Elsevier

Gait & Posture

Volume 9, Issue 2, May 1999, Pages 95-100
Gait & Posture

Comparison of gait with and without shoes in children

https://doi.org/10.1016/S0966-6362(99)00005-3Get rights and content

Abstract

Full body gait analysis was used to determine if differences exist in kinematic, kinetic, and temporal-spatial data with and without shoes in able-bodied children. The greatest difference noted between conditions was an increase in stride length with shoes. Minimal changes were seen in kinematics and kinetics with the addition of shoes. Due to the very tight standard deviations of the data, these minimal changes in the magnitude of the curves resulted in statistically significant differences, yet these changes do not appear to be clinically significant. It is believed that this study establishes that barefoot gait analysis is sufficient for most clinical studies, and an additional assessment undertaken while wearing shoes is not necessary.

Introduction

Computerized motion analysis laboratories have played an integral part in the advancement of surgical procedures and outcomes in children with cerebral palsy [1]. Thus, the objective data obtained from these laboratories are being utilized in pre- and post-operative clinical assessment, and in the evaluation of the effectiveness of orthotics and assistive devices on improving gait in these children [1], [2], [3], [4], [5], [6]. To differentiate between normal and abnormal gait patterns, normative databases of able-bodied barefoot children have been established [7], [8].

In order to reproduce testing conditions similar to those used in established normative databases, children with cerebral palsy are often tested barefoot as part of their pre-operative clinical assessment [9], [10]. Yet functional ambulation predominantly involves wearing shoes. Furthermore, since children with cerebral palsy are often prescribed orthoses following surgery, they may be evaluated pre-operatively without shoes, and post-operatively with shoes and an orthotic device.

Previous studies have reported that wearing an ankle-foot orthosis and tennis shoes resulted in differences in kinematic and temporal-spatial data in the gait of able-bodied children compared to their barefoot gait pattern [11]. It was not, however, established how much of an effect the shoes alone had on the alterations in the gait pattern. In a study undertaken on children with spastic hemiplegia, gait was analyzed while walking barefoot, with firm shoes, and with an ankle-foot orthoses [12]. Significant improvements were observed in temporal-spatial parameters while walking with shoes, compared to barefoot, although the changes were not as great as those observed with the orthosis [12].

The purpose of this study was to determine if differences exist in kinematic, kinetic, and temporal-spatial data in gait patterns performed with and without shoes in able-bodied children. The null hypothesis was that barefoot gait and gait while wearing shoes would not be of the same population. This information has clinical importance in regard to the validity of using databases collected on barefoot subjects as references of normal gait, and in determining if gait with shoes should be routinely included into the overall pre-operative assessment of children with gait abnormalities.

Section snippets

Subjects

Fourteen able-bodied children (eight females and six males) ranging in age from 7 to 10 years were recruited into the IRB approved study. Criteria for inclusion in this study consisted of no history of lower extremity injury occurring within the past year, and no known musculoskeletal or neurological disease. In addition, subjects were required to wear a pair of low cut athletic shoes with arch supports and rubber soles. Data from two subjects were excluded from the shoe condition of the study

Kinematics

Statistical analysis of the pelvis, hip, and knee did not demonstrate differences in the transverse plane. The only significant difference noted in the transverse plane was foot rotation at midstance and midswing. At these particular events there was a decrease in external rotation of the foot while wearing shoes as compared to barefoot (Fig. 1A).

In the sagittal plane, differences were noted at the knee and ankle. A slight decrease in knee flexion from initial contact through weight acceptance

Discussion

The major finding of this study is that shoes have a surprisingly small impact on gait kinetics and kinematics in able-bodied children. Although minimal changes in the kinematic and kinetic curves resulted in statistically significant differences, these changes do not appear to be clinically significant and are believed to be attributable to the very small standard deviations of the data. For example, the statistically significant difference noted in ankle kinematics in the sagittal plane for

Conclusion

This study supports that barefoot gait analysis is sufficient without the inclusion of analysis in shoes for clinical studies that evaluate the effectiveness of orthoses without having a pre-established normative database of gait while wearing shoes. This conclusion is based on the overall similarity in the data, with the exception of the temporal-spatial data. It is believed that this study establishes that barefoot gait analysis is sufficient without the inclusion of analysis in shoes for

References (15)

  • G.F. Harris et al.

    Procedures for gait analysis

    Arch. Phys. Med. Rehabil.

    (1994)
  • P.A. DeLuca

    Gait analysis in the treatment of the ambulatory child with cerebral palsy

    Clin. Orthoped.

    (1991)
  • E.H. Lee et al.

    Value of gait analysis in the assessment of surgery in cerebral palsy

    Arch. Phys. Med. Rehabil.

    (1992)
  • S.A. Rose et al.

    Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy

    J. Pediatr. Orthopaed.

    (1993)
  • J.R. Gage

    The clinical use of kinetics for evaluation of pathologic gait in cerebral palsy

    Instruct. Course Lectures

    (1995)
  • J.R. Gage

    Gait analysis: an essential tool in the treatment of cerebral palsy

    Clin. Orthopaed. Related Res.

    (1993)
  • S. Ounpuu et al.

    Three-dimensional Lower extremity joint kinetics in normal pediatric gait

    J. Pediatr. Orthopaed.

    (1991)
There are more references available in the full text version of this article.

Cited by (82)

  • Effects of flat-flexible shoes on lower limb joint kinetics and kinematics in gait

    2022, Journal of Biomechanics
    Citation Excerpt :

    The ankle joint power at A1 and A2 was significantly different. Previous studies reported that walking barefoot increased ankle power generation compared with walking with shoes (Oeffinger et al., 1999), high-heel shoes (Di Sipio et al., 2018), and rocker shoes (Sobhani et al., 2013). Both power absorption and generation in the ankle joint increased in another study, while running barefoot compared with running with shoes (Bonacci et al., 2013).

  • A comparison of young children's spatiotemporal gait measures in three common types of footwear with different sole hardness

    2021, Gait and Posture
    Citation Excerpt :

    Designing longer term studies on the impact of footwear features or their gait impact on younger children are both costly and ethically challenging. The impact of different types of footwear on immediate spatiotemporal variables, kinematics, kinetics, plantar loading and muscle activity have had limited investigation in children under 6 years old [14–19]. In toddlers, there has been a variable effect noted dependent on the walk experience and flexibility of footwear sole.

View all citing articles on Scopus
View full text