Locomotor effects of shoes

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Different types of shoes. Rubaiyat shoes 08.jpg
Different types of shoes.

Locomotor effects of shoes are the way in which the physical characteristics or components of shoes influence the locomotion neuromechanics of a person. Depending on the characteristics of the shoes, the effects are various, ranging from alteration in balance and posture, muscle activity of different muscles as measured by electromyography (EMG), and the impact force. There are many different types of shoes that exist, such as running, walking, loafers, high heels, sandals, slippers, work boots, dress shoes, and many more. However, a typical shoe will be composed of an insole, midsole, outsole, and heels, if any. In an unshod condition, where one is without any shoes, the locomotor effects are primarily observed in the heel strike patterns and resulting impact forces generated on the ground.

Contents

Insoles and inserts

The foot provides the sensory information to the central nervous system through cutaneous afferent feedback, which originates from the special mechanoreceptors within the plantar surface of the foot. This afferent feedback has a strong influence on postural stability [1] and balance correction [2] during standing and walking. Since sensory feedback from the foot may be influenced by the interaction of the foot with the insole surface, different types of insoles and shoe inserts have been used to try to enhance postural stability.

Textured inserts

Textured Inserts are regular shoe inserts that have a raised textured surface on the side that acts to provide enhanced mechanical contact and pressure on the plantar surface of the feet. Providing a textured surface of the shoe insert leads to significant changes during gait in ankle joint kinematics and in EMG amplitude of ankle flexor and extensor muscles. [3] Textured inserts mostly affect ankle motion in the sagittal plane, where plantar flexion of the foot is increased. As for muscle activity, textured inserts decrease the activation of soleus and tibialis anterior muscles during standing and walking. [4] [5]

Insoles with ridges

One of the most pervasive effects of aging is the loss of cutaneous and pressure sensation, which has been correlated with impaired balance control and increased risk of falling. [6] This is because for an upright stance, the center of mass(COM) of the body must be positioned over the base of support (BOS) established by the feet. Cutaneous feedback from the feet is necessary to provide the central nervous system (CNS) with the information about the proximity of the COM to the BOS limit, which is an important parameter for the maintenance of balance and stable gait. [7]

Since plantar pressure sensation aids in balancing reactions in stepping movements, insoles with raised ridges along the edges can enhance stimulation of cutaneous mechanoreceptors that help to define the BOS. Most of the time, the ridges are made so that stimulation only occurs when the COM nears the BOS limit. [8] Insoles with ridges appear to reduce the likelihood that the COM motion will exceed the BOS limit in the lateral direction, thereby resulting in a stabilizing effect on gait. Furthermore, the magnitude of this effect did not diminish with time, which suggests the CNS did not habituate to heightened cutaneous stimulation. Therefore, insoles with ridges can aid in reducing the fall rates among elderly populations. [7]

When considering the challenges of aging and diminished balance, it's crucial to address potential hazards in the living environment. Ensure that pathways are clear of obstacles, including the removal of vans or other potential tripping hazards, to create a safer living space for elderly individuals.

Midsole

Canvas trainers. Vans shoes talgraf777.jpg
Canvas trainers.

The midsole is between the outer sole (bottommost) and the insole (topmost) parts of the shoe sole. It can be made of a variety of materials to give the shoe different mechanical characteristics of cushioning, support, and flexibility. Polyurethane midsoles are denser and more supportive while ethylene vinyl acetate is used to make lighter and more compliant midsoles. [9]

Density/stiffness

By changing the material hardness of the midsole, one will be able to change the EMG activity in various lower extremity muscles such as rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior. Especially when running with the stiffer midsole, the EMG amplitude for tibialis anterior have shown to be significantly greater before the heel strike and lower following the heel strike than compared to the neutral midsole. Furthermore, walking in shoes with stiffer midsole appears to significantly reduce the energy dissipated at the metatarsophalangeal joints and aid in improving jumping performances and running economy. However, the underlying mechanisms that can be attributed to this improvement are still not fully understood. [10] [11]

