Effects of Daily Footwear Use on Lower Extremity Health and Movement in Healthy Adults

Footwear is one of the most influential external factors affecting lower extremity biomechanics, plantar sensory feedback, and postural control during daily activities. Modern footwear designs differ considerably in their structural characteristics, including cushioning, arch support, sole stiffness, and heel height. These features may alter foot mechanics, proprioceptive input, and neuromuscular control, potentially leading to long-term adaptations in balance and movement patterns. Supportive footwear is designed to improve comfort and reduce plantar loading through enhanced cushioning and medial arch support. However, prolonged use has been suggested to limit the natural motion of the foot and reduce activation of the intrinsic foot muscles. In contrast, flat footwear provides minimal structural support, allowing greater interaction between the plantar surface and the ground, which may enhance sensory feedback and promote more natural foot function.

Despite increasing interest in footwear biomechanics, evidence regarding the long-term effects of habitual footwear use in healthy individuals remains limited and inconsistent. Most previous studies have focused on the immediate effects of different shoe designs during walking or running, whereas few have investigated the chronic adaptations associated with everyday footwear habits. Furthermore, objective assessments combining plantar pressure analysis and computerized balance evaluation have rarely been used to compare individuals with different long-term footwear preferences.

The aim of this cross-sectional comparative study is to investigate whether habitual use of supportive or flat footwear is associated with differences in foot posture, plantar pressure distribution, and postural stability in healthy adults. Participants aged 18 to 35 years who have consistently worn either supportive or flat footwear for at least six months, for a minimum of six hours per day, will be recruited from the Faculty of Health Sciences at Bahçeşehir University.

Following informed consent, demographic characteristics, anthropometric measurements, and footwear history will be recorded. Static plantar pressure distribution and foot posture characteristics will be assessed using the Footwork Pedobarography System. Static and dynamic balance performance will be evaluated using the Biodex Balance System. Balance measurements will include double-leg and single-leg standing assessments, and objective stability indices will be recorded according to standardized testing protocols.

The primary outcomes will be the Overall Stability Index obtained from the Biodex Balance System and plantar pressure distribution parameters measured using the Footwork Pedobarography System. Secondary outcomes will include anterior-posterior and medial-lateral stability indices, foot contact area, arch-related plantar pressure characteristics, and balance performance during single-leg and double-leg stance.

It is hypothesized that individuals who habitually wear flat footwear will demonstrate different plantar pressure characteristics and balance performance compared with those who regularly wear supportive footwear, reflecting long-term biomechanical adaptations associated with footwear selection.

The findings of this study are expected to improve understanding of the relationship between habitual footwear use and lower extremity biomechanics in healthy adults. The results may contribute to evidence-based recommendations regarding footwear selection and support preventive strategies in physiotherapy, rehabilitation, sports medicine, and footwear design. Additionally, this study may provide a scientific basis for future longitudinal and interventional research investigating the long-term musculoskeletal consequences of everyday footwear habits.

Inclusion criteria

• Adults aged 18 years and older
• Diagnosis of hemophilia A or B
• Scheduled to undergo primary total knee arthroplasty
• Able to understand the study procedures and provide written informed consent
• Willing to participate in the prehabilitation program

Exclusion criteria

• Presence of neurological disorders affecting balance or gait
• Severe cognitive impairment
• Other musculoskeletal conditions affecting lower extremity function
• Revision total knee arthroplasty
• Any medical condition that would prevent safe participation in the exercise program