Elsevier

Gait & Posture

Volume 87, June 2021, Pages 87-94
Gait & Posture

Full length article
Children’s school footwear: The impact of fit on foot function, comfort and jump performance in children aged 8 to 12 years

https://doi.org/10.1016/j.gaitpost.2021.04.025Get rights and content

Highlights

  • Footwear that was too small restricted hindfoot, midfoot and 1st MTPJ motion.

  • Footwear sizing did not impact vertical or standing broad jump performance.

  • Correctly fitted footwear was rated as most comfortable.

Abstract

Background

There is a common perception that poorly fitting footwear will negatively impact a child’s foot, however, there is limited evidence to support this.

Aim

To determine the effect of shoe size on foot motion, perceived footwear comfort and fit during walking, maximal vertical jump height and maximal standing broad jump distance in children aged 8–12 years.

Methods

Fourteen participants completed 3D walking gait analysis and jumping tasks in three different sizes of school shoes (one size bigger, fitted for size, one size smaller). In-shoe motion of the hindfoot, midfoot and 1st metatarsophalangeal joint (1st MTPJ) were calculated using a multi-segment kinematic foot model. Physical performance measures were calculated via maximal vertical jump and maximal standing broad jump. Perceived footwear comfort and fit (heel, toes and overall) was assessed using a 100 mm visual analog scale (VAS). Differences were compared between shoe sizes using repeated measures ANOVA, post-hoc tests and effect sizes (Cohen’s d).

Results

Compared to the fitted footwear, the smaller sizing restricted hindfoot eversion (−2.5°, p = 0.021, d = 0.82), 1st MTPJ dorsiflexion (−3.9°, p = 0.012, d = 0.54), and compared to the bigger footwear, smaller sizing restricted sagittal plane midfoot range-of-motion during walking (−2.5°, p = 0.047, d = 0.59). The fitted footwear was rated as more comfortable overall with the smaller size rated as too tight in both the heel (mean difference 11.5 mm, p = 0.042, d = 0.58) and toes (mean difference 12.1 mm, p = 0.022, d = 0.59), compared to the fitted size. Vertical and standing broad jump distance were not impacted by footwear size (p = 0.218−0.836).

Significance

Footwear that is too small restricts foot motion during walking in children aged 8–12 years. Jump performance was not affected. Children were able to recognise shoes that were not correctly matched to their foot length, reinforcing that comfort is an important part of the fitting process.

Introduction

Footwear fit in children is a common concern for many parents and caregivers [1]. There is a well-held perception that ill-fitting shoes will negatively impact the development of children’s feet or their foot function now or in the future [2]. Adults often cite well-fitting footwear as an important consideration when choosing footwear for their children, as they seek to reduce foot related complaints [1,3]. This is supported in a review by Buldt and Menz [4] demonstrating an incorrect fit in adults negatively impacts on foot health. Limited empirical evidence exists to determine if consequences associated with ill-fitting footwear occurs in paediatric populations. One cross-sectional study observed that insufficient footwear length was associated with the angle of the hallux in the transverse plane in children [5], suggesting potential structural changes with poorly fitting footwear. To date, little research has been conducted on the impact of footwear fit on foot function during walking in children [[5], [6], [7], [8]]. Childhood is a time of extensive growth and development, with the feet often undergoing rapid and unexpected changes in dimension [9]. This can increase the difficulty for parents in achieving appropriate footwear fit. Purchasing footwear that is ‘too big’ can be tempting (to last longer), as well as unrecognised ‘growth spurts’ resulting in footwear becoming unintentionally ‘too small’.

Of the existing literature investigating the effect of footwear on foot function in children, only changes in gait (kinematics) between the barefoot condition and different styles of shoes has been reviewed. A systematic review by Wegener et al. [10] identified six studies investigating the effect of different types of footwear on gait kinematics. Interestingly, none of these six studies included measures of footwear comfort or measures of physical performance.

Comfort is an essential part of footwear fit to encourage wear and not impede normal activity [11]. Due to their high level of physical activity, such as play and sport, within both school and home environments [12], and the fact that one pair of shoes may be worn for all these activities, the potential effect of footwear fit on physical function in children is an important consideration. Maximal vertical jump and maximal standing broad jump tests are measures of physical performance used in children, and as they are a result of the combined performance of the posterior chain, had the potential to be impacted by changes to footwear [13]. With limited evidence of the impact of footwear fit within a paediatric population or the impact of fit on comfort or measures of physical performance, there is a need for further research. Therefore, the aim of this study was to determine the effect of shoe size on foot motion, perceived footwear comfort and fit during walking, maximal vertical jump height and standing broad jump distance in children aged 8–12 years.

Section snippets

Methods

A within subject, repeated measures pilot study investigating the impact of fit on biomechanics, physical performance and comfort was conducted. Participants completed walking and physical function tests (maximal jumps) wearing three different sized shoes and rated comfort. Ethical approval for this study was obtained from the University of South Australia Human Research Ethics Committee (Application ID 202592).

Participant characteristics

Fourteen children participated (9 female, 5 male) with footwear size range EU 33–39 and the following means; age 9.8 years (SD 1.1, range 8–12), body mass 37.3 kg (SD 7.2 kg), height 1.42 m (SD 7.46), BMI 18.3 (SD 2.6), FPI-6 score left foot 6.2 (SD 2.8, range 1–9) and right foot 6.57 (SD 2.0, range 4–10).

Walking speed

Mean walking speed was similar between footwear conditions (bigger: 1.27 m/s SD 0.18, fitted: 1.30 m/s SD 0.23 and smaller: 1.27 m/s SD 0.27) with no statistically significant difference (p =

Discussion

The aim of this study was to determine the effect of footwear fit on foot motion when walking, jump performance, and perceived footwear comfort in children aged 8–12 years. This study found, in a select group of children, using school shoes of one design, a reduction in midfoot ROM and 1st MTPJ dorsiflexion in the smaller footwear when walking, as compared to the fitted and bigger footwear, and a reduction of midfoot ROM in the fitted footwear as compared to the bigger. Furthermore,

Conclusion

This study identified smaller footwear sizing restricts hindfoot, 1st MTPJ and midfoot range of motion during walking in children. Furthermore, smaller footwear sizes impact upon comfort experienced in the toes and heels. There was no impact upon maximal jump height. Based on the data from this study the importance of footwear fit in healthy children is reinforced. The testing of footwear fit in children would benefit from further evaluation and testing in different cohorts longitudinally,

Authorship statement

Matthias (study design, data collection/analysis/interpretation, manuscript preparation, final approval of submitted version), Banwell (study design, manuscript preparation, final approval of submitted version), Arnold (study design, data collection/analysis/interpretation, manuscript preparation, final approval of submitted version).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors report no declarations of interest.

Acknowledgements

We would like to thank Skobi footwear for donating the shoes used in this study and vouchers for participant honorariums. Skobi footwear had no role in the study design, or in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. John Arnold is supported by a National Health & Medical Research Council Early Career Fellowship (ID: 1120560).

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