Foot and ankle problems in children and young people: a population-based cohort study.

The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for all CYP aged 0-18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as "musculoskeletal" (34%) and "unspecified pain" (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10-14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03).    Conclusions: Consultations for foot and ankle problems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings.

Health Promotion Models for Improving Footcare in Older Adults: A Scoping Review.

INTRODUCTION: Footcare is an important component of wellbeing in older adults and the promotion of appropriate footcare interventions is imperative for health professionals working with this population. In this scoping review, we describe the health promotion models informing footcare interventions for older adults. The objectives were to (i) understand the context(s) where health promotion models have informed footcare interventions; (ii) identify the health promotion models informing interventions; and (iii) document the effectiveness of theoretically informed health promotion interventions for improving footcare in older adults. METHODS: Footcare interventions developed using health promotion models worldwide and published in English before July 2023 were searched using MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar. RESULTS: A total of 2,078 articles were identified, of which 31 were retrieved and assessed for eligibility. Eight articles met the eligibility criteria, with most interventions delivered in Asia (n = 5) and using self-efficacy theory as their theoretical framework (n = 6). Most of the studies included people with diabetes (n = 6) and outcomes were measured using foot health outcomes, knowledge of foot health, and footcare behaviors and self-efficacy. CONCLUSION: This scoping review has identified a range of footcare interventions, with evidence of promising outcomes on improving footcare in older adults. Approaches toward methods and dosage of intervention varied across the studies and more broadly, we identified that few studies report the health promotion model informing the design of intervention(s). Further research is required to ascertain which health promotion model, modality of promotion, and implementation approach are the most effective for improving footcare in older adults.

Evaluation of bioelectrical impedance analysis in measuring body fat in 6-to-12-year-old boys compared with air displacement plethysmography.

Air displacement plethysmography (ADP) has been considered as the 'standard' method to determine body fat in children due to superior validity and reliability compared with bioelectrical impedance analysis (BIA). However, ADP and BIA are often used interchangeably despite few studies comparing measures of percentage body fat by ADP (%FMADP) with BIA (%FMBIA) in children with and without obesity. The objective of this study was to measure concurrent validity and reliability of %FMADP and %FMBIA in 6-to-12-year-old boys with and without obesity. Seventy-one boys (twenty-five with obesity) underwent body composition assessment. Ten boys participated in intra-day reliability analysis. %FMADP was estimated by Bodpod using sex- and age-specific equations of body density. %FMBIA was estimated by a multi-frequency, hand-to-foot device using child-specific equations based on impedance. Validity was assessed by t tests, correlation coefficients and limits of agreement (LoA); and reliability by technical error of measurement (TEM) and intraclass correlation coefficients (ICC). Compared with %FMADP, %FMBIA was significantly underestimated in the cohort (-3·4 ± 5·6 %; effect size = 0·42) and in both boys with obesity (-5·2 ± 5·5 %; ES = 0·90) and without obesity (-2·4 ± 5·5 %; ES = 0·52). A strong, significant positive correlation was found between %FMADP and %FMBIA (r = 0·80). Across the cohort, LoA were 22·3 %, and no proportional bias was detected. For reliability, TEM were 0·65 % and 0·55 %, and ICC were 0·93 and 0·95 for %FMBIA and %FMADP, respectively. Whilst both %FMADP and %FMBIA are highly reliable methods, considerable differences indicated that the devices cannot be used interchangeably in boys age 6-to-12 years.

A step in the right direction: Delphi consensus on a UK and Australian paediatric podiatry curriculum.

