The effects of walking, running, and shoe size on foot volumetrics
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Physical Therapy in Sport 4 (2003) 87–92
www.elsevier.com/locate/yptsp
The effects of walking, running, and shoe size on foot volumetrics
J. Wesley McWhorter*, Harvey Wallmann, Merrill Landers, Beth Altenburger,
Laura LaPorta-Krum, Peter Altenburger
Department of Physical Therapy, College of Health Sciences, The University of Nevada, 4505 Maryland Parkway, Box 453029,
Las Vegas, NV 89154-3029, USA
Abstract
Objectives. The objective of this study was to investigate the effects of walking and running on foot volumetrics, and its relationship between
measured foot size and preferred shoe size.
Design. This study was a single-group, repeated measures design. Twenty-eight physical therapy students participated in the testing.
Methods. Following 10 min of supine rest, a pre-exercise volumetric measurement of the right leg was obtained. Shoe size and foot length
measurements were taken. Subjects were randomly assigned to a treatment condition (walking or running). The treadmill speed was set at a
comfortable pace for each participant during exercise. Foot volume measurements were taken after the exercise. Subjects returned the next
week to participate in the second condition.
Results. Paired t-tests were used to compare differences in outcome variables. Significant increases in fluid volumes were noted within groups
after walking (2%) and running (3%) and between groups in the post-walk and post-run values (1.7%). A weak positive correlation was noted
between changes in volume during running and the measured difference between foot size and shoe size (r ¼ 0:39; p ¼ 0:038).
Conclusions. Treadmill running for 10 min may lead to significantly greater foot volume compared to treadmill walking for the same period.
Results also demonstrate that the greater the measured difference between shoe size and foot size, the greater the foot volume after running.
q 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Brannock device; Blood pressure; Physical therapy
1. Introduction In particular, running and jogging have been shown to
increase foot and ankle volume (Stick et al. 1992; Chalk
Health care practitioners commonly prescribe and or et al. 1995; Cloughley & Mawdsley 1995; Emby 1997;
recommend aerobic type activities for those patients seeking Lazzarini et al. 1997). In the young or recreational athlete,
to improve their cardiovascular fitness. These aerobic the small changes which occur as a result of running would
activities often include walking or running programs. It not be a problem. However, in the older adult or geriatric
has been demonstrated, however, that weight bearing patient, these small increases in foot volume when added to
activities such as walking or running can lead to foot and the prior conditions of chronic resting oedema, fibrosis, joint
ankle swelling (Stick et al. 1992; Chalk et al. 1995; stiffness, contractures, pain and dysfunction could prove to
Cloughley & Mawdsley 1995). A common complication be harmful (Sorenson 1989; Guyton & Hall 2000).
resulting from weight bearing activities and which can lead Previous researchers have examined the relationship
to more serious foot problems is oedema (Evanski 1982; between changes in foot and ankle volume during daily
Shereff 1987; Stick et al. 1992; Gordon & Cuttic 1994; activities and exercise (Chalk et al. 1995; Cloughley &
Cloughley & Mawdsley 1995). Mawdsley 1995; Moholkar & Fenelon 2001). In their study
Evidence exists demonstrating increases in interstitial involving nine volleyball players, Chalk et al. (1995)
and intracellular volume during and after exercise, reported no changes in foot volume before and after
especially as it relates to workload (Jacobbsson & Kjellmer workouts. Cloughley and Mawdsley (1995) examined 21
1964; Lundvall et al. 1972; Baker & David 1974; Schnizer subjects during walking and running. They reported a
et al. 1979; Stick et al. 1985; McGough & Zurwasky 1991). change in foot and ankle volume with running as compared
to walking using the Lucite foot volumeter measuring
* Corresponding author. Tel.: þ 1-70-2895-2629; fax: þ1-70-2895-4883. device. Foot and ankle volumes increased by an average of
E-mail address: jmcwhorter@ccmail.nevada.edu (J.W. McWhorter). 17.9 ml during walking, while increasing 31.2 ml after
1466-853X/03/$ - see front matter q 2003 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S1466-853X(03)00031-288 J.W. McWhorter et al. / Physical Therapy in Sport 4 (2003) 87–92
Fig. 1. Lucite volumeter.
running ðp ¼ 0:02Þ: However, they did not address if following the manufacturer’s guidelines. In addition, foot
changes in volume occurred within the walking or running measurements were taken using the Brannock device (Fig. 2)
groups or how this related to shoe size. which is designed and calibrated for the correct fitting of
Few studies have investigated the effects of running and athletic footwear (Brannock Device, Syracuse, NY, USA).
walking on foot volumetrics (Stick et al. 1992; Cloughley & There are several studies establishing the reliability and
Mawdsley 1995). In addition, only the paper by Chalk et al. validity of obtaining foot/ankle oedema from foot volume-
(1995) has reported the relationship between shoe size and try (Cloughley & Mawdsley 1995; Khiabani et al. 1999a,b;
changes in foot volume before and after exercise. Moholkar & Fenelon 2001). A pilot test was performed
The purpose of this study was to investigate the previously in order to allow the tester to practice taking foot
relationship between running and walking foot volumetrics, volumetric measurements. Analysis of the pilot data
and its relationship between measured foot size and
preferred shoe size. This research will serve as a pilot
study for future research to investigate the relationship of
exercise and oedema in the older athletic population and
how exercise intensity and weight bearing status might
influence these changes.
