Acute changes in gait biomechanics in children with cerebral palsy due to barefoot vs. footwear condition - An exploratory study.

Abstract

Children with unilateral spastic cerebral palsy (CP) show gait deviations that limit mobility and participation. Whether ordinary footwear can acutely modify gait is underexplored. We quantified the immediate effects of barefoot versus standard cushioned sneakers on spatiotemporal metrics, 3D kinematics/kinetics, and muscle activity. Randomized crossover of 13 children (6-9 years). Each completed multiple trials barefoot and in standard sneakers. Motion capture, force plates, and surface electromyography yielded spatiotemporal metrics, joint angles/moments, powers, and ground-reaction forces. Relative to barefoot walking, standard sneakers were associated with lower cadence (2.12 vs 2.31 steps/s; p < 0.001) and longer steps/strides (step 54 vs 50 cm; stride 107 vs 99 cm; both p < 0.001), while walking speed did not differ between conditions. Distal joint kinematics shifted toward greater ankle dorsiflexion at initial contact (-2° vs -7°; p < 0.001) and during stance (peak 20° vs 15°; p < 0.001). Knee motion showed small, phase-specific adjustments: slightly less flexion at initial contact (13° vs 14°; p = 0.008) but greater flexion in swing (64° vs 62°; p = 0.005). Hip kinematics changed little (toe-off 1° more extension; p = 0.011). Joint moments and powers at the hip and knee were largely unaffected, while ankle push-off power decreased (1.65 vs 2.23 W/kg; p < 0.001). Tibialis anterior activity at initial contact increased (p = 0.007), and propulsive vertical force peaks were modestly higher (p = 0.017). These findings indicate that everyday footwear can induce measurable acute changes in gait biomechanics, mainly at the distal level. However, the clinical relevance and persistence of these effects remain uncertain and should be examined in future confirmatory and longitudinal studies.