BACKGROUND: Previous research shows considerable variation in pre-registration paediatric podiatry curricula, and thus the clinical skills realised prior to graduation. Whilst pre-registration training is guided by regulatory bodies, these high level principles only refer briefly to standards in paediatric practice. An estimated 9% of podiatry caseloads in the United Kingdom (UK) and Australia are dedicated to paediatric service provision. Therefore, it is imperative that curricula support the consistent development of paediatric practice enabling newly registered podiatrists to work safely and effectively with children. Given that the global healthcare work force provides unique opportunities to explicitly align international curricula, the aim of this study was to determine the priorities for a UK and Australian binational pre-registration paediatric podiatry curriculum. METHODS: A four round modified Delphi design was employed to ascertain consensus and agreement of a panel of experts with a special interest in paediatrics working in the UK and Australia. Round 1 contained open questions designed to promote diverse responses on the broad topics of lecturer experience and curriculum organisation and delivery. The answers from Round 1 were developed, through content analysis, into a series of statements presented to the panel for agreement in Rounds 2, 3 and 4. RESULTS: Of the 297 statements generated following Round 1, 183 were accepted and 114 rejected by the end of Round 4. 109 of the accepted statements related to curriculum content. Participants also agreed on areas relating to lecturer experience, clinical education, and assessment of paediatric skills. CONCLUSIONS: This study is the first of its kind to describe elements of a curriculum for pre-registration podiatry training. The recommendations highlight opportunities that education providers can work towards during curriculum design. They also emphasise the collaboration that is needed between professional bodies, clinicians and higher education institutions when defining guidelines and expectations for paediatric specific skills.

Concurrent Validity of Lower Limb Muscle Strength by Handheld Dynamometry in Children 7 to 11 Years Old.

CONTEXT: The assessment of pediatric muscle strength is necessary in a range of applications, including rehabilitation programs. Handheld dynamometry (HHD) is considered easy to use, portable, and low cost, but validity to measure lower limb muscle strength in children has not been assessed. OBJECTIVE: To determine the concurrent validity of lower limb torque from HHD compared with isokinetic dynamometry (ID) in children aged from 7 to 11 years old. DESIGN: A descriptive assessment of concurrent validity of lower limb joint torques from HHD compared with ID. METHODS: Sixty-one typically developing children underwent assessment of maximal hip, knee, and ankle isometric torque by HHD and ID using standardized protocols. Joint positions were selected to represent maximal strength and were replicated between devices. Concurrent validity was determined by Pearson correlation, limits of agreement, and Bland-Altman plots. RESULTS: Correlations between HHD and ID were moderate to large for knee extension (r 95% CI, .39 to .73), small to large for plantar flexion (r 95% CI, .29 to .67), knee flexion (r 95% CI, .16 to .59), hip flexion (r 95% CI, .21 to .57), hip extension (r 95% CI, .18 to .54), and hip adduction (r 95% CI, .12 to .56), and small to moderate for dorsiflexion (r 95% CI, -.11 to .39) and hip abduction (r 95% CI, -.02 to .46). Limits of agreement for all joint torques were greater than 10% indicating large error in HHD measured torque compared with ID. A positive proportional bias was detected for plantarflexion, indicating that HHD underestimated torque to a greater extent in participants with higher torque values. CONCLUSIONS: Maximal torque values from HHD and ID are consistent with those previously reported in the literature. Poor concurrent validity of HHD may have arisen from issues around joint position, joint stabilization, and the experience of the tester to prevent an isokinetic contraction. Pediatric lower limb muscle strength assessed by HHD should be interpreted with caution.

The "price-tag" of foot health in infancy and early childhood: a cross sectional survey of UK parents.

Children's feet are complex structures and strategies for supporting good foot health throughout childhood can be challenging. Greater awareness of the contemporary factors influencing decisions, such as footwear purchases, is needed to inform health narratives which are more closely aligned to parents' attitude and behaviours. The aim of this study was to explore parent's knowledge of children's foot health, understand the common foot health concerns and experiences with footcare services. A purposeful sampling approach was used to recruit parents of children aged 5 years and under. Participants completed a self-administered, online survey which consisted of 39 questions across six sections: (1) Participant demographics; (2) Developmental events (milestones such as crawling and walking); (3) Foot health concerns; (4) Developmental aids (products such as baby bouncers and baby walkers); (5) Footwear; and (6) Foot health information. Both adaptive and mandatory questions were used. Descriptive statistics were used to summarise closed-ended questions, and a summative content analysis was adopted to draw inferences from the text data. Two-hundred thirty-nine parents completed the survey, and this represented female participants (n = 213) aged between the ages 34-42 (n = 126) or 25-34 (n = 83) years of age. The survey generated responses from a wide geographical spread across the UK, but the majority of these were from the North West of England (n = 75) and South East of England (n = 46). Four main themes were drawn from the content analysis: (1) foot health concerns and seeking advice; (2) information and advice; (3) how parents support infant milestone events; and (4) footwear.Conclusion: This work provides insight into parents' perspective on the broad topics of children's foot health, identifying common experiences and concerns about their children's foot health and the factors which influence decision making. Understanding more about these issues will help health professionals support parents during infancy and early years. What is Known: • Maintaining good foot health throughout childhood is important and many factors influence decision making. • There is little understanding about how parents care for their children feet and their understanding of good foot health practices and services. What is New: • Insight into the common factors which influence parents' approaches to supporting early development and the typical concerns that parents encountered about their children's overall foot health and footwear. • Identifies areas of children's foot health for health professionals to target when developing information sources for parents.

