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Foot motion in children shoes-A comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2007 Mar 10;
Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L
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The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inaequate 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.
Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot
as they did not set out to prove that assumption, how can they come to the conclusions of
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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.
The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inaequate footwear in childhood.
Both flatfoot and hallux valgus deformities are known to occur in non-shoe wearing populations. Are, then, these deformities accelerated by shoewear worn commonly by children? I doubt it. However, hallux valgus is probably greatly accelerated by adult female shoewear.
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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.
Do we really know that barefoot walking is best for all feet? I don't think so. If the individual has a fairly normal foot, and is able to walk in an environment devoid of objects that may cause injury to the foot, then I agree that barefoot walking is probably best. But what about the many mechanically abnormal feet that we see that can be aided mechanically by shoes and/or in-shoe inserts? Since mechanically abnormal feet form a good percentage of the population, then to make these feet more healthy, appropriate shoes should probably be worn.
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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.
When researchers say "no foot deformity", what does this really mean? Does it mean the feet all had five toes and the ankle joint, midtarsal joints and MPJs all had range of motion? Or does it mean that a biomechanical examination was performed and they found to have no equinus deformity present, were not maximally pronated in relaxed calcaneal stance position, the foot pronated a little in early stance and then resupinated in late midstance with normal propulsion during walking gait, and had a normal angle of gait?? I don't mean to pick only on these researchers, but it seems if we can't agree on what is a normal and abnormal foot then we will be continually fighting this semantic battle of foot normality and, as a result, the research being done is worthless to us as clinicians.
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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.
Again, their assumption that the children in their study walked more normally barefoot, I believe, is a flawed assumption. Could it have also possibly been the case that the children functioned more abnormally while barefoot, since their inclusion criteria for "no foot deformity" was weak, and the shoes actually made the kinematics of the foot improve?? We really don't know what is best for children's feet until we start to be more sophisticated in our biomechanical research and do some good longitudinal population studies so that we can see what types of feet in children lead to normal adult feet and what types of feet in children lead to adult feet with signficant pathology. As far as I can see, we are only making educated guesses at this point in time.
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
When researchers say "no foot deformity", what does this really mean?
I agree completely. The orthopaedic and podiatric literature is awash with 'no foot deformity' as being one of the inclusion criteria. This bland statement makes proper interpretation, comparison, and critical appraisal of the research very difficult.
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We really don't know what is best for children's feet until we start to be more sophisticated in our biomechanical research and do some good longitudinal population studies so that we can see what types of feet in children lead to normal adult feet and what types of feet in children lead to adult feet with signficant pathology. As far as I can see, we are only making educated guesses at this point in time.
In clinic, some of the hardest questions to answer come from parents who have children with a mechanical foot pathology. It usually goes something like, 'What will happen to my son/daughter's feet over the long term, and into adulthood?' We can only explain things dependent on where the research is at. For example, in a 4 year old with painless flexible pes planus (just using this as an example folks - this topic is well covered elsewhere on the forum), one clinician may adopt a 'wait and watch' approach, whilst another may be perfectly happy to introduce orthoses.
Yes, we can make educated guesses but as Kevin says, the hard evidence simply does not exist.
I did, however, come across this article which I think makes a very meaningful contribution to the topic.
The Evolution of Foot Morphology in Children Between 6 and 17 Years of Age: Stavlas P, Grivas TB, Michas C, Vasiliadis E, Polyzois V. A Cross-Sectional Study Based on Footprints in a Mediterranean Population. The Journal of Foot and Ankle Surgery Volume 44, No. 6, 2005.
Abstract
Footprint evaluation is a widely used method for the determination of foot morphology, but its efficacy and validity are considered controversial. Dynamic footprints were obtained from both feet of 5,866 school-aged children (6-17 years old) to detect any foot changes during growth. The interpretation of the imprint was performed using a classification scheme consisting of 6 types of footprints. In this scheme, footprint types I and II represent the typical and intermediate high-arched foot, respectively. Types III and IV represent normal foot variants, while type V corresponds to the low-arched foot and type VI to the severe flat foot, the latter often encountered in pathological conditions. There was statistically significant difference (P < .05) in footprint-type frequencies between boys and girls of ages 7, 9, 11, 14, and 15, which probably indicates the difference in growth potential of the foot between sexes. The proportion of high- and low-arched foot types decreased with increasing age in both boys and girls. Even though critical changes of the foot are believed to occur during pre-school development, this study shows that considerable changes also take place during school age and until late adolescence.
Foot motion in children shoes
Does it mean the feet all had five toes and the ankle joint, midtarsal joints and MPJs all had range of motion? Or does it mean that a biomechanical examination was performed and they found to have no equinus deformity present, were not maximally pronated in relaxed calcaneal stance position, the foot pronated a little in early stance and then resupinated in late midstance with normal propulsion during walking gait, and had a normal angle of gait?? I don't mean to pick only on these researchers, but it seems if we can't agree on what is a normal and abnormal foot then we will be continually fighting this semantic battle of foot normality and, as a result, the research being done is worthless to us as clinicians.
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