Effect of the shoes on the movement of feet and legs during gait primary report S.Yamamoto, Ph.D.l), Y.Watanabe 2), H.Usui 2),
Y.Hayakawa, RPO 3)
l)Tokyo Metropolitan Prosthetic and Orthotic Research Institute 2)Watanabe Ltd.
3)Waseda College of Medical Arts and Sciences
The purpose of this study was to investigate the effect of the of shoes on the gait. The gait of eight normal subjects were measured without any shoes, with room shoes of soft soles, and with shoes which fit each subject's feet. The gait was measured by a three dimensional motion analysis system and force plates. The angular displacement of the lower, logs and feet, floor
reaction forces, and the joint moments were calculated.
The difference of shoes influences the inversion eversion angle and the magnitude of the moment due to floor reaction forces around the ankle joint. The subjects who showed eversion at the late stance showed inversion when he/stl wore appropriate shoes.
It is supposed that the appropriate shoes substitute the insufficient activity of the intrinsic muscles of the foot during gait
Key words: Shoes, Normal gait, Inversion eversion, Joint moment
It is well known that the characteristics of shoes influences the
gait of not only patients but also normal people who seem to
have no problem in their legs. The effect of shoes have been
studied by many researchers but most of them measured the
pressure distribuéion ‘during the gait1)2). Recently the
relation between the pressure distribution and perceived comfort
in casual footwear was investigatedB). Other researchers
investigated the effect of the heel height 4) 5) and the shock
waves ,during the high—heel gait6). In these studies the
measurement was limited to the partial forces represented by the
The authors have seen many people who improve the pain at
the low back and the knee joint with appropriate shoes from the
experience of/shoe making and fitting. On the contrary we also
have seen méhy people who aggravate physical troubles for
example the Hullex Valgus with inappropriate shoes. The abpropriativeness
mainly depends on the fitness of the shoe shape .to the feet.
However, it is quite important to approximate the movement of the
feet of each subject to the normal movement by shoes in these
cases. From this point of View we measured the gait of subjects
with shoes by a three dimensional motion analysis system and
investigated the effects of shoes on the gait. Subjects were 8
normal people who have no trouble in their lower legs. The gaits
without any shoes, with room shoes of soft soles, and with shoes
which fit each subject feet were measured. The movement of the
lower leg, the floor reaction forces, and the joint moments were
examined and the evaluation procedure of the gait with shoes was
A three dimensional motion analysis system ( Oxford Metrics, Vicon 370) and force plates ( Kyowa Dengyo, EFP386AS) were used.
The reflective markers were
put on both shoulders, both hip
joints ( 1cm upper and 2cm ahead the greater trochanter), lateral and medial sides of the left knee joint ( 2cm upper the medial tibial plateau), and both tops of the maliolus and 1st and 5th metatarsal heads and the toe of the left foot as shown In Fig. 1.As for the segments distal from the knee joint only the
movement of the left leg were measured because there seemed to be no difference between left and right sides of normal subjects.
The gaits without shoes, with room shoes consisted of rubber soft sole, and with shoes appropriate to each subject, which we called the basic shoes, were measured. The range of motion of each subject's foot was examined by hand and the basic shoes by which the normal range of motion could be obtained was selected among commercial available shoes. The appearances of shoes are
shown in Fig. 2. During the
measurement with shoes markers
were put on shoes, but we confirmed whether there was no gap between the shoes and the feet. Any Instructions, for example the instructions about the cadence, were not given to subjects during the measurement.
Subjects were eight healthy people, 4 males and 4 females from 19 to 44 years old, who have no pathological trouble In their legs.
At first the
static rigidity of the feet was
examined by the hand. And the passive range of motion of the ankle joint, such as degrees of dorsiflexion and plantarflexion
and degrees of inversion
and eversion were measured by a
goniometer. Figure 3 shows the result of the range of motion of
all subjects. The horizontal axis represents each subject arrayed in the order of the examined rigidity from left to right. There was a tendency that the the feet of male subjects were more rigid than that of female subjects, and the
flexible feet showed large range of motion in the plantarfiexion and the Inversion. For convenience of the explanation below eight subjects were divided into three groups, such as rigid foot C subject A), intermediate foot C subject B, C, D, E, F ), and flexible foot ( subject G, H ).
The rotation of the trunk and the pelvis and the angular
displacement of the axis of the knee, the ankle, and the
metatarsal joints In the sagittal, the coronal, and the transverse planes were calculated from the positions of reflective markers which were put on the both sides of each segment. The rotation angle around the longitudinal axes of the shank and the foot were also calculated. The moment around the knee and the ankle joints due to floor reaction forces were calculated by the position data and floor reaction force data. All data was normalized by the gait cycle which started at the time of heel contact.
Figure 4 shows the superimposed angular displacement of the ankle axis, which was defined by the line between both markers at the maliolus, in the coronal plane during the gait of two
without any shoes. Although four
steps shown here were
not obtained by the continuous measurement, the reproducabil
lty of data is remarkable. Therefore all gait data in the following are averaged data of 4 to 8 steps.
For all gait data described above the rotation of the foot
showed the largest deviation among subjects. The axes of the ankle and the metatarsal joints were defined by the positions of markers attached at the both sides of each joint as shown in
Fig. 5a, and the relative angle of two axes was calculated.
