on the prevalence of flat foot. The incidence among children who used footwear was 8.6% compared with 2.8% in those who did not (p less than 0.001). Significant differences between the predominance in shod and unshod children were noted in all age groups, most marked in those with generalised ligament laxity. Flat foot was most common in children who wore closed-toe shoes, less common in those who wore sandals or slippers, and least in the unshod. Our findings suggest that shoe-wearing in early childhood is detrimental to the development of a normal longitudinal arch.
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.
The repeatability of gait variables is an important consideration in the clinical use of results of quantitative gait analysis. Statistical measures were used to evaluate repeatability of kinematic, kinetic, and electromyographic data waveforms and spatiotemporal parameters of 40 normal subjects. Subjects were evaluated three times on each test day and on three different test days while walking at their preferred or natural speed. Intrasubject repeatability was excellent for kinematic data in the sagittal plane both within a test day as well as between test days. For joint angle motion in the frontal and transverse planes, the repeatability was good within a test day and poor between test days. Poor between-day repeatability of joint angle motion in the frontal and transverse planes was noted to be partly due to variabilities in the alignment of markers. Vertical reaction and fore-aft shear forces were more repeatable than the mediolateral shear force. Sagittal plane joint moments were more repeatable than frontal or transverse plane moments. For electromyographic data, repeatability within a day was slightly better than between test days. In general, the results demonstrate that with the subjects walking at their natural or preferred speed, the gait variables are quite repeatable. These observations suggest that it may be reasonable to base significant clinical decisions on the results of a single gait evaluation.
A model of the human foot is proposed in which the foot is represented as eight rigid segments and eight monocentric, single-degree-of-freedom joints. The soft tissue under the foot is divided into seven independent sites of contact, or loading, and each of these is modelled as a nonlinear spring and a nonlinear damper in-parallel. The model was used to estimate the kinematics and kinetics of the foot during the stance phase of walking. The force sustained at each loading site was calculated from walking trials in which only portions of the foot landed on a small force platform. The position of the calcaneus was defined by surface markers, whereas the position of the distal segments were based upon chalk footprints and an estimate of the compression of the plantar soft tissue. The results suggest that the joints that constitute the longitudinal arch extend slightly when the forefoot is loaded. During push-off, these joints flex as the metatarsophalangeal joints extend. Similar kinematic results were estimated when the distal segments of the foot were defined by surface markers. The magnitude of the joint moments of force depended largely on the distribution of the load under the foot which varied considerably between subjects. The stable, yet resilient properties of the foot, as highlighted by this model, should be considered in three-dimensional dynamic models used to study human locomotion. The model provides an objective tool to quantify foot motion and loading, which may prove useful for describing foot function in normal and pathological conditions.
A five-camera Vicon (Oxford Metrics, Oxford, England) motion analysis system was used to acquire foot and ankle motion data. Static resolution and accuracy were computed as 0.86 +/- 0.13 mm and 98.9%, while dynamic resolution and accuracy were 0.1 +/- 0.89 and 99.4% (sagittal plane). Spectral analysis revealed high frequency noise and the need for a filter (6 Hz Butterworth low-pass) as used in similar clinical situations. A four-segment rigid body model of the foot and ankle was developed. The four rigid body foot model segments were 1) tibia and fibula, 2) calcaneus, talus, and navicular, 3) cuneiforms, cuboid, and metatarsals, and 4) hallux. The Euler method for describing relative foot and ankle segment orientation was utilized in order to maintain accuracy and ease of clinical application. Kinematic data from a single test subject are presented.
PURPOSE purpose of this study was to evaluate paediatric feet and to document possible problems.
In 345 high school pupils of the 5th and 6th class aged 10 to 13 the feet as well as leg alignment were evaluated with a standardised protocol.
Only 36.5% showed regular feet. In almost 2/3rd of the pupils malalignements or even deformities were present. The valgus foot showed the highest incidence with 39.4% followed by a flat foot with 19.1%. 17.1% of the children showed a hallux valgus. There was no correlation between body weight, body height, leg alignment and foot deformity. However, a significant correlation could we found between hallux valgus and splay foot.
The presented data underlines the necessity for paying attention on the problems of the paediatric feet. During sport lessons in school a special foot training for children should be performed.
To design a technique for the in vivo description of ankle and other foot joint rotations to be applied in routine functional evaluation using non-invasive stereophotogrammetry.
Position and orientation of tibia/fibula, calcaneus, mid-foot, 1st metatarsal and hallux segments were tracked during the stance phase of walking in nine asymptomatic subjects. Rigid clusters of reflective markers were used for foot segment pose estimation. Anatomical landmark calibration was applied for the reconstruction of anatomical landmarks.
Previous studies have analysed only a limited number of joints or have proposed invasive techniques.