Dynamic Characteristics of Foot Development: A Narrative Synthesis of Plantar Pressure Data During Infancy and Childhood.

PURPOSE: Quantifying plantar pressure throughout childhood enables clinicians to enhance knowledge of typical changes in foot function. This narrative review aims to describe existing research reporting plantar pressure analysis in infants and children developing typically, to advance understanding of foot development. METHODS: A narrative approach was used; 263 articles were identified and 13 met inclusion criteria. RESULTS: Plantar pressures during walking rapidly change in infancy and childhood. With development, pressures increasingly resemble those in adults with the development of initial heel contact, shift in pressure distribution from medial to lateral foot side, decreasing midfoot pressure magnitude. The literature has a variety of study designs, data collection protocols, and analysis. CONCLUSION: This review describes plantar pressure changes occurring as walking develops, emphasizing the typical trajectory of foot function development in infancy and childhood. The present finding describes the complex biomechanical development of foot function in typically developing infancy and childhood.

Comparison of Transverse Plane Tibial and Frontal Plane Rearfoot Motion and Movement Coordination Between Runners With Medial Tibial Stress Syndrome and Healthy Controls.

Medial tibial stress syndrome (MTSS) is a common running-related injury. Alterations in movement patterns and movement coordination patterns have been linked to the development of overuse injuries. The aim of this study was to compare transverse plane tibial and frontal plane rearfoot motion and the coordination of these movements between runners with MTSS and healthy controls. A total of 10 recreational runners with MTSS and 10 healthy controls ran at 11 km/h on a treadmill. A 3-camera motion analysis system operating at 200 Hz was used to calculate tibia and rearfoot motion. Stance phase motion patterns were compared between groups using multivariate analysis, specifically, Hotelling T2 test with statistical parametric mapping. A modified vector coding technique was used to classify the coordination of transverse plane tibial and frontal plane rearfoot motion. The frequency of each coordination pattern displayed by each group was compared using independent samples t tests. Individuals with MTSS displayed significantly (P = .037, d = 1.00) more antiphase coordination (tibial internal rotation with rearfoot inversion) despite no significant (P > .05) differences in stance phase kinematics. The increased antiphase movement may increase the torsional stress placed upon the medial aspect of the tibia, contributing to the development of MTSS.

Absolute and Allometrically Scaled Lower-Limb Strength Differences Between Children With Overweight/Obesity and Typical Weight Children.

Theis, N, Le Warne, M, Morrison, SC, Drechsler, W, and Mahaffey, R. Absolute and allometrically scaled lower-limb strength differences between children with overweight/obesity and typical weight children. J Strength Cond Res 33(12): 3276-3283, 2019-The purpose of this study was to compare isometric and isokinetic hip, knee, and ankle strength in children with overweight/obesity (OWB) and typical weight (TW) of age 6-12 years. Absolute torque and torque allometrically scaled to body mass and fat-free mass were derived to allow for comparison of strength irrespective of body size. Using a cross-sectional design, 26 OWB (body mass index [BMI] Z score: 2.28 ± 0.77, 54% females) children were matched in age and height with 26 TW (BMI Z score: -0.39 ± 0.96, 54% females). Subjects performed maximal isometric and isokinetic contractions in ankle dorsiflexion and plantarflexion, knee flexion and extension, hip flexion and extension, and isometric hip abduction and adduction. Between-group differences in absolute and normalized isometric and isokinetic strength were compared with 1-way analysis of variances. Statistical significance was set at p < 0.05. Children with OWB had significantly greater absolute torque in the knee flexors and extensors (15-21%) and greater isokinetic ankle dorsiflexion (8%) but lower isometric hip abduction (21%) compared with TW children. When strength was allometrically scaled to body mass, children with OWB were significantly weaker at the ankle (19-25%), hip (21-36%), and in the knee extensors (12-15%). When torque was allometrically scaled to fat-free mass, children in the OWB group had greater knee flexor and extensor strength (12-14%) but were weaker in isometric hip abduction (33%) and isokinetic hip flexion and extension (29-40%). The results demonstrated that deficits in strength, relative to body mass, at the ankle and hip may be greater than those of the knee. These strength deficits in the group with OWB highlight the need for targeted musculoskeletal strength interventions to incorporate all lower-limb muscle groups.

