The impact of shoe flexibility on gait, pressure and muscle activity of young children. A systematic review

Simone Cranage,Cylie Williams,Kelly‐Ann Bowles,Luke Perraton

doi:10.1186/s13047-019-0365-7

Simone Cranage, Cylie Williams + Show 2 more

Open Access

https://doi.org/10.1186/s13047-019-0365-7

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Abstract

BackgroundThere 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.MethodsStudy 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.ResultsFour 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.ConclusionsShoes 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.

Highlights

There is limited evidence of shoe impact in younger children, in the context of immature gait patterns
Studies observing the gait of children between the ages of 1 to 10 years have found that normalised velocity and step length increases gradually
Data were extracted from each study by age, and where there was greater than one participant per age and per condition gait variables were included for meta-analysis

Summary

Introduction

There is limited evidence of shoe impact in younger children, in the context of immature gait patterns. Studies observing the gait of children between the ages of 1 to 10 years have found that normalised velocity and step length increases gradually. Health professionals and members of the public often advise parents to allow their toddlers to be barefoot as much as possible, or to wear soft soled shoes in the early developmental stages of walking [3]. This is thought to allow an increase in muscle strength in their feet and to assist in sensory experiences with different surfaces.

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