Gait and Posture 19 (2004) 235–242 Evaluation of early walking patterns from plantar pressure distribution measurements. First year results of 42 children Carola Bertsch, Heidi Unger, Winfried Winkelmann, Dieter Rosenbaum * Motion Analysis Lab, Orthopaedic Department, University Hospital Muenster, Muenster, Germany Received 11 October 2002; received in revised form 24 February 2003; accepted 23 April 2003 Abstract This study evaluated developmental changes of foot and gait during the first year of independent walking. In a longitudinal design, plantar pressure distribution patterns were measured with a capacitive platform every 3 months in a group of 42 normal children. The first significant changes were already found after a few weeks of independent walking. The development of the longitudinal arch correlated with significantly reduced midfoot loading parameters even though the changes showed a wide interindividual variation. This study illustrates that a child’s foot goes through significant changes in shape and loading characteristics once the child starts to stand and walk. Some children showed a fairly mature appearance of the plantar pressure pattern after 1 year while others retained a more immature loading pattern. © 2003 Elsevier B.V. All rights reserved. Keywords: Gait; Children; Human walking; Foot development; Plantar pressure distribution 1. Introduction The feet of children show typical differences in size and shape in comparison with adults and especially in infants as the foot shape and gait pattern change rapidly. An un- derstanding of the physiological spectrum of change in the lower extremity during growth [1] enables the recognition of pathology and timing of interventions. At present the impor- tant phases in foot development and their age-related appear- ances remain unclear. Parents often feel insecure whether or not foot morphology or gait patterns of their children can be characterized as normal. Gait disorders or leg/foot de- formities are common reasons for referral of a child to an orthopaedic clinic [2,3]. The development of the child’s foot is strongly influenced by the point at which the child starts to stand and the start of walking. A wide variety of different foot shapes is consid- ered typical at this age, the variability reduces as the child grows older [4]. Children’s feet demonstrate typical differ- ences in comparison with the adult foot. Instead of a medial gap caused by the longitudinal arch a characteristic fat pad * Corresponding author. Present address: Funktionsbereich Bewegungs- analytik, Klinik für Allgemeine Orthopädie, Universitätsklinikum Mün- ster, Domagkstr. 3, D-48129 Münster, Germany. Tel.: +49-251-835-2970; fax: +49-251-835-2993. E-mail address: diroduni@muenster.de (D. Rosenbaum). can be found on the medial margin of the midfoot [5]. This fat pad has to protect the pediatric foot from overloading until the skeletal system has adapted to the vertical load dur- ing stance and gait [5]. The ossification of the foot skeleton continues up to the age of 5 years [6]. The fat pad increases the loaded area of the plantar surface and, therefore, reduces the pressures to protect the sensitive cartilage of the foot skeleton [1] and to reduce shear forces [7]. During the first 4 or 5 years of life the fat pad is absorbed and the longitu- dinal arch of the foot is said to continue to develop until the age of 6 years [8,9]. Apart from the changes in soft tissues the bones of the hind foot show a remodeling during growth [6] that supports the development of the longitudinal arch and is caused by a combination of static loading and mus- cular activity [10]. Nevertheless, it remains unclear whether the development of the longitudinal arch is related to a spe- cific period of growth and how long it is likely to last. The growth velocity of the foot reaches a maximum during the first months of life. Fifty percent of the final foot length is already attained by the age of 12–18 months. The growth velocity decreases rapidly until the age of 5 years. Between 5 and 12 years of age the feet of girls grow on an average of 0.9 cm per year. For boys this period lasts until the age of 14 years [4]. Children’s gait pattern also changes in childhood. Sagit- tal plane kinematic motion analysis has demonstrated that the initial heel strike with roll-over of the foot evolves 0966-6362/$ – see front matter © 2003 Elsevier B.V. All rights reserved. doi:10.1016/S0966-6362(03)00064-X