The Influence of Motion Control, Neutral, and Cushioned Running Shoes on Lower Limb Kinematics.

To date there is a paucity of information about how different types of conventional running shoes influence lower limb kinematics. The aim of the study was to determine the influence of motion control, neutral, and cushioned running shoes upon lower limb kinematics. Twenty-eight active males completed one test session running in standardized motion control, neutral, and cushioned running shoes on a treadmill at a self-selected pace (2.9 [0.6] m·s-1). Kinematic data were collected using a VICON motion analysis system with hip, knee, and ankle joint angles calculated. Discrete parameters associated with stance phase kinematics were compared between footwear conditions. Significant (P < .05) differences in knee flexion and internal rotation at toe off, and knee adduction range of motion were reported between footwear conditions. Significant (P < .05) differences in ankle joint dorsiflexion and adduction upon initial contact, peak dorsiflexion, eversion and abduction, and inversion at toe off were reported between footwear conditions. The influence of motion control, neutral, and cushioned running shoes on joint function dissipates moving proximally, with larger changes reported at the ankle compared with knee and hip joints. Although significant differences were reported between footwear conditions, these changes were of a small magnitude and effect size.

Masking approaches to analyse plantar pressure data of new and confident walking infants.

BACKGROUND: Due to its easy and straightforward use, regional analysis with the "standard" mask is the most common approach for quantifying plantar pressures in infancy. Such a mask, however, identifies foot regions based on typical foot proportions and pressure gradients. Alternatively, the use of a customised mask retaining infants' feet proportions has not been explored. RESEARCH QUESTION: Does a customised mask scaled on infants' feet improve processing of pressure data collected during walking development compared with a standard mask? METHODS: Thirteen infants walked across an EMED xl platform. Steps were grouped applying eight foot-regions standard and customised masks. To evaluate masks' performance, peak pressure (PP) and contact area (CA) were extracted from each region, and mask. Intra-individual coefficients of variation were then calculated for each variable, and compared between masks using a Mann-Whitney U test (p < 0.05). Unsuccessful masks application was reported, expressed as percentage of data loss. RESULTS: For CA variation, significant differences were found in all the regions but the lateral toes in new (Z = -0.184, p = 0.8540) and confident walking (Z = -1.562, p = 0.118). For PP variation, a significant difference was found in confident walking within the lateral midfoot (Z = -2.598, p = 0.009). With the standard mask, 22-27 % of data was lost in new and confident walking respectively, compared to 1.6-0 % with the customised. As a result, the customised mask characterised the more variable steps, demonstrating higher variation compared to the standard mask. SIGNIFICANCE: Identifying foot regions using a mask based on infants' feet proportions yielded an improved performance compared to the standard mask. With the customised mask, we retained almost all the steps and characterised the variability of the data, thereby providing an appropriate approach for infants' pressure data processing. Application of the customised mask could therefore be beneficial in future studies analysing highly variable data sets.

Foot plantar pressure and centre of pressure trajectory differ between straight and turning steps in infants.

Plantar pressure has been used to understand loading on infant feet as gait develops. Previous literature focused on straight walking, despite turning accounting for 25% of infant self-directed steps. We aimed to compare centre of pressure and plantar pressure in walking steps in different directions in infants. Twenty-five infants who were walking confidently participated in the study (aged 449 ± 71 days, 96 ± 25 days after first steps). Plantar pressure and video were recorded whilst five steps per infant were combined for three step types: straight, turning inwards and outwards. Centre of pressure trajectory components were compared for path length and velocity. Pedobarographic Statistical Parametric Mapping explored differences in peak plantar pressure for the three step types. Significant differences were identified primarily in the forefoot with higher peak pressures in straight steps. Centre of pressure path was longer in the medial-lateral direction during turning (outward 4.6 ± 2.3, inward 6.8 ± 6.1, straight 3.5 ± 1.2 cm, p < .001). Anterior-posterior velocity was higher in straight steps and medial-lateral velocity highest turning inwards. Centre of pressure and plantar pressures differ between straight and turning steps with greatest differences between straight and turning. Findings may be attributed to walking speed or a function of turning experience and should influence future protocols.

Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study.

BACKGROUND: Total hip arthroplasty (THA) patients have been shown to not achieve normal sagittal plane hip kinematics. However, previous studies have only conducted group level analysis and as such lack the sensitivity to highlight whether individual patients do achieve normal hip kinematics. As such this study looked to determine whether some patients with well-functioning THA achieve typical sagittal plane hip kinematics. METHODS: Sagittal plane hip kinematics were collected on 11 well-functioning THA patients (Oxford Hip Score = 46 ± 3) and 10 asymptomatic controls using a 3-dimensional motion analysis system during self-paced walking. High-functioning THA patients were identified as those who displayed sagittal plane hip kinematics that were within the variance of the control group on average, and low-functioning patients as those who did not. RESULTS: 5 THA patients were identified as high-functioning, displaying hip kinematics within the variance of the control group. High-functioning THA patients displayed peak hip flexion and extension values more closely aligned to asymptomatic control group than low-functioning patients. However, hip range of motion was comparable between high- and low-functioning total hip arthroplasty patients and reduced compared to controls. CONCLUSION: The presence of high-functioning THA patients who display comparable sagittal plane hip kinematics to controls suggests these patients do achieve normative function and challenges the conclusions of previous group level analysis. Understanding why some patients achieve better function post-operatively will aid pre- and post-operative practices to maximise functional recovery.

Exploring pelvis and thigh movement and coordination patterns during walking in patients after total hip arthroplasty.

BACKGROUND: Patients after total hip arthroplasty (THA) have altered hip kinematics compared to healthy controls, specifically hip extension and range of motion are lower. Exploring pelvis-thigh coordination patterns and coordination variability may help to elucidate why differences in hip kinematics are evident in patients following THA. RESEARCH QUESTION: Do sagittal plane hip, pelvis and thigh kinematics, and pelvis-thigh movement coordination and coordination variability differ between patients following THA and healthy controls during walking? METHODS: Sagittal plane hip, pelvis and thigh kinematics were collected using a three-dimensional motion capture system while 10 patients who had undergone THA and 10 controls walked at a self-selected pace. A modified vector coding technique was used to quantify pelvis-thigh coordination and coordination variability patterns. Peak hip, pelvis and thigh kinematics and ranges of motion, and movement coordination and coordination variability patterns were quantified and compared between groups. RESULTS: Patients after THA have significantly (p ≤ .036; g ≥ 0.995) smaller peak hip extension and range of motion, and peak thigh anterior tilt and range of motion compared to controls. Additionally, patients following THA have significantly (p ≤ .037; g ≥ 0.646) more in-phase distally and less anti-phase distally dominated pelvis-thigh movement coordination patterns compared to controls. SIGNIFICANCE: The smaller peak hip extension and range of motion displayed by patients following THA is due to smaller peak anterior tilt of the thigh, which in turn limits thigh range of motion. The lower sagittal plane thigh, and in turn hip, motion used by patients after THA may be due to increases in the in-phase coordination of pelvis-thigh motion patterns, which cause the pelvis and thigh to work as a singular functional unit.

Are spatiotemporal gait characteristics reliable outcome measures in children with developmental coordination disorder?

PURPOSE: To evaluate the reliability of spatiotemporal gait parameters used in the clinical evaluation of children with developmental coordination disorder (DCD). METHODS: Participants recruited were asked to ambulate across a 4.5-meter GAITRite walkway (CIR Systems, Inc, Havertown, Pennsylvania) at a self-selected walking speed. The spatiotemporal parameters recorded for both limbs were: velocity (cm/sec), stance phase duration (%), swing phase duration (%), stride length (cm), double support duration (%), and single support duration (%). RESULTS: Intraclass correlation coefficient values attained in this study ranged from 0.24 to 0.73, with good reliability achieved for one parameter (cadence = 0.73), and moderate reliability for step length (0.55-0.58), stride length (0.57-0.61), and double support duration (0.56-0.59). CONCLUSION: The findings from this study indicate that the clinical evaluation of spatiotemporal gait parameters in children with DCD can yield reliable data for some parameters but further work on this is warranted.

