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Effect of flip-flops on lower limb kinematics during walking: a cross-sectional study using three-dimensional gait analysis

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Abstract

Background

Flip-flops are a popular footwear choice in warm weather however their minimalist design offers little support to the foot.

Aim

To investigate the effect of flip-flops on lower limb gait kinematics in healthy adults, to measure adherence between the flip-flop and foot, and to assess the effect on toe clearance in swing.

Methods

Fifteen healthy adults (8 male, mean age 27 years) completed a three-dimensional gait analysis assessment using Codamotion. Kinematic and lower limb temporal-spatial data were captured using the Modified Helen Hayes marker set with additional markers on the hallux and flip-flop sole.

Results

Compared to barefoot walking, there were no differences in temporal-spatial parameters walking with flip-flops. There was an increase in peak knee flexion in swing (mean difference 4.6°, 95 % confidence interval (CI) [−5.8°, −3.4°], p < 0.001) and peak ankle dorsiflexion at terminal swing (mean difference 2°, 95 % CI [−3°, −1°], p = 0.001). Other kinematic parameters were unchanged. Peak separation between foot and flip-flop was 8.8 cm (SD 1.48), occurring at pre-swing. Minimum toe clearance of the hallux in barefoot walking measured 4.2 cm (SD 0.8). Minimum clearance of the flip-flop was 1.6 cm (SD 0.56).

Conclusions

Healthy adults adapted well to flip-flops. However, separation of the flip-flop from the foot led to increased knee flexion and ankle dorsiflexion in swing, probably to ensure that the flip-flop did not contact the ground and to maximise adherence to the foot. Minimum clearance of the flip-flop was low compared to barefoot clearance. This may increase the risk of tripping over uneven ground.

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Acknowledgments

Funding to author TS was kindly provided by the Royal College of Surgeons in Ireland, Dublin, under its Research Summer School programme. The authors would like to thank Michael Walsh, gait laboratory manager, for facilitating the project.

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Authors and Affiliations

  1. School of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland

    T. Sharpe

  2. Gait Laboratory, Central Remedial Clinic (CRC), Vernon Avenue, Clontarf, Dublin 3, Ireland

    A. Malone, D. Kiernan & T. O’Brien

  3. School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland

    H. French

Authors
  1. T. Sharpe
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  2. A. Malone
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  3. H. French
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  4. D. Kiernan
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  5. T. O’Brien
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Corresponding author

Correspondence to A. Malone.

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Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Sharpe, T., Malone, A., French, H. et al. Effect of flip-flops on lower limb kinematics during walking: a cross-sectional study using three-dimensional gait analysis. Ir J Med Sci 185, 493–501 (2016). https://doi.org/10.1007/s11845-016-1421-y

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  • DOI: https://doi.org/10.1007/s11845-016-1421-y

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