Midsole wedging

With the increasing number of injuries associated with excessive pronation of the foot, much research has been conducted with different types of midsoles that could possibly aid in prevention of such injuries. The varus-wedged shoes, which have a medial incline, seem to decrease pronation during stance time, reduce the net inversion of the joint moment, and decrease the activities of the inverter muscles, such as tibialis posterior, gastrocnemius, and soleus. The valgus-wedged shoes, which have a lateral incline, are designed to accentuate pronation and have the opposite effect as the varus-wedged shoes. Also when walking in valgus-wedged shoes, it may lead to an increase in calcaneus eversion and up to 58% of energy absorption in the frontal plane of the body. [12]

Heel curvature

Rocker bottom shoes have thicker-than-normal soles with rounded heels, and most varieties of the shoes are constructed such as to shift the wearer's body weight to behind the ankle, therefore finding the balance requires more effort. [13]

Heel height

Shoe heel height can have significant biomechanical effects on the shoe wearer that can be detrimental or beneficial.

High heels

High heels are shoes where the rearfoot (the heel) is positioned higher than the forefoot (toes). High heels of various heights are worn by men and women on a daily basis. The main reason many people wear high heeled shoes is for aesthetic purposes, where high heels are believed to enhance the wearer's physical appearance. These same high heeled shoes, however, can have undesirable biomechanical effects.

Different types of high heels. Schuhabsaetze fcm.jpg
Different types of high heels.

During gait, high heeled shoes are shown to affect the ankle joint, causing significantly increased plantarflexion. [14] This, in turn, increases the metabolic costs of walking and leads to faster muscle fatigue. Accelerated muscle fatigue may then increase the likelihood of ankle sprains and or falls due to impaired foot and ankle stability. [15] Wearing high heels can also lead to shorter stride lengths, greater stance time, unstable posture and gait, and a decrease in lumbar flexion angles. [16] [17]

Changes to muscle activity are also observed with high heeled shoes, mostly affecting the tibialis anterior and erector spinae muscles. The increase in plantar flexion of the foot causes the EMG amplitude of tibialis anterior to increase. The high heels also lead to an increase in the lumbar flexion angle due to a compensatory mechanism to prevent one from falling forward.

In addition, increased heel height may lead to numerous foot problems including:

In contrast, moderate heel elevation has also been used as a conservative treatment for plantar fasciitis to decrease strain in the plantar fascia. [18]

Negative heels

Negative heeled shoes, which are also known as earth shoes, are shoes that are designed to mimic uphill walking to increase the resistance training effect on the leg muscles during normal walking. The forefoot(toes) of the shoe is 1.5 cm higher than the heel of the shoes, creating an approximately 10 degree angle of dorsiflexion at the ankle during stance on level ground.

Walking in negative heeled shoes leads to a faster cadence and shorter stride length, resulting in a significantly shorter stride cycle time than when walking with a natural cadence. The range of the ankle motion is also significantly greater in the negative heeled shoes, remaining in dorsiflexion longer throughout the stance and swing phases of gait. The increased duration of dorsiflexion leads to lengthening of the gastrocnemius and soleus muscle-tendon units and the length of the moment arm of the Achilles tendon. [19] [20] A similar post-operative exercise effect involving increased dorsiflexion is often desired after surgeries involving the gastrocnemius and soleus muscles or Achilles tendon. The purpose of the exercise is to increase the range of motion in the ankle joint and strengthen the gastrocnemius and soleus muscles and the Achilles tendons. Wearing negative heeled shoes, therefore, may offer an alternative method for post-operative rehabilitation in these situations. Although dorsiflexion of the ankle may be beneficial, it also causes the center of gravity to shift backward, which can cause instability and difficulty in propelling forward during gait. [21]

When walking in negative heeled shoes, muscle activity of gastrocnemius and tibialis anterior muscles are similar to that observed in uphill walking. The duration of the EMG activity is longer and the EMG amplitude is higher for the calf and the biceps femoris muscles than compared to normal shoes. Also the EMG readings for the rectus femoris and biceps femoris indicate an enhanced co-contraction of the two muscles, and therefore the negative heeled shoes may be helpful in exercising these muscle groups.

Barefoot (unshod)

In the city, barefoot. Barefoot in Berlin.JPG
In the city, barefoot.

