Stepping Back to Minimal Footwear

Applications Across the Lifespan

Irene S. Davis; Karsten Hollander; Daniel E. Lieberman; Sarah T. Ridge; Isabel C.N. Sacco; Scott C. Wearing

Disclosures

Exerc Sport Sci Rev. 2021;49(4):228-243. 

In This Article

Minimal Footwear in Children

The foot undergoes crucial developmental changes during childhood and adolescence. Although several bones ossify prenatally, the main ossification period extends over the first 10 yr of life.[25] Epiphyseal union of all long bones in the foot, as well as the talus and calcaneus, occurs throughout late adolescence or early adulthood, representing the end of foot bone growth.[26] The foot typically achieves its final length at an age of about 13 yr in girls and 15 yr in boys.[27] The arch of the foot also develops during childhood. Although infants have no arch, it begins to develop once toddlers begin to walk. The shape of the arch is, thus, determined, not just by the shapes of the bones, but also by the muscles and ligaments.

Childhood and adolescence are critical periods in which the developing foot is more prone to external influences. One of these influences is incorrectly fitted footwear. The prevalence of incorrectly fitted footwear has been estimated to be up to 66% (too narrow) and 72% (too short) in school children.[28] Improperly fitted footwear has been shown to increase the risk of foot deformities such as pes planus or hallux valgus in children and adolescents.[29–31] In contrast, children and adolescents who grow up barefoot have been shown to have significantly higher arches than those who have grown up shod.[32–35] One large-scale study reported on 2300 children in India between the ages of 3 and 15 yr.[25] In one community, children were barefoot, in another they wore sandals, and in a third they wore closed-toe shoes. Flat footedness was most prevalent in the group that wore shoes and least prevalent in those who were barefoot.

Low arches are associated with pathologies such as pes planus deformity,[29] which can lead to altered function. For example, children with low arches have been shown to walk with greater foot progression angle and greater external rotation of the lower extremity.[30] Along with higher arches, children who are habitually barefoot also demonstrate improved jumping and balance skills.[36] A recent, large-scale study compared Japanese children from two schools in the same city that incorporate a running program, with one being barefoot and the other shod.[37] Children in the barefoot program exhibited significantly greater performance in jumping and sprinting, and a greater proportion ran with a midfoot or forefoot strike (FFS) pattern compared with the shod group.

Minimal footwear has been associated with the ability to mimic some of the barefoot walking characteristics in children.[38,39] For example, Hillstrom et al.[38] compared the gait of toddlers with only a few months of walking experience as they walked barefoot, and in minimal and structured shoes. Similar plantar pressure distributions between the barefoot and minimal footwear were noted compared with more structured footwear. The authors conclude that this similarity may enhance proprioception, which they suggested was important for developing gait in young children. In addition, Wolf et al.[39] studied a cohort of 6- to 10-yr-old children. They noted that walking kinematics in minimal footwear were closer to the barefoot condition than in structured footwear in 12 of 15 parameters tested. They also noted that minimal footwear allowed the medial longitudinal arch to deform more naturally than in traditional, stiff footwear.[39]

Running mechanics in children also are influenced by minimal footwear. Hollander et al.[40] conducted a comparison of minimal and cushioned footwear with barefoot running in 6- 9-yr-old children. The greatest differences in mechanics were found between the cushioned and barefoot conditions, and the most similarities were noted between the minimal and barefoot conditions. For example, the rate of RFSs was highest for the cushioned shod running and lower but similar for the barefoot and minimally shod running. This pattern was also true for other variables. The impact force and step length were higher, and cadence was lowest in the cushioned shoe, but similar between the barefoot and minimal shoe conditions.

Based on these collective studies, minimal shoes may be optimal for the developing feet of children. These shoes are designed to better match the natural shape of the foot with additional width in the forefoot. This helps overcome the issue with improper fit of shoes, which is especially important for the developing foot. They seem to replicate many aspects of both walking and running mechanics as being barefoot while protecting the sole of the foot. Despite these potential benefits, recommendations for youth footwear, to date, still do not address minimal shoes.[41,42]

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