Longitudinal study of foot pressures during real-world walking as infants develop from new to confident walkers

Price, C; Montagnani, E; Martinez Santos, A; Nester, CJ; Morrison, S

Abstract

Background: Onset of walking in infants leads to regular cyclic loading of the plantar foot
surface for the first time. This is a critical period for evolving motor skills and foot structure
and function. Plantar pressure literature typically studies gait only once walking is
established and under conditions that artificially constrain the walking direction and bouts
compared to how infants move in the real-world. We therefore do not know how the foot is
loaded when self-directed walking is first achieved and whether it changes as walking is
practiced. Research Question: How do pressures on the plantar foot in real-world walking
change from new to confident walking? Methods: Fifty-seven infants participated in a twosite longitudinal study. Bespoke child-friendly spaces incorporated large pressure platforms
and video. Data was collected at two milestones: new (403 days) and confident (481 days)
walking. Steps were defined as walking straight or turning medially/laterally. Pressure
variables were calculated for eight-foot regions and compared between milestones. Results:
Confident walking resulted in more steps (median: 18 v 35) and almost twice as many
turning steps. During straight-line steps, confident walking increased peak pressures in the
medial heel (median: 99.3 v 106.7kPa, p<.05) and lateral forefoot (median: 53.9 v 65.3kPa,
p<.001) and reduced medial toe pressure (median: 98.1 v 80.0kPa, p<.05). Relative medial
midfoot contact area reduced (median: 12.4 v 11.2%, p<.05) as absolute foot contact
increased. A faster transition across stance and a reduced relative contact time in the
forefoot were recorded in confident walking. Significance: Pressures change rapidly as
walking is initiated with significant differences in foot loading evident within an average 77
days. Importantly, these changes differ in straight and turning walking. Continued reliance on
assessment of straight-line walking during early stages of ambulation likely fails to
characterise 26% of steps experienced by infant feet.

Citation

Price, C., Montagnani, E., Martinez Santos, A., Nester, C., & Morrison, S. (2022). Longitudinal study of foot pressures during real-world walking as infants develop from new to confident walkers. Gait & Posture, 92, 351-358. https://doi.org/10.1016/j.gaitpost.2021.12.003

• Journal Article Type: Article
• Acceptance Date: Dec 3, 2021
• Online Publication Date: Dec 6, 2021
• Publication Date: Feb 1, 2022
• Deposit Date: Dec 7, 2021
• Publicly Available Date: Dec 6, 2022
• Journal: Gait & Posture
• Print ISSN: 0966-6362
• Electronic ISSN: 1879-2219
• Publisher: Elsevier
• Volume: 92
• Pages: 351-358
• DOI: https://doi.org/10.1016/j.gaitpost.2021.12.003
• Publisher URL: https://doi.org/10.1016/j.gaitpost.2021.12.003
• Related Public URLs: http://www.journals.elsevier.com/gait-and-posture/
• Additional Information: Projects : Great Foundations