Unshod condition is where one is without any shoes, or is barefoot. Much of the research on unshod locomotion has been conducted on barefoot running. However, some of the learned principles may apply to both running and walking.

Foot strike patterns

Barefoot runners run very differently from typical shod runners. Shod runners tend to heel strike due to the designs of the modern shoes, which have thick heels to reduce the impact force from the ground. When running barefoot, however, some runners tend to shift to a forefoot striking pattern to avoid such impact, which is equivalent to 2–3 times the body weight. [22] The forefoot strike is where the forefoot lands first, followed by the heels coming down. The midfoot strike is characterized by the heel and the ball of the foot landing at the same time, and heel strike is where the heel lands first followed by the forefoot.

Vibram FiveFingers Shoes. Five Fingers shoes.jpg
Vibram FiveFingers Shoes.

Impact forces

In barefoot locomotion, the impact force (impact transient) on the ground is diminished compared to shod running. It has been suggested that unshod runners are better able to take advantage of elastic energy storage in the Achilles tendon and arch of the foot, and can avoid potential injury due to repetitive impact of the heel bone (calcaneus) due to heel striking. [22] However, the long-term and actual health benefits of unshod running are still not well understood and remain an area of active research.

Those who wish to approximate the experience of running barefoot, but would prefer some protection, can resort to shoes that mimic barefoot locomotion. Such shoes as water socks, running sandals, moccasins, huaraches, dime-store plimsolls, Vibram FiveFingers footwear and other minimal running shoes have relatively thin soles but provide some protection. However minimal shoes do not give runners the same feedback from the plantar mechanoreceptors. Because of the greater protection they offer in comparison to barefoot running, minimal shoes may also interfere with the development of a gentle foot strike, toughening of the soles of the feet, and awareness of road hazards. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Foot</span> Anatomical structure found in vertebrates

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws and/or nails.

<span class="mw-page-title-main">Running</span> Method of terrestrial locomotion allowing rapid movement on foot

Running is a method of terrestrial locomotion by which humans and other animals move rapidly on foot. Running is a gait with an aerial phase in which all feet are above the ground. This is in contrast to walking, where one foot is always in contact with the ground, the legs are kept mostly straight, and the center of gravity vaults over the stance leg or legs in an inverted pendulum fashion. A feature of a running body from the viewpoint of spring-mass mechanics is that changes in kinetic and potential energy within a stride co-occur, with energy storage accomplished by springy tendons and passive muscle elasticity. The term "running" can refer to a variety of speeds ranging from jogging to sprinting.

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Achilles tendon</span> Tendon at the back of the lower leg

The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and flexion at the knee.

<span class="mw-page-title-main">Gait (human)</span> A pattern of limb movements made during locomotion

A gait is a manner of limb movements made during locomotion. Human gaits are the various ways in which humans can move, either naturally or as a result of specialized training. Human gait is defined as bipedal forward propulsion of the center of gravity of the human body, in which there are sinuous movements of different segments of the body with little energy spent. Varied gaits are characterized by differences such as limb movement patterns, overall velocity, forces, kinetic and potential energy cycles, and changes in contact with the ground.

<span class="mw-page-title-main">Soleus muscle</span> Powerful muscle in the back part of the lower leg

In humans and some other mammals, the soleus is a powerful muscle in the back part of the lower leg. It runs from just below the knee to the heel and is involved in standing and walking. It is closely connected to the gastrocnemius muscle, and some anatomists consider this combination to be a single muscle, the triceps surae. Its name is derived from the Latin word "solea", meaning "sandal".

<span class="mw-page-title-main">Triceps surae muscle</span> Pair of muscles: gastrocnemius and the soleus

The triceps surae consists of two muscles located at the calf – the two-headed gastrocnemius and the soleus. These muscles both insert into the calcaneus, the bone of the heel of the human foot, and form the major part of the muscle of the posterior leg, commonly known as the calf muscle.

<span class="mw-page-title-main">Gastrocnemius muscle</span> Calf muscle

The gastrocnemius muscle is a superficial two-headed muscle that is in the back part of the lower leg of humans. It is located superficial to the soleus in the posterior (back) compartment of the leg. It runs from its two heads just above the knee to the heel, extending across a total of three joints.