The foot consists of so cnany joints that it is difficult to represent the movement of the foot by a rotation around a single axis. The
angle calculated here is an approximate value
of the inversion
eversion of the ankle joint. The inversion eversion rotation occurs at the subtalar joint. It is necessary to put many markers on each segment of the foot to calculate the accurate inversion eversion7). However, it was difficult to put markers
exactly on the surface of shoes, so the simple rotation described above was adopted. The zero value of the rotation represents the
value during standing and the plus value indicates the eversion.
Figure 6 shows the result of the inversion eversion of a subject with rigid foot, a subject with intermediate foot, and a subject with flexible foot. The result of barefoot, with room shoes , and the basic shoes are shown by the dotted line, broken line, and the solid line, respectively. The rigid foot rotates into inversion direction during the mid to late stance phase in any conditions as shown in Fig. Ba. The rotation angle of the intermediate foot during the mid stance shows a constant value in
the case of barefoot and the room shoes, but inversion occurs
when he wore basic shoes. This phenomena was observed among other subjects who have intermediate feet. The rotation of the
flexible foot is extremely large when she walked without any shoes, but it is restricted by shoes as shown in Fig. 6c.
Figure 7 shows the result of the rotational moment around the
longitudinal axis of the foot due to floor reaction forces.
All shown in Fig. 5b the longitudinal axis of the foot was defined by the line connecting the midpoints of lateral and medial markers at the ankle and the metatarsal joints. The rotational moment due to floor reaction forces was calculated around this axis. The p
lus value indicates the direction which the floor reaction
forces act to evert the foot. The result of the rigid foot
shows the large eversion moment during the mid to the late stance as shown in Fig. 7a., It is caused by the lateral location of the center of pressure at the late stance.
The result of the intermediate foot shows relatively small magnitude and it reduces
case of wearing shoes. This
phenomena was observed among
other subjects who have intermediate feet. The magnitude of the moment of the flexible foot is small through the stance phase, and it shows that the center of pressure locates under the longitudinal axis of the foot.
The results obtained here is shown schematically in Fig. 8. The effect of shoes is not evident in the case of rigid foot.
However, the magnitude of the moment which the floor reaction forces act to evert the foot reduces remarkably when subjects
intermediate and flexible foot wore basic shoes. The main
reason of this reduction is the movement of the center of pressure toward the longitudinal axis of the foot during mid to late stance.
The role of the foot during the stance phase is to absorb the shock at the initial stance and to transmit the muscle forces of the plantarflexors to the floor at the time of push off. Therefore the foot is required two conflict characteristics, such as flexible at the initial stance and rigid at the late stance.
To obtain such characteristics the activity of intrinsic muscles during the mid to late stance stabilizes the foot so that the
acts as a lever to facilitate the smooth push off8). In
this study the activity of intrinsic muscles of subjects who have the intermediate and the flexible feet seems to be insufficient to make a rigid lever. In other words the Internal forces are insufficient to resist the external floor reaction forces which act to evert the foot. The eversion at the late stance causes excessive load at the 1st metatarsal joint.
It might cause excessive distortion of the
foot and the legs and subsequently aggravate the frambles of the whole body. On tne
contrary tne' inversion occurs
during tne mid to late stance wnen the subjects wear basic snoes because tne moment to evert the foot reduces. it is said that the basic shoes substitutes the role o,f intrinsic muscles which makes the foot rigid.
From results obtained here it was clarified that the inversion eversion movement of the foot during mid to late stance was influenced by the characteristics of shoes. It might be useful to evaluate the gait" with shoes. We intend to measure the gait of other subject and investigate the effect of the characteristics of the shoes on the movement of upper body, such as the pelvis and the' trunk In the future.
1) Young M J, Cavanagh P R, Thomas G, Johnson M M, Murry H, Boulton A J M. The effect of callus removal on dynamic plantar foot pressures in diabetic patients. Diabetic Med 1992, 9 55-57
2) Chantelau E. Tanudjaja T. Altenhofer F. Ersanli Z. Lacigova S.Metzger C. Anatlbiotic treatment for uncomplicated neuropathlc
forefoot ulcers in diabetes; a controlled trail, Diabetic Med 1996 13, 156-159
3) Jordan C, Bartlett R. Pressure distribution and perceived comfort in casual footwear, Gait & Posture, 1995 3; No.4, 215ー 220
4)Trevino S G. Calidsities, corns, and callusues, 3) Soames R W, Clark C. Heel height Induced changes in metatarsal loading patterns during gait. In:Biomechanlcs IX-S. Champaign, IL: Human Kinetics Press, 1985, 7; 447-450
5) Gastwlrth B W, O'Brien T D, Nelson R M, Manger D C, Kindeg S A. An electrodynographis study of foot function in shoes of varying heel heights. J. Am. Podiatr Med Assoc 1991; 81, 463-372
6) Voloshin A S, Loy D J. Biomechanical evaluation and management of the shock waves resulting from the high-heel gait: I-temporal domain study, Gait & Posture, 1994 2; No.2, 117-12
7) Scott S H, Winter D A. Biomechanical model of the human foot kinematics and kinetics during the stance phase of walking, J. Biomechanics 1993 Vol.26, No.9, 1091-1104
8) Mann R, Inman V T, Structure and function, Surgery of the Foot, The C.V. Mosby Company, 1965