Minimal shoes improve stability and mobility in persons with a history of falls.
ABSTRACT: Postural and walking instabilities contribute to falls in older adults. Given that shoes affect human locomotor stability and that visual, cognitive and somatosensory systems deteriorate during aging, we aimed to: (1) compare the effects of footwear type on stability and mobility in persons with a history of falls, and (2) determine whether the effect of footwear type on stability is altered by the absence of visual input or by an additional cognitive load. Thirty participants performed standing and walking trials in three footwear conditions, i.e. conventional shoes, minimal shoes, and barefoot. The outcomes were: (1) postural stability (movement of the center of pressure during eyes open/closed), (2) walking stability (Margin of Stability during normal/dual-task walking), (3) mobility (the Timed Up and Go test and the Star Excursion Balance test), and (4) perceptions of the shoes (Monitor Orthopaedic Shoes questionnaire). Participants were more stable during standing and walking in minimal shoes than in conventional shoes, independent of visual or walking condition. Minimal shoes were more beneficial for mobility than conventional shoes and barefoot. This study supports the need for longitudinal studies investigating whether minimal footwear is more beneficial for fall prevention in older people than conventional footwear.
Project description:BACKGROUND:In recent years, minimalist footwear has been increasingly promoted for its use in sportive and recreational activities. These shoes are considered to function naturally like barefoot walking while providing a protective surface. Despite a growing popularity of these shoes in the older population, little is known about the influence of minimalist footwear on gait patterns. This study investigated whether overground walking with minimalist shoes is comparable to barefoot walking regarding gait stability and variability parameters. METHODS:In a randomized within-subject study design, 31 healthy younger (29?±?4?years) and 33 healthy community-dwelling older adults (71?±?4?years) volunteered. Participants walked on flat ground, once barefoot and once with minimalist shoes. Gait variability of minimum toe clearance (MTC), stride length, stride time, and local dynamic gait stability were analysed. RESULTS:The results for both age groups showed significant condition effects (minimalist shoes vs. barefoot walking) for the outcomes of local dynamic stability (p?=?.013), MTC variability (p?=?.018), and stride length variability (p?<?.001) indicating increased local dynamic stability and decreased gait variability during the minimalist shoe condition. Group effects (young vs. older adults) were detected in all gait outcomes. CONCLUSION:Walking with minimalist shoes appeared to be associated with better gait performance than walking barefoot in both age groups. Thus, walking with minimalist shoes is not similar to barefoot walking. With respect to reducing the risk of falling, we suggest that minimalist shoes could be an alternative to barefoot walking or a transition option between shoes to barefoot for older adults.
Project description:BACKGROUND:Diminished somatosensory function is a critical age-related change which is related to postural instability in the older population. Footwear is a cost-effective way to modulate the postural stability by altering sensorimotor inputs via mechanoreceptors on the plantar surface of the feet. Compared to insoles with indentions in the entire surface, we innovatively developed a textured insole with site-specific nodulous protrudous. This study thus aimed to investigate the immediate effect of the nodulous insole and supporting surface condition on static postural stability and lower limb muscle activation for healthy older women. METHODS:This is a single-session study with repeated measurements. Twenty-three healthy older women stood on the firm (i.e., concrete floor) and foam surfaces with their eyes open in the three footwear conditions, namely barefoot, plain shoes and shoes with an innovative textured insole, for 30 seconds. Static postural sway and muscle activation of biceps femoris (BF), vastus lateralis (VL), tibialis anterior (TA), and lateral gastrocnemius (LG) of the dominant leg were measured during each testing condition. RESULTS:Compared to a firm surface, standing on the foam could significantly increase the body sway and lower limb muscle activation (p<0.05). When standing on the foam, compared to barefoot, wearing footwear significantly decreased the VL and TA muscle activation and minimize the postural sway in medial-lateral and anterior-posterior direction, while the influence is larger for the shoes with nodulous insloe compared to the plain shoes. No significant differences between the footwear conditions for static stability and muscle activation were observed on firm surface condition. CONCLUSIONS:For older women, footwear could improve the postural stability in the unstable surface, particularly the footwear with nodulous insole, with the underlying mechanism as enhancing the mechanoreceptors on the plantar surface of the feet.
Project description:Despite substantial recent interest in walking barefoot and in minimal footwear, little is known about potential differences in walking biomechanics when unshod versus minimally shod. To test the hypothesis that heel impact forces are similar during barefoot and minimally shod walking, we analysed ground reaction forces recorded in both conditions with a pedography platform among indigenous subsistence farmers, the Tarahumara of Mexico, who habitually wear minimal sandals, as well as among urban Americans wearing commercially available minimal sandals. Among both the Tarahumara (n?=?35) and Americans (n?=?30), impact peaks generated in sandals had significantly (p?<?0.05) higher force magnitudes, slower loading rates and larger vertical impulses than during barefoot walking. These kinetic differences were partly due to individuals' significantly greater effective mass when walking in sandals. Our results indicate that, in general, people tread more lightly when walking barefoot than in minimal footwear. Further research is needed to test if the variations in impact peaks generated by walking barefoot or in minimal shoes have consequences for musculoskeletal health.