<span class="mw-page-title-main">Foot drop</span> Gait abnormality

Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the deep fibular nerve, including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.

<span class="mw-page-title-main">Barefoot running</span> Running with minimalist or no shoes

Barefoot running, also called "natural running", is the act of running without footwear. With the advent of modern footwear, running barefoot has become less common in most parts of the world but is still practiced in parts of Africa and Latin America. In some Western countries, barefoot running has grown in popularity due to perceived health benefits.

<span class="mw-page-title-main">Pronation of the foot</span> Type of foot movement

Pronation is a natural movement of the foot that occurs during foot landing while running or walking. Composed of three cardinal plane components: subtalar eversion, ankle dorsiflexion, and forefoot abduction, these three distinct motions of the foot occur simultaneously during the pronation phase. Pronation is a normal, desirable, and necessary component of the gait cycle. Pronation is the first half of the stance phase, whereas supination starts the propulsive phase as the heel begins to lift off the ground.

<span class="mw-page-title-main">Orthotics</span> Medical specialty that focuses on the building and designing of artificial legs

Orthotics is a medical specialty that focuses on the design and application of orthoses, sometimes known as braces or calipers. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces.

Terrestrial locomotion by means of a running gait can be accomplished on level surfaces. However, in most outdoor environments an individual will experience terrain undulations requiring uphill running. Similar conditions can be mimicked in a controlled environment on a treadmill also. Additionally, running on inclines is used by runners, both distance and sprinter, to improve cardiovascular conditioning and lower limb strength.

Neuromechanics of orthoses refers to how the human body interacts with orthoses. Millions of people in the U.S. suffer from stroke, multiple sclerosis, postpolio, spinal cord injuries, or various other ailments that benefit from the use of orthoses. Insofar as active orthoses and powered exoskeletons are concerned, the technology to build these devices is improving rapidly, but little research has been done on the human side of these human-machine interfaces.

<span class="mw-page-title-main">Minimalist shoe</span> Shoes that approximate barefoot running

Minimalist shoes are shoes intended to closely approximate barefoot running or walking conditions in comparison to traditional shoes. Minimalist shoes are defined as providing "minimal interference with the natural movement of the foot, because of its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices." Minimalist shoes provide more sensory contact for the foot on the ground while simultaneously providing the feet with some protection from ground hazards and conditions. Research shows that wearing a minimalist shoe can help improve running economy, foot strength and arch function.

<span class="mw-page-title-main">Proportional myoelectric control</span>

Proportional myoelectric control can be used to activate robotic lower limb exoskeletons. A proportional myoelectric control system utilizes a microcontroller or computer that inputs electromyography (EMG) signals from sensors on the leg muscle(s) and then activates the corresponding joint actuator(s) proportionally to the EMG signal.

<span class="mw-page-title-main">Cutaneous reflex in human locomotion</span>

Cutaneous, superficial, or skin reflexes, are activated by skin receptors and play a valuable role in locomotion, providing quick responses to unexpected environmental challenges. They have been shown to be important in responses to obstacles or stumbling, in preparing for visually challenging terrain, and for assistance in making adjustments when instability is introduced. In addition to the role in normal locomotion, cutaneous reflexes are being studied for their potential in enhancing rehabilitation therapy (physiotherapy) for people with gait abnormalities.

Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.

The function of the lower limbs during walking is to support the whole-body against gravitational forces while generating movement patterns which progress the body forward. Walking is an activity that is primarily confined to the sagittal plane, which is also described as the plane of progression. During one gait cycle, there are two major phases: stance and swing. In a healthy individual walking at a normal walking speed, stance phase makes up approximately 60% of one gait cycle and swing makes up the remaining 40%. The lower limbs are only in contact with the ground during the stance phase, which is typically subdivided into 5 events: heel contact, foot flat, mid-stance, heel off, and toe off. The majority of stance phase (~40%) takes place in single-limb support where one limb is in contact with the ground and the contralateral limb is in swing phase. During this time interval, the lower limb must support constant changes in alignment of body weight while propelling forward. The hip, knee, and ankle joints move through cyclical kinematic patterns that are controlled by muscles which cross these joints. As postural changes occur, the body adapts by motor tuning an efficient muscular pattern that will accomplish the necessary kinematics required to walk.