Anatomical landmark trajectories were reconstructed in the laboratory frame using data from the anatomical calibration procedure. Anatomical co-ordinate frames were defined using the obtained landmark trajectories. Joint co-ordinate systems were used to calculate corresponding joint rotations in all three anatomical planes.
The patterns of the joint rotations were highly repeatable within subjects. Consistent patterns between subjects were also exhibited at most of the joints.
The method proposed enables a detailed description of ankle and other foot joint rotations on an anatomical base. Joint rotations can therefore be expressed in the well-established terminology necessary for their clinical interpretation.
Functional evaluation of patients affected by foot diseases has recently called for more detailed and non-invasive protocols for the description of foot joint rotations during gait. The proposed method can help clinicians to distinguish between normal and pathological pattern of foot joint rotations, and to quantitatively assess the restoration of normal function after treatment.
Full body gait analysis was used to determine if differences exist in kinematic, kinetic, and temporal-spatial data with and without shoes in able-bodied children. The greatest difference noted between conditions was an increase in stride length with shoes. Minimal changes were seen in kinematics and kinetics with the addition of shoes. Due to the very tight standard deviations of the data, these minimal changes in the magnitude of the curves resulted in statistically significant differences, yet these changes do not appear to be clinically significant. It is believed that this study establishes that barefoot gait analysis is sufficient for most clinical studies, and an additional assessment undertaken while wearing shoes is not necessary.
An unbiased understanding of foot kinematics has been difficult to achieve due to the complexity of foot structure and motion. We have developed a protocol for evaluation of foot kinematics during barefoot walking based on a multi-segment foot model. Stereophotogrammetry was used to measure retroreflective markers on three segments of the foot plus the tibia. Repeatability was evaluated between-trial, between-day and between-tester using two subjects and two testers. Subtle patterns and ranges of motion between segments of the foot were consistently detected. We found that repeatability between different days or different testers is primarily subject to variability of marker placement more than inter-tester variability or skin movement. Differences between inter-segment angle curves primarily represent a shift in the absolute value of joint angles from one set of trials to another. In the hallux, variability was greater than desired due to vibration of the marker array used. The method permits objective foot measurement in gait analysis using skin-mounted markers. Quantitative and objective characterisation of the kinematics of the foot during activity is an important area of clinical and research evaluation. With this work we hope to have provided a firm basis for a common protocol for in vivo foot study.
The purposes of this study were a) to develop a model of the foot capable of describing the foot motion during dynamic movements and b) to study the influence of different mats on foot motion during landing in gymnastics.
Six female gymnasts (height: 1.63 +/- 0.04 m, weight: 58.21 +/- 3.46 kg) participated in this study. All six gymnasts carried out barefoot landings, falling from 80 and 115 cm onto three mats each with a different stiffness (hard, medium, and soft). Three synchronized digital high-speed video cameras (250 Hz) captured the motion of the left shank and foot. At the same time, the reaction forces between mat and foot at the forefoot and rearfoot were measured by two instrumented insoles (Paromed, 1000 Hz). The kinematics of the tibiotalar, talonavicular, and calcaneocuboid joints were examined. The lower leg and the foot were modeled by means of a multi-body system, comprising seven rigid bodies. For each joint, two joint coordinate systems attached on each of the connected segments were defined.
The mat stiffness did not show any influence on the maximal reaction forces or on the kinematics of the tibiotalar joint. For the soft mat, higher maximal eversion angles at the talonavicular and the calcaneocuboid joints were measured.
The relative motion between forefoot and rearfoot was influenced by changing mat stiffness. Therefore, the construction of the mat influenced the motion of the foot. The observation of only the tibiotalar joint is not enough when studying the influence of different mats on foot motion. The functional benefit of the mechanical advantages of a soft mat (higher energy absorption) includes a decrease in stability. The surface of the landing mat should, therefore, be reinforced by a stabilizing mechanism.
Gait analysis models typically analyze the ankle joint complex and treat the foot as a rigid segment. Such models are inadequate for clinical decision making for patients with foot impairments. While previous multisegment foot models have been presented, no comprehensive kinematic and kinetic databases for normal gait exist. This study provides normative foot joint angles, moments and powers during adolescent gait. Eighteen subjects were evaluated using 19 retroreflective markers, six cameras, a pressure platform and a force plate. A nine-segment model determined 3D angles, 3D moments, and powers in eight joints or joint complexes. A complete sets of sagittal, coronal and frontal plane results are presented. Results indicate that single link models of the foot significantly overestimate ankle joint powers during gait. Understanding normal joint kinematics and kinetics during gait will provide a baseline for documenting impairments in patients with foot disorders.
To test a multisegment foot model for kinematic analysis during barefoot walking in patients with well established rheumatoid arthritis (RA) and foot impairments.
