• 1.

    Hillstrom, HJ, M Buckland, C McCarthy, et al. :Torsional shoe flexibility effects on functional performance of children learning to walk. .Footwear Sci 1( suppl 1:):73. ,2009. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Zifchock, RA, I Davis, H Hillstrom, et al. :The effect of gender, age, and lateral dominance on arch height and arch stiffness. .Foot Ankle Int 27::367. ,2006. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Butler, RJ, H Hillstrom, J Song, et al. :Arch height index measurement system: establishment of reliability and normative values [published correction appears in JAPMA 98:277, 2008]. .JAPMA 98::102. ,2008. .

    • Search Google Scholar
    • Export Citation
  • 4.

    Song, J, HJ Hillstrom, D Secord, et al. :Foot type biomechanics: comparison of planus and rectus foot types. .JAPMA 86::16. ,1996. .

  • 5.

    Cavanagh, PR, E Morag, AJ Boulton, et al. :The relationship of static foot structure to dynamic foot function. .J Biomech 30::243. ,1997. .

  • 6.

    Morag, E and PR Cavanagh. :Structural and functional predictors of regional peak pressures under the foot during walking. .J Biomech 32::359. ,1999. .

  • 7.

    Liu, W, S Siegler, H Hillstrom, et al. :Three-dimensional, six-degrees-of-freedom kinematics during the stance phase of level walking. .Hum Mov Sci 16::283. ,1997. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Canseco, K, L Rankine, J Long, et al. :Motion of the multisegmental foot in hallux valgus. .Foot Ankle Int 31::146. ,2010. .

  • 9.

    Shultz, SP, MR Sitler, RT Tierney, et al. :Effects of pediatric obesity on joint kinematics and kinetics during 2 walking cadences. .Arch Phys Med Rehabil 90::2146. ,2009. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hillstrom, HJ, J Song, BP Heilman, et al. : “A Method for Testing Shoe Torsional and Toe Break Flexibilities, International Society of Biomechanics (ISB). ,” inProceedings of the 7th Symposium on Footwear Biomechanics,July 28–30, 2005,Cleveland, OH.

    • Search Google Scholar
    • Export Citation
  • 11.

    Hillstrom, HJ, J Song, E Kim, et al. : “Does Sandal Arch Height Effect Foot and Ankle Biomechanics? International Society of Biomechanics (ISB). ,” inProceedings of the 7th Symposium on Footwear Biomechanics,July 28–30, 2005,Cleveland, OH.

    • Search Google Scholar
    • Export Citation
  • 12.

    Dib, MY, J Smith, KA Bernhardt, et al. :Effect of environmental temperature on shock absorption properties of running shoes. .Clin J Sport Med 15::172. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Charanya, G, KM Patil, VB Narayanamurthy, et al. :Effect of foot sole hardness, thickness and footwear on foot pressure distribution parameters in diabetic neuropathy. .Proc Inst Mech Eng H 218::431. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Nigg, BM, P Stergiou, G Cole, et al. :Effect of shoe inserts on kinematics, center of pressure, and leg joint moments during running. .Med Sci Sports Exerc 35::314. ,2003. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Mündermann, A, BM Nigg, RN Humble, et al. :Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners. .Med Sci Sports Exerc 35::1710. ,2003. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Erhart, JC, A Mündermann, B Elspas, et al. :Changes in knee adduction moment, pain, and functionality with a variable-stiffness walking shoe after 6 months. .J Orthop Res 28::873. ,2010. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Rao, S, JF Baumhauer, L Becica, et al. :Shoe inserts alter plantar loading and function in patients with midfoot arthritis. .J Orthop Sports Phys Ther 39::522. ,2009. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Hillstrom, HJ, J Song, BP Heilman, et al. : “How Does Shoe Upper Design Influence Plantar Pressure Distribution? International Society of Bioemchanics (ISB). ,” inProceedings of the 7th Symposium on Footwear Biomechanics,July 28–30, 2005,Cleveland, OH.

    • Search Google Scholar
    • Export Citation
  • 19.

    Song, J, HJ Hillstrom, EH Kim, et al. : “Effect of Sandal Arch Height on Dynamic Plantar Pressures, International Society of Biomechanics (ISB). ,” inProceedings of the 7th Symposium on Footwear Biomechanics,July 28–30, 2005,Cleveland, OH.

    • Search Google Scholar
    • Export Citation
  • 20.

    Ivanenko, Y, N Dominici, G Cappellini, et al. :Development of pendulum mechanism and kinematic coordination from the first unsupported steps in toddlers. .J Exp Biol 207::3797. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Ivanenko, Y, N Dominici, G Cappellini, et al. :Kinematics in newly walking toddlers does not depend upon postural stability. .J Neurophysiol 94::754. ,2005. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Valmassy, RL . :Biomechanical evaluation of the child. .Clin Podiatry 1::563. ,1984. .

