Longitudinal study of foot pressures during real-world walking as infants develop from new to confident walkers

Carina Price, Eleonora Montagnani, Ana Martinez-Santos, Chris Nester, Stewart C. Morrison

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
JournalGait & Posture
Publication statusPublished - 6 Dec 2021

Bibliographical note

Funding Information:
The authors would like to acknowledge the contribution of Charlotte Sedgewick and Molly Hodges to data collection. The study is part of the larger “Great Foundations” project, funded by the Dr. William M Scholl Unit of Podiatric Development Fund . The study sponsors had no role in the study design, collection, analysis, or interpretation of data or the decision to submit, or writing of, the manuscript.

Publisher Copyright:
© 2021 Elsevier B.V.


  • Foot plantar pressure
  • Gait
  • Independent Walking
  • Paediatrics


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