Email updates

Keep up to date with the latest news and content from Journal of Foot and Ankle Research and BioMed Central.

Open Access Highly Accessed Research

Effect of children's shoes on gait: a systematic review and meta-analysis

Caleb Wegener1*, Adrienne E Hunt1, Benedicte Vanwanseele1, Joshua Burns2 and Richard M Smith1

Author Affiliations

1 Discipline of Exercise and Sports Science, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, PO Box 170, Lidcombe, 1825, NSW, Australia

2 Faculty of Health Sciences, The University of Sydney/Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Locked Bag 4001 Westmead, NSW, 2145, Australia

For all author emails, please log on.

Journal of Foot and Ankle Research 2011, 4:3  doi:10.1186/1757-1146-4-3

Published: 18 January 2011

Abstract

Background

The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running.

Methods

Study inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P < 0.05. Heterogeneity was measured by I2. Where I2 > 25%, a random-effects model analysis was used and where I2 < 25%, a fixed-effects model was used.

Results

Eleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, 'subtalar' rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, single-support time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibial-acceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running.

Conclusions

Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.