Effect of children's shoes on gait: a systematic review and meta‐analysis

Abstract

BackgroundThe effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running.MethodsStudy inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P < 0.05. Heterogeneity was measured by I2. Where I2 > 25%, a random-effects model analysis was used and where I2 < 25%, a fixed-effects model was used.ResultsEleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, 'subtalar' rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, single-support time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibial-acceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running.ConclusionsShoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.

Back and neck muscle activity in healthy adults during barefoot walking and walking in conventional and flexible shoes

“…The observed changes in the kinematic gait parameters elicited by the conventional footwear are well in line with earlier studies (Majumdar et al 2006, Lythgo et al 2009, Wegener et al 2011. With regard to the flexible shoes, the model used in the present study was able to imitate barefoot walking in terms of muscle activity, with the exception of the SCM, which however, showed very little relation to gait cycle.…”

“…An alternative explanation for the changes in kinematic gait parameters by wearing footwear might be the increase in leg length or in mass as observed in children (Wegener et al 2011). The flexible shoes used in this study were however completely flat and extremely light (200 g).…”

Comparison of Foot Taping Versus Custom-Made Medial Arch Support on Pronated Flatfoot in School Going Children

“…35 As a pragmatic approach, these factors have been categorized as 'easy' or 'difficult' to influence clinically. Strength 36,37 , obesity or overweight 38 and shoe use 39 are the 'easy' factors which may be altered so as to possibly influence foot posture and resulting gait.…”

El pie plano: las recomendaciones del traumatólogo infantil al pediatra

“…Algunos padres creen que el niño camina mejor con una bota tipo ortopédi-co, notando sin zapatos empeoramiento del aspecto del pie. Esto suele ser real, aunque la evolución final del pie va a ser la misma, independientemente del uso del calzado u ortosis [9][10][11][12][13] . Se deben excluir de estos casos los pies que resultan dolorosos o sus equivalentes de niños que no son conscientes de su dolor y tienden progresivamente a engordar y a ser poco activos en el deporte.…”