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Longitudinal study of foot pressures during real-world walking as infants develop from new to confident walkers
Carina Price1, Eleonora Montagnani2, Ana Martinez Santos1
1School of Health and Society, University of Salford, Frederick Road Campus, Salford, UK.
Insights
Infant foot loading pressures change significantly within 77 days of learning to walk, with confident walkers showing distinct patterns during straight and turning steps. This highlights the need to study real-world infant gait beyond simple straight-line walking.
Area of Science:
- Biomechanics
- Pediatrics
- Motor Development
Background:
- Infant walking marks the first regular cyclic loading of the plantar foot.
- Early walking is crucial for developing motor skills and foot structure.
- Existing plantar pressure studies often use artificial conditions, not real-world infant movement.
Purpose of the Study:
- To investigate how plantar foot pressures change in infants from newly acquired to confident walking.
- To compare foot loading patterns during straight and turning steps in early ambulation.
Main Methods:
- A longitudinal study of 57 infants at two milestones: new (403 days) and confident (481 days) walking.
- Utilized child-friendly spaces with large pressure platforms and video recording.
- Analyzed pressure variables across eight foot regions for straight and turning steps.
Main Results:
- Confident walking involved more steps and significantly more turning steps.
- Peak pressures increased in the medial heel and lateral forefoot, while medial toe pressures decreased during straight steps.
- Reduced midfoot contact area and faster stance transition were observed in confident walkers.
Conclusions:
- Plantar foot pressures evolve rapidly within the first 77 days of walking.
- Changes in foot loading differ between straight and turning gaits.
- Assessing only straight-line walking underestimates the dynamic foot loading experienced by infants.
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 two-site 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.
