Shoe flexibility influences gait in early walkers

Sole stiffness affects stance time.

A recent study published in the winter issue of Pediatric Physical Therapy found that children just learning to walk may have altered gait characteristics when wearing flexible shoes.

Myths about learning to walk. The Baby Post

Myths about learning to walk. The Baby Post

By Erin Boutwell, Lower Extremity Review February 2015

Whether novice walkers should wear flexible or stiff shoes is not a new question, said Melanie Buckland, DPT, at the Hospital for Special Surgery in New York City and study author, but it is a frequent question fielded by pediatricians and physical therapists.

Previous studies have associated stiff shoes with the delayed development of arches in early walkers, and arch development is often the primary focus of the flexible versus stiff shoe debate. However, Buckland and her coauthors contend that shoe flexibility may also have an important influence on children’s functional activities, especially walking and balance.

Buckland’s study investigated the gait and stability of 25 early walkers, children aged 9 to 24 months who had been walking for less than five months. Four shoes with different torsional flexibilities (from
most flexible to least: UltraFlex, MedFlex, LowFlex, and Stiff) and a barefoot condition were compared during level walking.

While walking speed and step length were not affected by shoe flexibility, stance time was significantly lower for the most flexible shoe (UltraFlex) than the LowFlex shoe. Additionally, the barefoot condition was associated with a significantly shorter stance time than any shod condition.

Buckland attributed the shorter stance time in the UltraFlex condition to improved sensory feedback, saying, “We believe they were able to feel the ground better with the more flexible shoe…and they were able to accommodate and go ahead and take another step.”

Elaine Owen, MSc, superintendent physiotherapist at the Child Development Center in Bangor, North Wales, UK, proposed an alternative explanation: Reduced stance time could be a result of biomechanical effects of the footwear.

“The stiffer the material… the longer it will take for the MTPJs [metatarsophalangeal joints] to extend to the amount they need to by end of stance,” Owen explained.

Continue reading in Lower Extremity Review

The effect of torsional shoe flexibility on gait and stability in children learning to walk, Buckland MA, Slevin CM, Hafer JF, Choate C, Kraszewski AP; Hospital for Special Surgery Pediatric Research Team. Pediatr Phys Ther. 2014 Winter;26(4):411-7. doi: 10.1097/PEP.0000000000000084.

Effect of shoe flexibility on plantar loading in children learning to walk, Hillstrom HJ, Buckland MA, Slevin CM, Hafer JF, Root LM, Backus SI, Kraszewski AP, Whitney KA, Scher DM, Song J, Furmato J, Choate CS, Scherer PR. J Am Podiatr Med Assoc. 2013 Jul-Aug;103(4):297-305.

Also see
Gait changes associated with footwear may explain foot complaints in children in Lower Extremity Review

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