# Biomechanical mechanisms underlying the effect of minimalist footwear on walking stability in persons with a history of falls

## TL;DR

This study explores how minimalist shoes affect walking stability in older adults who have a history of falls, revealing biomechanical changes that could help prevent future falls.

## Contribution

The study identifies specific biomechanical and neuromuscular adaptations caused by minimalist footwear that explain improved gait stability in fall-prone older adults.

## Key findings

- Minimalist footwear increases ankle dorsiflexion and external rotation while reducing hip flexion during stance.
- Hip and ankle joint power generation and thigh muscle activity are enhanced with minimalist shoes.
- Biomechanical changes from minimalist footwear mediate improvements in gait stability under both single and dual-task conditions.

## Abstract

Footwear design influences sensory input and motor control during gait—key factors in fall risk among older adults. Our previous work showed that minimalist footwear alters walking stability in individuals with a history of falls, but the underlying biomechanical mechanisms remain unclear. Here, we investigated how footwear type influences lower-limb biomechanics, whether these effects are altered by cognitive load, and whether they mediate adaptations in gait stability.

In this cross-sectional repeated-measures design, thirty older adults with a history of falls (mean ± SD age 68.6 ± 4.4 years) completed walking trials under three footwear types (barefoot, supportive, minimalist) and two task conditions (single and dual-task with cognitive load). 3D kinematics, ground reaction forces, and surface electromyography were collected to quantify joint angles, powers, and muscle activity. Statistical parametric mapping and linear mixed models tested condition effects and cognitive load interactions, while mediation analysis assessed whether biomechanical changes explain previously reported stability differences.

Here we show that minimalist shoes induce distinct biomechanical adaptations, including greater ankle dorsiflexion and external rotation, reduced hip flexion during stance, and increased knee flexion during swing. They also enhance hip and ankle joint power generation and elicit higher activity in rectus femoris and vastus lateralis. These effects are consistent across cognitive conditions. Hip kinematics, kinetics, and quadriceps muscle activity mediated adaptations in gait stability observed with minimalist footwear.

These findings identify specific neuromuscular changes associated with minimalist footwear that may explain adaptations in walking stability. Our results support the development of footwear-based interventions for fall prevention in older adults and highlights the need for randomized controlled trials in broader populations to confirm causality.

Because footwear affects movement control, it may influence fall risk - a major concern for older adults. Our study examined how minimalist shoes, which are lightweight with thin, flexible soles. supportive shoes, and barefoot walking change leg movements and muscle activity in older adults with a history of falls. We measured 30 participants while they walked normally and while performing a thinking task. We found that minimalist shoes promoted a distinct walking pattern, increasing muscle activity in the thighs and changing movement dynamics. This suggests the body adopts a more active, controlled strategy to manage different sensory feedback from minimalist shoes. These findings show how footwear can alter gait mechanics in fall-prone older adults. Understanding these adaptations is a crucial step for future research into designing footwear and interventions that may help prevent falls.

Cudejko et al. explore the neuromechanical mechanisms by which footwear influences walking stability in fall-prone older adults. Findings reveal that minimalist footwear induces joint and muscle biomechanical changes that explain adaptations in dynamic balance control, reflecting a shift towards a more neuromechanically engaged walking pattern.