Age-related changes in three-dimensional foot motion during barefoot walking in children aged between 7 and 11 years old.

BACKGROUND: The biomechanical complexity of children's feet changes throughout childhood, yet kinematic development of the feet is poorly understood. Further work exploring the kinematic profile of children's feet would be beneficial to help inform our understanding of the typical development of children's feet. RESEARCH QUESTION: Do three-dimensional segmental kinematics of the feet during gait relate to age in a sample of children age 7-11 years? METHODS: This study was a secondary analysis of an existing database representing one hundred and twenty-one children age 7 - 11 years (90 male, 31 female; mean ± SD: age 9.57 ± , 1.17 years, height 1.37 ± 0.08 m, body mass 35.61 ± 9.33 kg). Fifteen, 9 mm retroreflective markers were attached to the right shank and foot of each participant in, line with the 3DFoot model. Multi-segmental joint kinematics were collected during barefoot walking. Sagittal, frontal, and transverse planar motion was described for the shank-calcaneus, calcaneus-midfoot, and midfoot-metatarsals segment of the right foot. Principal component analysis (PCA) was used to reduce the major modes of variation in the data to fully explore foot segment motion over the entire gait cycle. Correlations and multiple regression between PCA outputs with age, and potential confounding factors are presented. RESULTS: Significant positive correlations were found between age and greater calcaneus, dorsiflexion, midfoot inversion and adduction, and metatarsal dorsiflexion, plantarflexion and abduction. There were no significant confounding effects of height, body mass, walking speed or gender on the relationships between age and PCA outputs. SIGNIFICANCE: The findings from this study demonstrated a relationship between foot kinematics and age suggesting that the development of foot kinematics is ongoing until at least the age of 11 years. This work offers a comprehensive data set of inter-segmental kinematics which helps to advance understanding of the development of the pediatric foot.

Young children's footwear taxonomy: An international Delphi survey of parents, health and footwear industry professionals.

OBJECTIVE: There is little consistency between commercial grade footwear brands for determining shoe sizing, and no universally accepted descriptors of common types or features of footwear. The primary aim of this research was to develop a footwear taxonomy about the agreed types of footwear commonly worn by children under the age of six. Secondary aims were to gain consensus of the common footwear features, when different types of footwear would be commonly worn, common terms for key footwear parts, and how movement at some of these footwear parts should be described. MATERIALS AND METHODS: Opinions were collected through a three-round modified Delphi international online survey from parents, health professionals, researchers, and footwear industry professionals. The first survey displayed generic pictures about different footwear types and asked participants to provide a grouping term, when the footwear would be worn (for what type of activity) and any grouping features. The second and third rounds presented consensus and gathered agreement on statements. RESULTS: There were 121 participants who provided detailed feedback to open-ended questions. The final round resulted in consensus and agreement on the names of 14 different footwear types, when they are commonly worn and their common features. Participants also reached consensus and agreement on the terms heel counter to describe the back part of footwear and fixtures as the collective term for features allowing footwear adjustability and fastening. They also agreed on terms to quantify the flexibility at footwear sole (bend or twist) or the heel counter. CONCLUSION: This first taxonomy of children's footwear represents consensus amongst different stakeholders and is an important step in promoting consistency within footwear research. One shoe does not fit all purposes, and the recommendations from this work help to inform the next steps towards ensuring greater transparency and commonality with footwear recommendations.

Parents, health professionals and footwear stakeholders' beliefs on the importance of different features of young children's footwear: a qualitative study.