References

  1. Magnusson, Måns; Enbom, Håkan; Johansson, Rolf; Pyykkö, Ilmari (1990-01-01). "Significance of pressor input from the human feet in anterior-posterior postural control: The effect of hypothermia on vibration-induced body-sway". Acta Oto-Laryngologica. 110 (3–4): 182–188. doi:10.3109/00016489009122535. ISSN   0001-6489. PMID   2239205.
  2. Hayashi, R.; Miyake, A.; Watanabe, S. (1988-02-01). "The functional role of sensory inputs from the foot: stabilizing human standing posture during voluntary and vibration-induced body sway". Neuroscience Research. 5 (3): 203–213. doi:10.1016/0168-0102(88)90049-1. ISSN   0168-0102. PMID   3357585.
  3. Nurse, Matthew A.; Hulliger, Manuel; Wakeling, James M.; Nigg, Benno M.; Stefanyshyn, Darren J. (2005-10-01). "Changing the texture of footwear can alter gait patterns". Journal of Electromyography and Kinesiology. 15 (5): 496–506. doi:10.1016/j.jelekin.2004.12.003. ISSN   1050-6411. PMID   15935961.
  4. Aniss, A. M.; Gandevia, S. C.; Burke, D. (1992-05-01). "Reflex responses in active muscles elicited by stimulation of low-threshold afferents from the human foot". Journal of Neurophysiology. 67 (5): 1375–1384. doi:10.1152/jn.1992.67.5.1375. ISSN   0022-3077. PMID   1597720.
  5. Yang, J. F.; Stein, R. B. (1990-05-01). "Phase-dependent reflex reversal in human leg muscles during walking". Journal of Neurophysiology. 63 (5): 1109–1117. doi:10.1152/jn.1990.63.5.1109. ISSN   0022-3077. PMID   2358865.
  6. McIntyre, Sarah; Nagi, Saad S.; McGlone, Francis; Olausson, Håkan (2021-06-01). "The effects of ageing on tactile function in humans". Neuroscience. 464: 53–58. doi:10.1016/j.neuroscience.2021.02.015. ISSN   0306-4522. PMID   33607227.
  7. 1 2 Menant, Jasmine C.; Perry, Stephen D.; Steele, Julie R.; Menz, Hylton B.; Munro, Bridget J.; Lord, Stephen R. (2008-10-01). "Effects of shoe characteristics on dynamic stability when walking on even and uneven surfaces in young and older people". Archives of Physical Medicine and Rehabilitation. 89 (10): 1970–1976. doi:10.1016/j.apmr.2008.02.031. ISSN   0003-9993. PMID   18760402.
  8. Do, M. C.; Bussel, B.; Breniere, Y. (1990-01-01). "Influence of plantar cutaneous afferents on early compensatory reactions to forward fall". Experimental Brain Research. 79 (2): 319–324. doi:10.1007/BF00608241. ISSN   1432-1106. PMID   2323379.
  9. Wang, Lin; Hong, Youlian; Li, Jing Xian (2012-12-01). "Durability of running shoes with ethylene vinyl acetate or polyurethane midsoles". Journal of Sports Sciences. 30 (16): 1787–1792. doi:10.1080/02640414.2012.723819. ISSN   0264-0414. PMID   22967232.
  10. Roy, Jean-Pierre R.; Stefanyshyn, Darren J. (2006-03-01). "Shoe midsole longitudinal bending stiffness and running economy, joint energy, and EMG". Medicine & Science in Sports & Exercise. 38 (3): 562–569. doi:10.1249/01.mss.0000193562.22001.e8. ISSN   0195-9131. PMID   16540846.
  11. Wakeling, James M.; Pascual, Silvia A.; Nigg, Benno M. (2002-09-01). "Altering muscle activity in the lower extremities by running with different shoes". Medicine & Science in Sports & Exercise. 34 (9): 1529–1532. doi:10.1097/00005768-200209000-00021. ISSN   0195-9131. PMID   12218750.