Five healthy adult subjects and 11 RA patients with advanced disease were studied. Foot impairments were assessed using standardized outcomes and clinical examination techniques. A 6-camera 60 Hz video-based motion analysis system was used to measure motion of the shank, rearfoot, forefoot, and hallux segments and the vertical displacement of the navicular. Face validity and estimates of repeatability were determined. Motion patterns were calculated and comparisons were made between healthy subjects and patients with RA. Relationships between clinical impairment and abnormal motion were determined through inspection of individual RA cases.
Across the motion variables, the within-day and between-day coefficient of multiple correlation values ranged from 0.677 to 0.982 for the healthy subjects and 0.830 to 0.981 for RA patients. Based on previous studies, motion parameters for the healthy subjects showed excellent face validity. In RA patients, there was reduced range of motion across all segments and all planes of motion, which was consistent with joint stiffness. In the RA patients, rearfoot motion was shifted towards eversion and external rotation and peak values for these variables were increased, on average, by 7 degrees and 11 degrees, respectively. Forefoot range of motion was reduced in all 3 planes (between 31% and 53%), but the maximum and minimum angles were comparable to normal. The navicular height, during full foot contact, was on average 3 mm lower in the RA patients in comparison to normal. The hallux was less extended in the RA subjects in comparison to normal (21 degrees vs 33 degrees) during the terminal stance phase. Individual cases showed abnormal patterns of motion consistent with their clinical impairments, especially those with predominant forefoot pain or pes planovalgus.
In RA, multisegment foot models may provide a more complete description of foot motion abnormalities where pathology presents at multiple joints, leading to complex and varied patterns of impairment. This technique may be useful to evaluate functional changes in the foot and to help plan and assess logical, structurally based corrective interventions.
Although fluoroscopy has been used to evaluate motion of the foot during gait, the accuracy and precision of fluoroscopic measures of osseous structures of the foot has not been reported in the literature. This study reports on a series of experiments that quantify the magnitude and sources of error involved in digital fluoroscopic measurements of the medial longitudinal arch. The findings indicate that with a global distortion correction procedure, errors arising from image distortion can be reduced threefold to 0.2 degrees for angular measurements and to 0.1 mm for linear measures. The limits of agreement for repeated angular measures of the calcaneus and first metatarsal were +/-0.5 degrees and +/-0.6 degrees , indicating that measurement error was primarily associated with the manual process of digitisation. While the magnitude of the residual error constitutes about +/-2.5% of the expected 20 degrees of movement of the calcaneus and first metatarsal, out-of-plane rotation may potentially contribute the greatest source of error in fluoroscopic measures of the foot. However, even at the extremes of angular displacement (15 degrees ) reported for the calcaneum during running gait, the root mean square (RMS) error was only about 1 degrees . Thus, errors associated with fluoroscopic imaging of the foot appear to be negligible when compared to those arising from skin movement artefact, which typically range between 1.5 and 4 mm (equating to errors of 2 degrees to 17 degrees for angular measures). Fluoroscopy, therefore, may be a useful technique for analysing the sagittal movement of the medial longitudinal arch during the contact phase of walking.
This study used a previously tested foot model and adapted it for use with children. A number of variations on this adapted model were implemented and tested for repeatability and accuracy on 15 healthy children on three occasions. These included redefinition of the long axes of the tibia and forefoot, assessment of the flexibility of the forefoot and evaluation of the variability of the wand marker on the heel for both static and dynamic trials. It was found that variations on the model produced only minimal changes in repeatability, the only significant change being elimination of the wand marker on the heel in the static trial, which reduced between-day variability of hindfoot motion in the transverse plane. However, some differences were evident in the mean values for all variations. Based on these results, the most accurate and appropriate version of the model is proposed, and average kinematic curves are presented based on the measurements from 14 healthy children.
The aim of this study was to develop and evaluate a kinematic measurement method for the foot that could be applied clinically to measure foot function including all typical foot deformities. The ankle was modelled as two anatomically based hinge joints rotating around anatomical axes estimated by the use of projection angles. For the mid- and forefoot a descriptive approach was chosen by defining angles between anatomical landmarks or reference points derived from these landmarks. The motion of 17 markers on the lower leg and foot was measured during walking gait on 10 adult participants with no known abnormalities to determine the pattern of normal foot motion, assess reliability and provide a reference against which pathological foot behaviour could be compared. Functional angles for mid- and forefoot motions were developed to improve clinical applications of the data. The combination of anatomically and technically oriented marker placement on the foot is a reliable basis for reproducible kinematic measurements and the method was shown to be viable for clinical practice.
Kinematic analys is of a multi-segment 18
- Mc Carson
- Me Harrington
- N Thompson
- O Connor
- Jj Theologis
Carson MC, Harrington ME, Thompson N, O'Connor JJ, Theologis TN. Kinematic analys is of a multi-segment
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