  • 23.

    Kristen, K, J Kastner, S Holzreiter, et al. :Functional evaluation of shoes for children based on gait analysis of children in the learning to walk stage. .Z Orthop Ihre Grenzgeb 136::457. ,1998. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Gould, N, M Moreland, R Alvarez, et al. :Development of the child’s arch. .Foot Ankle 9::241. ,1989. .

  • 25.

    Staheli, L . :Shoes for children: a review. .Pediatrics 88::371. ,1991. .

  • 26.

    WHO Multicentre Growth Reference Study Group .WHO Motor Development Study: windows of achievement for six gross motor development milestones. .Acta Paediatr Suppl 450::86. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Norkin, C and J White. :Measurement of Joint Motion: A Guide to Goniometry. ,FA Davis. ,Philadelphia. ,1995. .

Effect of Shoe Flexibility on Plantar Loading in Children Learning to Walk

Howard J. Hillstrom Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.
Temple University School of Podiatric Medicine, Gait Study Center, Temple University, Philadelphia, PA.

Search for other papers by Howard J. Hillstrom in
Current site
Google Scholar
PubMed
Close
 PhD
,
Melanie A. Buckland Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Melanie A. Buckland in
Current site
Google Scholar
PubMed
Close
 PT, DPT
,
Corinne M. Slevin Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Corinne M. Slevin in
Current site
Google Scholar
PubMed
Close
 PT, DPT, MS
,
Jocelyn F. Hafer Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Jocelyn F. Hafer in
Current site
Google Scholar
PubMed
Close
 MA
,
Leon M. Root Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Leon M. Root in
Current site
Google Scholar
PubMed
Close
 MD
,
Sherry I. Backus Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Sherry I. Backus in
Current site
Google Scholar
PubMed
Close
 PT, DPT, MA
,
Andrew P. Kraszewski Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by Andrew P. Kraszewski in
Current site
Google Scholar
PubMed
Close
 MS
,
Kendrick A. Whitney Temple University School of Podiatric Medicine, Gait Study Center, Temple University, Philadelphia, PA.

Search for other papers by Kendrick A. Whitney in
Current site
Google Scholar
PubMed
Close
 DPM
,
David M. Scher Leon Root, M.D. Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery, New York, NY.

Search for other papers by David M. Scher in
Current site
Google Scholar
PubMed
Close
 MD
,
Jinsup Song Temple University School of Podiatric Medicine, Gait Study Center, Temple University, Philadelphia, PA.

Search for other papers by Jinsup Song in
Current site
Google Scholar
PubMed
Close
 DPM, PhD
,
James Furmato Temple University School of Podiatric Medicine, Gait Study Center, Temple University, Philadelphia, PA.

Search for other papers by James Furmato in
Current site
Google Scholar
PubMed
Close
 DPM, PhD
,
Cherri S. Choate Department of Applied Biomechanics, California College of Podiatric Medicine, Samuel Merritt University, Oakland, CA.

Search for other papers by Cherri S. Choate in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Paul R. Scherer Department of Applied Biomechanics, California College of Podiatric Medicine, Samuel Merritt University, Oakland, CA.

Search for other papers by Paul R. Scherer in
Current site
Google Scholar
PubMed
Close
 DPM
Restricted access

Background:

In a previous pilot study of “cruisers” (nonindependent ambulation), “early walkers” (independent ambulation for 0–5 months), and “experienced walkers” (independent ambulation for 6–12 months), developmental age significantly affected the children’s stability when walking and performing functional activities. We sought to examine how shoe structural characteristics affect plantar pressure distribution in early walkers.

Methods:

Torsional flexibility was evaluated in four shoe designs (UltraFlex, MedFlex, LowFlex, and Stiff based on decreasing relative flexibility) with a structural testing machine. Plantar pressures were recorded in 25 early walkers while barefoot and shod at self-selected walking speeds. Peak pressure was calculated over ten masked regions for the barefoot and shod conditions.

Results:

Torsional flexibility, the angular rotation divided by the applied moment about the long axis of the shoe, was different across the four shoe designs. As expected, UltraFlex was the most flexible and Stiff was the least flexible. As applied moment increased, torsional flexibility decreased in all footwear. When evaluating early walkers during gait, peak pressure was significantly different across shoe conditions for all of the masked regions. The stiffest shoe had the lowest peak pressures and the most flexible shoe had the highest.

Conclusions:

It is likely that increased shoe flexibility promoted greater plantar loading. Plantar pressures while wearing the most flexible shoe are similar to those while barefoot. This mechanical feedback may enhance proprioception, which is a desirable attribute for children learning to walk. (J Am Podiatr Med Assoc 103(4): 297–305, 2013)

Corresponding author: Howard J. Hillstrom, PhD, Leon Root, M.D. Motion Analysis Laboratory, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. (E-mail: HillstromH@HSS.edu)