A Question

I saw a a two year old take off at full speed only to fall on his face about ten steps later. After repeating this process a few times, his father stopped and took off the child’s boots after which he ran barefoot without falling.

 

Do shoes change the way children walk and run? If so, is the change beneficial or detrimental to the development of motor skills and resistance to injury?Should children be allowed to run barefoot as much as possible or should their little arches be supported by shoes as soon as possible?

 

 

Some Data

I was able to find a systematic review on the effect of children’s shoes on gait published in 2011 in the journal of foot and ankle research. Caleb Wegener and his team from the University of Sydney found eleven studies on the topic with sample sizes ranging from 4 to 898 participants under the age of 16. Overall when children were wearing shoes they  walked 1) faster; 2) took longer steps; 3) took fewer steps 4) used a wider stance 5) stayed on two feet longer and spent less time on one foot 6) pushed off later 7) used more ankle and knee range of motion but less big toe range of motion; 8) reached a greater maximal ankle  plantar flexion (toes going down) but less dorsiflexion; 8) had more activity in the tibialis anterior muscle (a muscle on the front of the shin that resists plantarflexion); 9) and had less movement in the midfoot (arch). While wearing shoes children ran with 1) slower moving knees and shins; 2) and less plantarflexion at foot strike.

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My Application

 

The list of differences above is a condensed version of what was found by Wegener’s team and demonstrates that children do indeed walk and run differently when wearing shoes. Many of the variables overlap and I have grouped them around what I think is a likely causative factor.

 

While walking with shoes kids walk faster by taking fewer but longer steps. Wearing shoes impairs balance by reducing sensory input to the feet and the kids compensate for this by adopting a wider stance and staying on two feet for a greater percentage of the gait cycle.

 

Shoes restrict toe motion and ankle dorsiflexion so the children compensate by increasing their knee range of motion and plantarflexion.

 

The increased tibialis anterior activity is necessary to control dorsiflexion with the longer moment between the ankle joint and the ground created by the shoes.

 

The cushioning provided by shoes reduces the demand for the foot arch to change shape to cushion the impact. The result is that children walk with a foot that stays in pronation throughout the gait cycle while contributing very little to shock absorption.

 

During running the weight of the shoes slows down the movement of the leg. The increased cushion of the shoes allows the child to land in more dorsiflexion instead of cushioning the impact with their ankle by landing in plantarflexion

 

Kids walk and run very differently with shoes but the relative harm or benefit of these changes is only speculative as no longitudinal data is available that directly addresses this question.The differences between barefoot and shod running in kids are similar to that of adults and the data from adults is currently no more conclusive than that of children.

 

Walking and running barefoot results in movement patterns that cushion impact and produce force differently from those patterns that occur when a shoe provides cushioning. Proponents of barefoot walking and running claim that humans have evolved movement patterns that are optimally efficient and injury resistant in the absence of supportive footwear. They often cite the huge success in distance running of Kenyans from the rift valley who grew up running barefoot to school for 6-12 kilometers. Although these athletes grew up running barefoot they have almost unanimously set personal records while wearing shoes.

 

It may be that the movement patterns established by unsupported running during childhood forced the most efficient movement patterns. Extrapolation from this population to others is at this point a matter of preference for no prospective evidence exists to support or reject such the hypothesis that barefoot movement during childhood produces more efficient running patterns.

 

While wearing shoes, children walk with a more pronated foot and have less movement through their arch. Because babies are born without any appreciable foot arch, one may be concerned that wearing shoes throughout childhood will result in a failure to develop the arch. Prospective longitudinal data has proven this not to be the case, as children’s arch develops independently of footwear and is most likely determined by genetics.

 

So don’t blame the shoes if you or your children don’t have an arch. To wear or not wear shoes in childhood is a matter of preference and practicality at this point. Hopefully future prospective data will show us whether the differences that shoes create are helpful or harmful.