Introduction
Although many people experience foot problems in the west [1], [2] foot problems seem to be rare in Africa [3], [4]. This might be due to the shoe wearing habits, the foot shape and/or the loading pattern. While the influence of shoes on the foot is currently at the focus of interest in footwear science [5]-[8], the role of the foot shape and especially the accompanying loading pattern is yet underexposed. Therefore the aim of this study was to investigate the difference in foot loading between shod African and Caucasian adults.
Already in 1905, sir Phil Hoffman demonstrated irreversible damage to the forefoot due to wearing shoes. He stated: ‘because of the tightness of the “modern” shoe, the habitual wide shape of the forefoot, with lots of space between the toes (necessary for grasping functions) is lost [9]’. Although the design of the shoes is modernized during the years, more recent literature confirms Hoffman’s idea; common foot problems, such as forefoot pain and hallux valgus, are related to the use of (inadequate) footwear in daily life [10]-[13]. Furthermore, studies have shown that there are differences between shod and unshod groups in foot biomechanics, for instance in plantar pressure distribution [5] or height of the MLA [5], [14], [15]. For example D’Aout and colleagues demonstrated that the unshod Indian adults had more loading under the midfoot area compared to the habitual shod Indian and a western group, indicating a lower MLA for the unshod groups [5].
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However, the difference in biomechanical function of the foot between groups of different ethnic descents can not only be a result of shoes. Dunn et al. [16] reported that flat feet are more common in shod African Americans compared to shod non-Hispanics white and shod Puerto Ricans [16]. However, they used a fairly uncommon method to assess the foot structure; a participant was considered to have flatfeet if the examiner was unable to insert his/her fingers under the arch of the foot with the participant in a standing position [16]. Nevertheless, a more reliable study of Igbigbi et al. [17] confirmed the results of Dunn et al. [16], as they measured the plantar pressure dynamically using a blue print and found that the AI was statistically higher in Malawians (indicating a lower medial longitudinal foot arch) compared to Caucasian-Americans [17]. Also the recent study of D’Aout revealed ethnical differences, as the midfoot area of both the shod and unshod Indians was significantly more loaded compared to the western population, indicating that the Indian group as a whole had flatter feet compared to the western group [5].
The more equal distribution of plantar pressure found in the African and Asian population groups might be a preventive factor for foot complaints, as the development of foot complaints is often associated with overloading of the (fore)foot [18]-[21]. Data at pixel level of dynamic plantar pressure measures and, probably more important, on the loading pattern (roll off) of the feet of such an habitual shod African group is, however, still missing. Therefore, the aim of this study was to compare the static foot geometry, dynamic plantar pressure pattern and roll off of the foot (at pixel level) between Malawian and Dutch shod adults without a history of foot complaints.
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Category: WHY