  12. O’Connor, Kristian M; Hamill, Joseph (2004-01-01). "The role of selected extrinsic foot muscles during running". Clinical Biomechanics. 19 (1): 71–77. doi:10.1016/j.clinbiomech.2003.09.001. ISSN   0268-0033. PMID   14659933.
  13. Vieira, Edgar Ramos; Guerrero, Gerardo; Holt, Daniel; Arreaza, Monica; Veroes, Valentina; Brunt, Denis (2014-06-01). "Limits of stability and adaptation to wearing rocker bottom shoes". Foot & Ankle International. 35 (6): 607–611. doi:10.1177/1071100714531227. ISSN   1071-1007. PMID   24709743.
  14. Snow, Rebecca E.; Williams, Keith R.; Holmes, George B. (1992-02-01). "The effects of wearing high heeled shoes on pedal pressure in women". Foot & Ankle. 13 (2): 85–92. doi:10.1177/107110079201300206. ISSN   0198-0211. PMID   1572591.
  15. Ebbeling, Christine J.; Hamill, Joseph; Crussemeyer, Jill A. (1994-04-01). "Lower extremity mechanics and energy cost of walking in high-heeled shoes". Journal of Orthopaedic & Sports Physical Therapy. 19 (4): 190–196. doi:10.2519/jospt.1994.19.4.190. ISSN   0190-6011. PMID   8173565.
  16. Esenyel, Meltem; Walsh, Katlen; Walden, Judith Gail; Gitter, Andrew (2003-01-01). "Kinetics of high-heeled gait". Journal of the American Podiatric Medical Association. 93 (1): 27–32. doi:10.7547/87507315-93-1-27. ISSN   1930-8264. PMID   12533553.
  17. Lee, Chang-Min; Jeong, Eun-Hee; Freivalds, Andris (2001-12-01). "Biomechanical effects of wearing high-heeled shoes". International Journal of Industrial Ergonomics. 28 (6): 321–326. doi:10.1016/S0169-8141(01)00038-5. ISSN   0169-8141.
  18. Huang, Hai; Kornberg, Thomas B (2016-09-03). Nathans, Jeremy (ed.). "Cells must express components of the planar cell polarity system and extracellular matrix to support cytonemes". eLife. 5: e18979. doi: 10.7554/eLife.18979 . ISSN   2050-084X. PMC   5030081 . PMID   27591355.
  19. Leroux, Alain; Fung, Joyce; Barbeau, Hugues (2002-02-01). "Postural adaptation to walking on inclined surfaces: I. Normal strategies". Gait & Posture. 15 (1): 64–74. doi:10.1016/S0966-6362(01)00181-3. ISSN   0966-6362. PMID   11809582.
  20. Leroux, Alain; Fung, Joyce; Barbeau, H. (1999-05-01). "Adaptation of the walking pattern to uphill walking in normal and spinal-cord injured subjects". Experimental Brain Research. 126 (3): 359–368. doi:10.1007/s002210050743. ISSN   1432-1106. PMID   10382621.
  21. Li, Jing Xian; Hong, Youlian (2007-11-01). "Kinematic and electromyographic analysis of the trunk and lower limbs during walking in negative-heeled shoes". Journal of the American Podiatric Medical Association. 97 (6): 447–456. doi:10.7547/0970447. ISSN   1930-8264. PMID   18024839.
  22. 1 2 Lieberman, Daniel E.; Venkadesan, Madhusudhan; Werbel, William A.; Daoud, Adam I.; D’Andrea, Susan; Davis, Irene S.; Mang’Eni, Robert Ojiambo; Pitsiladis, Yannis (2010-01-01). "Foot strike patterns and collision forces in habitually barefoot versus shod runners". Nature. 463 (7280): 531–535. Bibcode:2010Natur.463..531L. doi:10.1038/nature08723. ISSN   1476-4687. PMID   20111000.
  23. Francis, Peter; Schofield, Grant (2020-04-01). "From barefoot hunter gathering to shod pavement pounding. Where to from here? A narrative review". BMJ Open Sport & Exercise Medicine. 6 (1): e000577. doi:10.1136/bmjsem-2019-000577. ISSN   2055-7647. PMC   7202747 . PMID   32405429.