Clinical Pilates in Practice: Footwear Alters Lower Extremity Coordination Variability

This was a small study gauging the influence of footwear on motor coordination, and thus results are not transferable across populations. However, the findings are interesting from a clinical perspective, as this adds to information re: training for functional tasks with appropriate footwear.

Romer, Braden H., Wendi Weimar, and John Fox. "Footwear Alters Lower Extremity Coordination Variability." Perceptual and Motor Skills 126, no. 5 (2019), 764-778. doi:10.1177/0031512519863183.

Key Points: Footwear and Coordination

• Footwear, footwear components, and tactile feedback are capable of producing significant changes in gait mechanics and lower extremity muscle activity.

• The amplitude and time to peak amplitude for the tibialis anterior, peroneus longus, and medial gastrocnemius are significantly different between barefoot and shod gait.

• Footwear has a mechanical effect on gait, due to the increased mass of the distal segment of the shoe when the walker is shod.

• Footwear causes significant alterations in spatiotemporal variables, and also causes significant changes in lower extremity coordination variability.

• Footwear exerts significant mass effect on mechanical and physiological gait parameters when running.

• Footwear that provides augmented plantar facilitation causes a significant decrease in the incidence of extra limb movements as well as center-of-pressure trajectory in response to postural perturbations.

Barefoot gait is associated with a reduced stride length and higher cadence compared to shod gait.

• Significant differences in joint kinematics occur during barefoot gait, including

  → Increased plantarflexion;

  → Decreased hip flexion; and

  → Increased knee flexion at foot contact.

• Augmented tactile feedback has the ability to significantly alter spatiotemporal gait parameters and gait symmetry measures in young, healthy adults.

  → The authors suggest that augmented tactile feedback appears to enhance proprioceptive feedback and neuromuscular control in a variety of populations.

• The use of a textured insole appears to have no effect on lower extremity coordination when placed within a shoe.

• The primary source of neuromuscular adaptations between shod and barefoot gait is through the more proximal joint rather than the distal lower extremity joint.

• An increase in variability of joint coordination may indicate a lower synergistic state among the various movement control centers.

• There is also increased lower extremity variability during slower versus "normal" walking, due to greater challenges to the neuromuscular system from a temporal increase in the single support phase of gait.

Clinical Pilates in practice

• While building foot and lower limb strength while barefoot is essential for foundational movement training, most people we work with spend a significant amount of time in shoes.

  → It is worth assessing movement in shoes and barefoot.

  → It is worth treating/facilitating movement with shoes on, if appropriate.

• Especially consider the parameters of returning to a functional task: what footwear will someone be using, and how will this affect their lower extremity coordination?

• When training reciprocal lower limb movements, practice at different speeds to challenge the neuromuscular system:

  → Scooter on the Reformer.

  → Step Ups on the Wunda Chair.

  → Walking at the Tower.

• Integrate tactile feedback to support the transition from barefoot to shod training:

• Footwork in different positions on the feet.

• Straps and handles in different positions on the feet.

• Soft vs hard surfaces.

• Integrate manual therapy where appropriate.