Research Highlight- The Effect of Torsional Shoe Flexibility on Gait and Stability in Children Learning to Walk

In order to be a good clinician, a physical therapist must also keep up with recent research and try to apply relevant research to their practice.  So I thought I would highlight a recent research article that involves a topic that I have been asked about frequently!  One of the big questions parents ask around the time their kiddo starts walking is: what are the best shoes to buy?

Typically my answer is based on:

1- how each patient presents- do they have low tone or high tone?  do they have decreased strength in their legs/hips?  do they have good body awareness/balance?  are they new/experienced walkers?

2- what I know about how different types of shoes have affected past patients I have treated?

3- what research says about different types of footwear for a particular patient population


So here is 1 relevant recent research article about how footwear affects new walkers!

The Effect of Torsional Shoe Flexibility on Gait and Stability in Children Learning to Walk (click to go to article)  by: Buckland, Melanie A. PT, DPT, ATP, C/NDT; Slevin, Corinne M. PT, DPT, MS; Hafer, Jocelyn F. MA; Choate, Cherri DPM; Kraszewski, Andrew P. MS

Article Abstract:


To examine the effects of different torsional flexibilities of shoes on gait and stability in children who are newly walking.


Twenty-five children walking 5 months or less were evaluated barefoot and in 4 shoes with different torsional flexibilities (UltraFlex, MidFlex, LowFlex, and Stiff). Gait pattern was assessed using GaitMatII. Stability was determined by the number of stumbles/falls during functional tasks.


Stance time was shorter barefoot compared with all shoe conditions (P = .000). Stance time was shorter in UltraFlex than in LowFlex (P = .000). Step width was wider in UltraFlex than in MidFlex and LowFlex (P = .028). Velocity, step length, and the number of stumbles/falls did not differ significantly across shoe conditions. Children walking for 2 months or less had significantly more stumbles and falls than children walking more than 2 months (P = .003).


Stance time and step width differ across shoe conditions. Stability does not differ across shoe conditions.


So what does all that mean?

  • The study looked at 4 different shoes of different levels of flexibility in their sole.
  • The study used children who were walking <5 months and had no other diagnoses or delays that were evaluated by a pediatric physical therapy.
  • The study found that children spent less time standing on each foot when walking barefoot than when walking in any of the test shoes.
  • The study found that children spent more time standing on each foot when using a LowFlex shoe vs an UltraFlex shoe.
  • The study found that children walked with a wider step when in the UltraFlex shoe than in MidFlex and LowFlex shoe- usually an individual will take a wider step if they feel less balanced because a wider base is more stable than a narrow base.
  • What I found interesting was that there was no difference in stumbles/falls, step length, and walking speed, when comparing the 4 different types of shoes.
  • The obvious results were that children who were walking for <2 months had more falls/ stumbles than those who walked >2 months


What do I take from this study?

It depends on what your goals are!

If you are looking to give a child some help to maintain their balance, then from this study, I would prefer starting with the LowFlex shoe over the UltraFlex since children were able to stand longer on each foot.  When a child is able to spend more time on 1 foot, that means that the child has better balance in that condition.  If someone has poor balance, they will always spend less time standing only on 1 leg because they will feel more stable standing with 2 feet on the floor.

As a child walks with less falls and stumbles, I would progress to an UltraFlex shoe or barefoot to further challenge their standing balance.

If you want to challenge a kiddo or really work on standing balance, then walking barefoot or in an UltraFlex shoe would be more challenging to work on balance since the study found that that the children studied spent less time standing on 1 leg and took wider steps under those conditions.

In my opinion, I rarely recommend stiff shoes for my patients since I feel they prevent them from effectively using their foot muscles to maintain balance because they can’t feel the floor as well in stiff shoes.  Those smaller foot muscles are important when learning how to maintain standing balance.  Take a look at how much a child’s toes/arches are working when they are standing/walking barefoot so you can see how these muscles are important to maintaining balance.

If you have access to the above full article, it would also be helpful to take a look at the research articles that were cited in their report, which provide further research regarding footwear and learning to walk.

Remember that this study did not look at children with any delays or diagnoses.  If your child has any diagnosis that you think may affect their muscle tone/strength/balance, then these results may not directly relate to your situation.  If you are wondering about what footwear to use, I would recommend speaking with a pediatric PT or possibly your pediatrician if they are familiar with footwear.  


Categories: Research

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5 replies

  1. Do you have any recommendations for lower flexibility shoes? I have birth-3 kiddos who is learning to walk and I don’t want to brace her just yet. I haven’t found anything in my searches that aren’t super flexible, since being barefoot is what is popular right now.


  2. Hello
    My son is 15 month old diagnosed by cerbral palsy right hemiparesis , he has high tone in his right leg , he just started taking some steps by his own and bought him a normal wide stride ride shoes but his physical medicine doctor want him to wear ankle brace for better alignment. He do great with the shoes. What I am thinking about is to wait for the brace until he strengthen his muscles by practiceing walking without braces. What do you think?


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