Revival of ‘Paduka’, an ancient form of Indian footwear to increase foot muscle strength and balance: A randomized controlled trial – A Hypothesis

Vol 6 | Issue 1 | Jan - Dec 2020 | page: 6-9 | Viral Sarvaiy, Apurv Shimpi, Suroshree Mitra

Author: Viral Sarvaiya [1], Apurv Shimpi [1] , Suroshree Mitra [1]

[1] Community Physiotherapy Department, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashtra,India.
Institute at which research was conducted: Sancheti institute College of Physiotherapy, Thube park, Shivajinagar Pune 411005, Maharashtra.
University Affiliation of Thesis: Research hypothesis (synopsis) submitted for MPT registration to Maharashtra University of Health Sciences (MUHS), Nashik.
Year of Acceptance: 2020

Address of Correspondence
Dr. Apurv Shimpi,
Sancheti Institute College of Physiotherapy, 12, Thube Park, Shivaji Nagar, Pune - 411005, Maharashtra.


Background: TFoot muscle strength is one of the intrinsic factor responsible for maintaining balance in older population. Footwear is another extrinsic factor having an impact on foot muscle strength, balance and gait. Footwear recommendation by clinician is rational due to role of footwear style in leading to fall or even increase in the risk of fall is unclear. Thus training intrinsic factor, that is foot muscle strength and balance, seems to be sensible which may help individual to maintain control in the conventional footwear. Foot muscle strengthening is mainly limited to short foot exercises, toes curls and its variations. In this study we reintroduce an age old Indian 'Paduka' wooden footwear, an extrinsic factor as a 'practical tool' for rehabilitation. A randomized controlled trial will be conducted where participants will be made to wear 'Paduka' footwear, which has a flat wooden sole and a toe knob to hold between great toe and second toe, to perform a multidirectional walking protocol. They will be assessed for foot muscle strength using MicroFET3 handheld dynamometer and enhanced paper grip test and balance using various clinical tests. Results will be compared with barefoot group following same walking protocol and passive control group. This will be followed by statistical analysis within and between groups.
Clinical Importance: 'Paduka' footwear can give an efficient strategy towards training foot muscles strength and balance amongst elderly in shorter duration, increase compliance and promote a new perspective towards fall prevention strategy.
Future research: Biomechanical implications and gait parameters can be assessed and further studied. Cost effectiveness, environmental factors and footwear preference over minimalist footwear for training can be considered.
Keywords: Wooden footwear, Intrinsic foot muscles, community dwelling elderly, fall prevention.
CTRI trial registration number: CTRI/2020/09/028137.


1. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015 Mar 1;49(5):290
2. Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proceedings of the National Academy of Sciences. 2019 Jan 29;116(5):1645-50
3. Kelly LA, Kuitunen S, Racinais S, Cresswell AG. Recruitment of the plantar intrinsic foot muscles with increasing postural demand. Clinical biomechanics. 2012 Jan 1;27(1):46-51
4. Uritani D, Fukumoto T, Matsumoto D, Shima M. Reference values for toe grip strength among Japanese adults aged 20 to 79 years: a cross-sectional study. Journal of foot and ankle research. 2014 Dec;7(1):28
5. Chatzistergos PE, Healy A, Naemi R, Sundar L, Ramachandran A, Chockalingam N. The relationship between hallux grip force and balance in people with diabetes. Gait & posture. 2019 May 1;70:109-15
6. Mickle KJ, Munro BJ, Lord S, Menz HB, Steele JR. Are toe weakness and deformity associated with falls in older people. 2009
7. Zhang X, Schütte KH, Vanwanseele B. Foot muscle morphology is related to center of pressure sway and control mechanisms during single-leg standing. Gait & posture. 2017 Sep 1;57:52-6
8. Tudpor K, Traithip W. Fall Prevention by Short-Foot Exercise in Diabetic Patients. Indian Journal of Physiotherapy & Occupational Therapy. 2019 Apr 1;13(2)
9. Ridge ST, Olsen MT, Bruening DA, Jurgensmeier K, Griffin D, Davis IS, Johnson AW. Walking in minimalist shoes is effective for strengthening foot muscles. Medicine & Science in Sports & Exercise. 2019 Jan 1;51(1):104-13
10. Yamaguchi T, Cheng KC, McKay SM, Maki BE. Footwear width and balance-recovery reactions: A new approach to improving lateral stability in older adults. Gerontechnology: international journal on the fundamental aspects of technology to serve the ageing society. 2015;13(3):359
11. Chander H, Morris CE, Wilson SJ, Garner JC, Wade C. Impact of alternative footwear on human balance. Footwear Science. 2016 Sep 1;8(3):165-74.
12. Davis A, Haines T, Williams C. Do footwear styles cause falls or increase falls risk in healthy older adults? A systematic review. Footwear Science. 2019 Jan 2;11(1):13-23.
13. Radhakrishna S. Feet & Footwear in Indian Culture by Jutta Jain-Neubauer. Indian Folklore Research Journal. 2002;1(2)
14. Willems C. Future footwear : the birth of feet, the re-birth of footwear. [Ghent, Belgium]: Ghent University. Faculty of Arts and Philosophy; 2015
15. Willems C. Do you want you feet back? Barefoot Cobblers Foot Future Footwear Foundation, Publication, 2018
16. Vass C, Edwards C, Smith A, Sahota O, Drummond A. What do patients wear on their feet? A service evaluation of footwear in elderly patients. International Journal of Therapy and Rehabilitation. 2015 May 2;22(5):225-32
17. Kachhwaha R. Efficacy of Strength and Balance Training Exercise for Fall Prevention in Elderly. International Journal of Health Sciences and Research. 2018;8(6):104-15
18. Franklin S. Feet and footwear: friends or foes? (Doctoral dissertation, University of Birmingham).
19. Franklin S, Grey MJ, Heneghan N, Bowen L, Li FX. Barefoot vs common footwear: a systematic review of the kinematic, kinetic and muscle activity differences during walking. Gait & posture. 2015 Sep 1;42(3):230-9.
20. Franklin S, Li FX, Grey MJ. Modifications in lower leg muscle activation when walking barefoot or in minimalist shoes across different age-groups. Gait & posture. 2018 Feb 1;60:1-5.
21. Cudejko T, Gardiner J, Akpan A, D'Août K. Minimal footwear improves stability and physical function in middle-aged and older people compared to conventional shoes. Clinical Biomechanics. 2020 Jan 1;71:139-45.
22. Willems C, Stassijns G, Cornelis W, D'Août K. Biomechanical implications of walking with indigenous footwear. American journal of physical anthropology. 2017 Apr;162(4):782-93.

How to Cite this Article: Sarvaiya V, Shimpi A, Mitra S. Revival of 'Paduka', an ancient form of Indian footwear to increase foot muscle strength and balance: A randomized controlled trial - A hypothesis. Journal Medical Thesis 2020 Jan-Dec ; 6(1):6-9.

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