Development of the infant foot as a load bearing structure: study protocol for a longitudinal evaluation (the Small Steps study)

Abstract

BackgroundAn improved understanding of the structural and functional development of the paediatric foot is fundamental to a strong theoretical framework for health professionals and scientists. An infant’s transition from sitting, through crawling and cruising, to walking is when the structures and function of the foot must adapt to bearing load. The adaptation of skin and other hard and soft tissue, and foot and gait biomechanics, during this time is poorly understood. This is because data characterising the foot tissue and loading pre-walking onset does not exist. Of the existing kinematic and plantar pressure data, few studies have collected data which reflects the real-life activities of infants with modern equipment.MethodsThis is a longitudinal study and part of the Great Foundations Initiative, a collaborative project between the University of Brighton and the University of Salford, which is seeking to improve foot health in children. Two cohorts of 50 infants will be recruited at the two sites (University of Brighton, Eastbourne, UK and University of Salford, Salford, UK). Infants will be recruited when they first reach for their feet and attend four laboratory visits at milestones related to foot loading, with experienced independent walking being the final milestone. Data collection will include tissue characteristics (skin thickness, texture, elasticity, pH and tendon thickness and cross-sectional area), plantar pressures and kinematics captured during real world locomotion tasks.DiscussionThis study will provide a database characterising the development of the infant foot as it becomes a weight bearing structure. The data will allow effective comparison and quantification of changes in structure and function due to maturation and loading by measuring pre and post established walking. Additional variables which impact on the development of the foot (gender, ethnicity and body weight) will also be factored into our analysis. This will help us to advance understanding of the determinants of foot development in early childhood.

Soft soled footwear has limited impact on toddler gait

“…Markers were placed at the following locations on both limbs: posterior calcaneus, dorsal aspect of the midfoot, medial aspect of the navicular, lateral aspect of the cuboid, medial and lateral malleoli, medial and lateral knee joint, anterior and posterior superior iliac spines, mid-lateral thigh and mid-lateral lower leg shank, right and left anterior aspect of the shoulder, and at C7 at the back of the neck. The marker placement locations were chosen based on a similar protocol recently published by a research team investigating gait acquisition in young children [18]. The marker placement was also similar to the marker position protocols used with older children (S1 Fig) [19].…”

Intra-subject sample size effects in plantar pressure analyses

“…That intra-subject sample size effects have not been extensively studied despite this breadth of application is perhaps not surprising given that many experiments pose unique and inherent challenges that may restrict sample size, and influence the characterisation of plantar pressure. For example, in non-companion animal research, intra-subject sample size is limited by access to animals and their willingness to partake in, and follow experimental protocols, limitations that are also commonplace in human paediatric research (Price et al, 2018). In clinical and veterinary contexts, the number of steps per subject is often restricted by physical limitations and efficacy levels that are unique to each patient.…”

Using a Dance Mat to Assess Inhibitory Control of Foot in Young Children

“…Foot structure is essential for regulating balance and locomotion and enables young children to develop motor and social skills (Price et al, 2018). Compared with the hand, the foot is less stimulated by the environment, which means that it develops later.…”