In response to the recent debate on barefoot running and walking of children
published in the New Zealand Herald1 we have put together an argument relating to
the pros and cons based on current evidence.
There is very limited evidence specifically relating to barefoot running and walking in
children. One study from Germany reported that the increased prevalence of flatfoot
and hallux valgus (bunions) in modern societies may be the consequence of
inadequate footwear in childhood.2 The German study postulated that barefoot
walking represents the best condition for the development of a healthy foot.
Walking and running on different types of surfaces such as grass, sand, and artificial
running tracks may indeed enhance healthy foot development. However, the problem
of barefoot walking on hard surfaces such as pavements may alter the biomechanics
of walking and running. This may lead to potential arthritic changes and consequently
a reduction in foot function.
A more worrying concern is the impact of obesity and overweight on children’s feet.
A recent study from New Zealand suggested that three lifestyle risk factors related to
obesity: low physical activity, skipping breakfast, and insufficient sleep on
weekdays.3
To prevent children undertaking physical activity may exacerbate a major issue
already within New Zealand. A recent study from Australia suggests that the function
of the arches of the feet in overweight and obese children may change and this might
worsen if excess weight impacts on the foot throughout childhood and into
adulthood.4
Another problem to address relating to barefoot walking is the issue of children with
diabetes. The long-term complication of diabetes on the foot includes infection,
ulceration, and a loss of peripheral sensation. A UK study by Karabouta5 found over
50% of adolescents with Type 2 diabetes had peripheral neuropathy and weak
posterior tibial pulses. The authors recommend that all children with Type 2 diabetes
need podiatric surveillance for complications from the time of diagnosis. A study
from rural Australia suggested that walking barefoot is a risk factor for diabetic foot
disease.6
It is interesting to note that certain types of footwear may cause injuries in children. A
study from Ireland showed that there was an increasing trend in orthopaedic injuries
using Heelys and Street Gliders.7. Another study using a cloth sport shoe showed
inferior cushioning capability but the same lateral stability as the other sports shoes
for children.8 However, a study from Germany reports shows that slimmer and more
flexible children's shoes do not change foot motion as much as conventional shoes
and therefore should be recommended for children of all ages.1
Painful feet in children are often caused by flatfeet or mechanical instability of the
arches of the foot. A recently conducted New Zealand review on children’s shoes
found no evidence to support the suggestion that different types of footwear reduced
pain in children’s flatfeet.9
Finally, a study from Australia found significant structural differences between the
feet of European and Australian children.9 The German children displayed
significantly longer and flatter feet relative to their Australian counterparts, whereas
the Australian children reveal a significantly smaller ball angle, implying that the
forefoot of the Australian children is squarer in shape.
These findings imply that footwear must be designed to cater to the unique foot
dimensions of children in different continents to ensure that shoe shape matches foot
shape. Most footwear companies do not vary the dimensions of their shoe lasts to
accommodate intercontinental differences in foot morphology based on racial and/or
environmental factors. The results of this study will have immediate implications for
the design of comfortable footwear suitable for the developing feet of children.10
In summary, further research is required in this area.
Keith Rome
Professor of Podiatry
Dene Hancock
Senior Lecturer
Daniel Poratt
Head
School of Podiatry
Division of Rehabilitation & Occupation Studies
AUT University, Auckland
References:
1. Johnston M. Running debate over going barefoot. New Zealand Herald, 31 March 2008.
http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10501075
2. Wolf S, Simon J, Patikas D, et al. Foot motion in children’s shoes: a comparison of barefoot
walking with shod walking in conventional and flexible shoes. Gait Posture. 2008;27:51–9.
3. Duncan JS, Scholfield G, Duncan EK. Risk factors for excess body fatness in New Zealand
children. Asia Pac J Clin Nutr. 2008;17:138–47.
4. Mickle KJ, Steele JR, Munro BJ. The feet of overweight and obese young children. Obesity.
2006;14:1949–53.
5. Karabouta Z, Barnett S, Shield JP, et al. Peripheral neuropathy is an early complication of
type 2 diabetes in adolescence. Pediatr Diabetes. 2008 [in press].
6. Jayasinghe SA, Atukoraia I, Gunethilleke B, et al. Is walking barefoot a risk factor for diabetic
foot disease in developing countries? Rural Remote Health. 2007;7:692.
7. Vioreanu M, Sheehan E, Glynn A, et al. Heelys and street gliders injuries: a new type of
paediatric injury. Paediatrics. 2007;119:1294–6.
8. Fong DT. Cushioning and lateral stability functions of cloth sport shoes. Sports Biomech.
2007;6:407–17.
NZMJ 18 April 2008, Vol 121 No 1272; ISSN 1175 8716 Page 111
URL:
http://www.nzma.org.nz/journal/121-1272/3024/ ©NZMA
9. Rome K, Ashford RA, Evans AE. Conservative interventions for paediatric pes planus
(protocol). Cochrane Systematic Review. 2007;2.
10. Mauch M, Mickle KJ, Munro BJ, et al Do the feet of German and Australian children differ in
structure? Implications for children’s shoe design. Ergonomics. 2008;51:527–39.
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