Flip-flops do not alter the neuromuscular function of the gastrocnemius muscle and tendon during walking in children

Introduction/Aim: Flip-flops are a popular choice of footwear for children. However, their inherent design provides minimal support to the foot and ankle and has been suggested to increase the work performed by muscle and tendon structures, potentially predisposing them to injury. Therefore, the aim of this study was to compare the length change behaviour of the medial gastrocnemius (MG) muscle fascicles and muscle tendon unit (MTU) and their mechanical function at the ankle and subtalar joints in children during walking with and without flip-flop. Methods: Eight healthy children walked barefoot and with flip-flops whilst 3D gait analysis and simultaneous B-mode ultrasound images of the MG fascicles during level walking were collected. Joint kinematics, kinetics and MTU lengths were analysed using musculoskeletal modelling and fascicle lengths using a semi-automated tracking algorithm. Results: The muscles and tendons across the ankle absorbed greater amounts of power during barefoot walking compared to flip-flop walking. The muscle activations of the lateral gastrocnemius, soleus and tibialis anterior remained invariant across the conditions as did the activation, and fascicle length change behaviour of the medial gastrocnemius. In the barefoot condition, there was a trend of greater MTU lengthening, to potentially absorb greater amounts of power, although no differences in shortening was observed during late stance. Conclusion: Walking with flip-flops does not increase the mechanical work performed by the MG muscle at the ankle and subtalar joints, suggesting that flip-flops do not increase the stresses and strains of the Achilles tendon and hence its predisposition to strain induced injury. Instead, our results suggest that flip-flops, act as a compliant surface and absorb energy during contact and hence the strain experienced by the Achilles tendon. © 2020 Elsevier B.V.