BACKGROUND: A small but building pool of evidence of the impact of footwear on children's function means understanding the different beliefs of stakeholders about footwear key features and flexibility is critical for translation into recommendations and to support parents and caregivers in purchasing footwear for their children. Therefore, this research aimed to describe how different stakeholders (health professionals, parents, and footwear industry representatives) described the importance of flexibility and other footwear features for young children. METHODS: This qualitative study was nested within an international modified Delphi online survey. Participants responded to open-ended questions about footwear component flexibility and asked if and why flexibility in these areas were important. Participants also described any other important footwear features. Inductive thematic analysis was used to generate themes. RESULTS: There were 121 responses from three stakeholder groups including health professionals (n = 90), parents of young children (n = 26) and footwear industry representatives (n = 5). Overarching themes described by participants included developmental impacts of footwear, therapeutic impact and how footwear may play a role in function. CONCLUSION: There were key differences in how stakeholders viewed footwear and any perceived benefits of footwear components, much of which was not backed with empirical evidence. It was also identified that health professionals are using footwear within treatment recommendations. This work highlights the importance of understanding circumstances in which footwear may have a therapeutic impact or be the first line of treatment for children with complex foot needs. This is the first step in developing contemporary footwear recommendations for parents and caregivers.

Pedobarographic Statistical Parametric Mapping of plantar pressure data in new and confident walking infants: A preliminary analysis.

In infancy, plantar pressure data during walking has been investigated through regional approaches, whilst the use pedobarographic Statistical Parametric Mapping (pSPM) has not been reported. Analysis of pressure data using pSPM is higher in resolution and can enhance understanding of foot function development, providing novel insights into plantar pressure changes. This work aims to detail the implementation of the pSPM data processing framework on infants' pressure data, comparing plantar pressure patterns between new and confident walking steps. Twelve infants walked across an EMED- xl platform. Steps were extracted and imported into MATLAB for analysis. Maximum pressure pictures were transformed to point clouds and registered within and between participants with iterative closest point and coherent point drift algorithms, respectively. Root mean square error (RMSE) was calculated within both registrations as a quality measure. Pressure patterns were compared between new and confident walking using nonparametric-paired sample SPM1D t-test. RMSEs were under 1 mm for both registration algorithms. In the transition to confident walking, significantly increasing pressure was detected in the left central forefoot. Implementing pSPM to infants' pressure data was non-trivial, as several phases of data processing were required to ensure a robust approach. Our analysis highlighted the presence of significant changes in pressure in central left forefoot after 2.2 months of walking, which have not been reported before. This can be explained as previous regional approaches in infancy considered the forefoot as whole, preventing detection of changes in discrete anatomical regions.

Three-dimensional foot shape analysis in children: a pilot analysis using three-dimensional shape descriptors.

BACKGROUND: Existing clinical measures to describe foot morphology are limited in that they are commonly two-dimensional, low in resolution and accuracy, and do not accurately represent the multi-planar and complex changes during development across childhood. Using three-dimensional (3D) scanner technology provides the opportunity to understand more about morphological changes throughout childhood with higher resolution and potentially more relevant 3D shape measures. This is important to advance the prevailing arguments about the typical development of children's feet and inform the development of appropriate clinical measures. 3D shape descriptors derived from 3D scanning can be used to quantify changes in shape at each point of the 3D surface. The aim of this study was to determine whether 3D shape descriptors derived from 3D scanning data can identify differences in foot morphology between children of different ages. METHODS: Fifteen children were recruited from three age groups (2, 5, and 7 years of age). Both feet were scanned in bipedal stance, using the Artec Eva (Artec Group, Luxembourg, Luxembourg) hand-held scanner. Three dimensional shape descriptors were extracted from the 3D scans of the right foot, to create histograms for each age group and heat maps of representative participants for comparison. RESULTS: There were changes to the dorsal, medial and lateral surfaces of the feet with age. The surfaces became less round along with an increase in indented areas. This is supported by the heat maps which demonstrated that the surfaces of the anatomical landmarks (e.g. the malleoli and navicular tuberosity) became more rounded and protruding, with indented surfaces appearing around these landmarks. On the plantar surface, the concavity of the midfoot was evident and this concavity extended into the midfoot from the medial aspect as age increased. CONCLUSIONS: The findings of this study indicated that with increasing age the foot becomes thinner in 3D, with bony architecture emerging, and the medial longitudinal arch (MLA) increases in area and concavity. Three-dimensional shape descriptors have shown good potential for locating and quantifying changes in foot structure across childhood. Three-dimensional shape descriptor data will be beneficial for understanding more about foot development and quantifying changes over time.