Project description:Flip-flops may change walking gait pattern, increase muscle activity and joint loading, and predispose wearers to foot problems, despite that quantitative evidence is scarce. The purpose of this study was to examine the lower limb muscle co-contraction and joint contact force in flip-flops gait, and compare with those of barefoot and sports shoes walking. Ten healthy males were instructed to perform over-ground walking at self-selected speed under three footwear conditions: 1) barefoot, 2) sports shoes, and 3) thong-type flip-flops. Kinematic, kinetic and EMG data were collected and input to a musculoskeletal model to estimate muscle force and joint force. One-way repeated measures ANOVA was conducted to compare footwear conditions. It was hypothesized that flip-flops would induce muscle co-contraction and produce different gait kinematics and kinetics. Our results demonstrated that the musculoskeletal model estimation had a good temporal consistency with the measured EMG. Flip-flops produced significantly lower walking speed, higher ankle and subtalar joint range of motion, and higher shear ankle joint contact force than sports shoes (p < 0.05). There were no significant differences between flip-flops and barefoot conditions in terms of muscle co-contraction index, joint kinematics, and joint loading of the knee and ankle complex (p > 0.05). The variance in walking speed and footwear design may be the two major factors that resulted in the comparable joint biomechanics in flip-flops and barefoot walking. From this point of view, whether flip-flops gait is potentially harmful to foot health remains unclear. Given that shod walking is more common than barefoot walking on a daily basis, sports shoes with close-toe design may be a better footwear option than flip-flops for injury prevention due to its constraint on joint motion and loading.
Project description:<h4>Background</h4>Although minimalist footwear is increasingly popular among runners, claims that minimalist footwear enhances running biomechanics and efficiency are controversial.<h4>Hypothesis</h4>Minimalist and barefoot conditions improve running efficiency when compared with traditional running shoes.<h4>Study design</h4>Randomized crossover trial.<h4>Level of evidence</h4>Level 3.<h4>Methods</h4>Fifteen experienced runners each completed three 90-second running trials on a treadmill, each trial performed in a different type of footwear: traditional running shoes with a heavily cushioned heel, minimalist running shoes with minimal heel cushioning, and barefoot (socked). High-speed photography was used to determine foot strike, ground contact time, knee angle, and stride cadence with each footwear type.<h4>Results</h4>Runners had more rearfoot strikes in traditional shoes (87%) compared with minimalist shoes (67%) and socked (40%) (P = 0.03). Ground contact time was longest in traditional shoes (265.9 ± 10.9 ms) when compared with minimalist shoes (253.4 ± 11.2 ms) and socked (250.6 ± 16.2 ms) (P = 0.005). There was no difference between groups with respect to knee angle (P = 0.37) or stride cadence (P = 0.20). When comparing running socked to running with minimalist running shoes, there were no differences in measures of running efficiency.<h4>Conclusion</h4>When compared with running in traditional, cushioned shoes, both barefoot (socked) running and minimalist running shoes produce greater running efficiency in some experienced runners, with a greater tendency toward a midfoot or forefoot strike and a shorter ground contact time. Minimalist shoes closely approximate socked running in the 4 measurements performed.<h4>Clinical relevance</h4>With regard to running efficiency and biomechanics, in some runners, barefoot (socked) and minimalist footwear are preferable to traditional running shoes.
Project description:Background:Higher peak external knee flexion moments (KFM) during running has been observed in healthy people wearing athletic footwear compared to barefoot, which may increase risk of knee pathologies such as patellofemoral pain. Currently, no studies have examined whether stability and neutral style athletic shoes influence the peak KFM differently, or explored the underlying biomechanical mechanisms by which footwear alters peak KFM in young females. Methods:Lower limb biomechanics of sixty girls aged between 10 and 25?years old were collected while running in footwear (both stability and neutral) and barefoot. The external peak KFM, sagittal plane kinematics, sagittal plane knee ground reaction force (GRF) lever arm and sagittal plane resultant GRF magnitude were analysed by repeated measures Analysis of Variance. Linear mixed models were fit to identify predictors of a change in peak KFM, and to determine if the effects of these predictors differed between footwear conditions. Results:The peak KFM was higher wearing both shoe styles compared to barefoot (p?<?0.001), while no between-shoe differences were found (p?>?0.05). Both shoes also increased kinematic variables at the hip, knee, and ankle (p?<?0.05). When all these variables were entered into the mixed model, only a change in the knee-GRF lever arm was predictive of a change in peak KFM wearing shoes compared to barefoot (p?<?0.001). Conclusion:These findings provide evidence that stability and neutral shoes increase peak KFM compared to barefoot, which is associated with a change in the knee-GRF lever arm rather than a change in lower limb kinematics. Future studies may consider manipulating footwear characteristics to reduce the knee-GRF lever arm in an effort to reduce peak KFM and the potential risk of patellofemoral pain.
