Effect of flip-flops on lower limb kinematics during walking: a cross-sectional study using three-dimensional gait analysis

Sharpe, Tom; Malone, Ailish; French, Helen; Kiernan, Damien; OʼBrien, Timothy M.

doi:10.1007/s11845-016-1421-y

Cited by 13 publications

(10 citation statements)

References 19 publications

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“…Besides, there was significantly higher ankle and subtalar ROM in flip-flops compared to that of sports shoes [ 40 ]. The results were in partial accordance with those of previous studies [ 4 , 6 , 13 ]. The lower ROM but similar muscular control for sports shoe could be attributed to its close-toe design and the structural stiffness of the footwear.…”

Section: Discussionsupporting

confidence: 93%

“…Given that walking speed was significantly lower in the flip-flops condition, this might even out the possible increases in foot muscle co-contraction for flip-flops gait. In fact, reduced walking speed was consistently observed in flip-flops wearers [ 4 , 7 , 8 , 39 ]. It could be argued that if slow walking is the inherent nature of wearing flip-flops, then perhaps controlling it in the experiment limits the external validity of the results.…”

Section: Discussionmentioning

confidence: 99%

“…The lower ROM but similar muscular control for sports shoe could be attributed to its close-toe design and the structural stiffness of the footwear. Conversely, flip-flops demanded a higher range of ankle motion to maintain the adherence between the sole and the foot due to a lack of shoe straps [ 4 ]. It is unclear to what extent this increased joint ROM would affect foot health.…”

Section: Discussionmentioning

confidence: 99%

“…Flip-flops typically feature a thin, flat, and flexible sole attached with few straps in the forefoot region [ 3 ]. Without the protection of heel counter that is commonly seen in the closed-toe shoes, flip-flops wearers largely expose their hindfoot and receive no supports to the heel and ankle due to the limited foot/shoes contacts [ 1 , 4 ]. This minimalist structure was speculated to cause many foot problems associated with mechanical instability [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies argued that the minimalism of flip-flops helped to simulate barefoot walking and might be safe to foot healthy on this basis [ 5 ]. Nevertheless, flip-flops were consistently reported to increase ankle dorsiflexion [ 4 , 6 , 8 , 13 ], knee flexion [ 4 , 6 ] and tibialis anterior activation [ 13 , 14 ] compared to barefoot walking. In combination, these changed gait patterns are likely to redistribute joint force and cause abnormal loading.…”

Section: Introductionmentioning

confidence: 99%

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Lower limb muscle co-contraction and joint loading of flip-flops walking in male wearers

Chen

Wong

et al. 2018

PLoS ONE

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Flip-flops may change walking gait pattern, increase muscle activity and joint loading, and predispose wearers to foot problems, despite that quantitative evidence is scarce. The purpose of this study was to examine the lower limb muscle co-contraction and joint contact force in flip-flops gait, and compare with those of barefoot and sports shoes walking. Ten healthy males were instructed to perform over-ground walking at self-selected speed under three footwear conditions: 1) barefoot, 2) sports shoes, and 3) thong-type flip-flops. Kinematic, kinetic and EMG data were collected and input to a musculoskeletal model to estimate muscle force and joint force. One-way repeated measures ANOVA was conducted to compare footwear conditions. It was hypothesized that flip-flops would induce muscle co-contraction and produce different gait kinematics and kinetics. Our results demonstrated that the musculoskeletal model estimation had a good temporal consistency with the measured EMG. Flip-flops produced significantly lower walking speed, higher ankle and subtalar joint range of motion, and higher shear ankle joint contact force than sports shoes (p < 0.05). There were no significant differences between flip-flops and barefoot conditions in terms of muscle co-contraction index, joint kinematics, and joint loading of the knee and ankle complex (p > 0.05). The variance in walking speed and footwear design may be the two major factors that resulted in the comparable joint biomechanics in flip-flops and barefoot walking. From this point of view, whether flip-flops gait is potentially harmful to foot health remains unclear. Given that shod walking is more common than barefoot walking on a daily basis, sports shoes with close-toe design may be a better footwear option than flip-flops for injury prevention due to its constraint on joint motion and loading.

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