Project description:Background:High heel shoes (HHS) can affect human postural control because elevated heel height (HH) may result in plantar flexed foot and limit ankle joint range of motion during walking. Effects of HH and HHS wearing experience on postural stability during self-initiated and externally triggered perturbations are less examined in the literature. Hence, the objective of the present study is to investigate the influences of HH on human postural stability during dynamic perturbations, perceived stability, and functional mobility between inexperienced and experienced HHS wearers. Methods:A total of 41 female participants were recruited (21 inexperienced HHS wearers and 20 experienced HHS wearers). Sensory organization test (SOT), motor control test (MCT), and limits of stability (LOS) were conducted to measure participant's postural stability by using computerized dynamic posturography. Functional reach test and timed up and go test were performed to measure functional mobility. The participants' self-perceived stability was assessed by visual analog scale. Four pairs of shoes with different HH (i.e., 0.8, 3.9, 7.0, and 10.1 cm) were applied to participants randomly. Repeated measures analysis of variance was conducted to detect the effects of HH and HHS wearing experience on each variable. Results:During self-initiated perturbations, equilibrium score remarkably decreased when wearing 10.1 cm compared with flat shoes and 3.9 cm HHS. The contribution of vision to postural stability was larger in 10.1 cm HHS than in flat shoes. The use of ankle strategy worsened when HH increased to 7 cm. Similarly, the directional control of the center of gravity (COG) decreased for 7 cm HHS in LOS. Experienced wearers showed significantly higher percentage of ankle strategy and COG directional control than novices. Under externally triggered perturbations, postural stability was substantially decreased when HH reached 3.9 cm in MCT. No significant difference was found in experienced wearers compared with novices in MCT. Experienced wearers exhibited considerably better functional mobility and perceived stability with increased HH. Conclusions:The use of HHS may worsen dynamic postural control and functional mobility when HH increases to 3.9 cm. Although experienced HHS wearers exhibit higher proportion of ankle strategy and COG directional control, the experience may not influence overall human postural control. Sensory organization ability, ankle strategy and COG directional control might provide useful information in developing a safety system and prevent HHS wearers from falling.
Project description:Background:In specific populations, including those at risk of falls or foot ulcers, indoor footwear is an important aspect of preventative care. This study aims to describe the indoor footwear worn most over the previous year in a sample representative of the Australian inpatient population, and to explore the sociodemographic, medical, foot condition and foot treatment history factors associated with the indoor footwear worn. Methods:This was a secondary analysis of data collected from inpatients admitted to five hospitals across Queensland, Australia. Sociodemographic information, medical history, foot conditions and foot treatment history were collected as explanatory variables. Outcomes included the self-reported type of indoor footwear (from 16 standard footwear types) worn most in the year prior to hospitalisation, and the category in which the self-reported footwear type was defined according to its features: 'protective', 'non-protective' and 'no footwear'. Multivariate analyses determined explanatory variables independently associated with each type and category. Results:Protective footwear was worn by 11% of participants (including 4% walking shoes, 4% running shoes, 2% oxford shoes), and was independently associated with education above year 10 level (OR 1.78, p?=?0.028) and having had foot treatment by a specialist physician (5.06, p?=?0.003). Most participants (55%) wore non-protective footwear (including 21% slippers, 15% thongs/flip flops, 7% backless slippers), which was associated with older age (1.03, p?<?0.001). No footwear was worn by 34% of participants (30% barefoot, 3% socks only). Those of older age (0.97, p?<?0.001) and those in the most disadvantaged socioeconomic group (0.55, p?=?0.019) were less likely to wear no footwear (socks or barefoot). Conclusions:Only one in nine people in a large representative inpatient population wore a protective indoor footwear most of the time in the previous year. Whilst having education levels above year 10 and having received previous foot treatment by a specialist physician were associated with wearing protective footwear indoors, the presence of a range of other medical and foot conditions were not. These findings provide information to enable clinicians, researchers and policymakers to develop interventions aimed at improving indoor footwear habits that may help prevent significant health burdens such as falls and foot ulcers.
Project description:The longitudinal arch (LA) helps stiffen the foot during walking, but many people in developed countries suffer from flat foot, a condition characterized by reduced LA stiffness that can impair gait. Studies have found this condition is rare in people who are habitually barefoot or wear minimal shoes compared to people who wear conventional modern shoes, but the basis for this difference remains unknown. Here we test the hypothesis that the use of shoes with features that restrict foot motion (e.g. arch supports, toe boxes) is associated with weaker foot muscles and reduced foot stiffness. We collected data from minimally-shod men from northwestern Mexico and men from urban/suburban areas in the United States who wear 'conventional' shoes. We measured dynamic LA stiffness during walking using kinematic and kinetic data, and the cross-sectional areas of three intrinsic foot muscles using ultrasound. Compared to conventionally-shod individuals, minimally-shod individuals had higher and stiffer LAs, and larger abductor hallucis and abductor digiti minimi muscles. Additionally, abductor hallucis size was positively associated with LA stiffness during walking. Our results suggest that use of conventional modern shoes is associated with weaker intrinsic foot muscles that may predispose individuals to reduced foot stiffness and potentially flat foot.
Project description: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.