2. Method
2.1. Subjects
The subjects consisted of 13 females and 15 male physical
therapy student volunteers without a history of musculoske-
letal injuries, health problems or surgery to the lower
extremities. The age range was from 22 to 34 years with a
mean of 27.1 ^ 3.7 years. Their self assessed individual
activity levels ranged from sedentary to moderately active.
2.2. Instrumentation
All measurements were obtained using a lucite, foot
volumeter set (Fig. 1) which included the volumeter
container, an obturator which was used to calibrate the
water levels prior to each measurement, a receiver to catch
the water overflow, and a 1000-ml graduated cylinder with
10-ml graduations (Foot Volumeter, P.O. Box 146,
Idyllwild, CA. 92349). All measurements were taken Fig. 2. Brannock shoe size measuring instrument.J.W. McWhorter et al. / Physical Therapy in Sport 4 (2003) 87–92 89
Table 1
Reliability intra-class correlation of pilot study
Between subject SS Between subject df Between sject MS Error SS Error df Error MS RICC
Pre-walk 43864 3 14621.33 6.0 4 1.5 0.999
Post-walk 47116.37 3 15705.45 127.5 4 31.875 0.998
Pre-run 44155.37 3 14718.45 15.5 4 3.875 0.999
Post-run 49909.37 3 16636.45 7.5 4 1.875 0.999
RICC ; reliability intra-class correlation; RICC ; (MS Between Subjects MS Error) 4 MS between subjects.
demonstrated a reliability intra-class correlation coefficient instructed to slowly lower the right foot into the volumeter.
(RICC) of.99 (Payton 1994) (Table 1). At this time, resting blood pressure and heart rates were
The displaced water was captured in a plastic container recorded. Prior to the exercise sessions, all subjects were
and subsequently measured in a graduated cylinder. All data instructed to bring their athletic footwear and their shoe size
was immediately recorded on a personalized data sheet. As was recorded. In addition, the right foot size was measured
water has a tendency to creep up the sides of the plastic with the Brannock device and recorded in the US sizes. A
cylinder, measurements were taken from the lowest level at conversion chart for UK and European sizes is available at
the water line. Each volume measurement was inspected by the Brannock web site: http://www.brannock.com.
two researchers and the average of the two observations was The treadmill speed for both exercise sessions was set at
recorded. a comfortable pace for each individual participant. Due to
the fact that walking and running speeds vary greatly among
individuals, it was felt that allowing each individual to
3. Procedure determine their own speed would more closely mimic a real
life scenario (Winter 1984; Rodgers 1988).
3.1. Design Each exercise session lasted 10 min and was preceded by
a 5-minute warm-up session. The warm-up sessions
All subjects were tested during walking and running and consisted of light stretching of the lower extremities. Prior
thus served as their own controls. The subjects were given a to beginning the exercise session, each subject performed a
group instructional session at which time all aspects of the 2-minute warm-up session on the treadmill at which time
research study was explained and possible complications as they gradually increased their speed until they felt
a result of participation were discussed. During this session comfortable.
each subject read and signed an informed consent. Following each exercise session, a 2-minute cool-down
period on the treadmill was performed which consisted of
3.2. Exercise sessions slow walking. Immediately following both exercise sessions,
heart rates and blood pressures were measured followed by
All subjects were required to rest in a supine position for volumetric measurements. All subjects were required to
10 min prior to testing. The activity for the first condition remain in the lab until blood pressure and heart rate values
(walking or running) was randomly chosen by a flip of a returned to pre-exercise levels. The second exercise
coin. A pre-exercise volumetric measurement of the right condition was scheduled one week later. All procedures
leg was obtained in the sitting position. The subjects were were performed in a consistent manner for both sessions.
Table 2
Comparison of fluid volume changes during walking and running
Mode of exercise ðN ¼ 28Þ % Volume changes Mean volume (ml) Standard error t-values p-values
Pre-walk 2 650.04 40.19 3.023 0.005
Post-walk 662.64 40.61
Pre-run 3 654.21 41.07 3.909 0.001
Post-run 674.43 39.36
Pre-walk 0% 650.04 40.19 709.0 0.484
Pre-run 654.21 41.07
Post-walk 1.7% 662.64 40.61 3.516 0.002
Post-run 674.43 39.36
Alpha level 2p ¼ 0:05:90 J.W. McWhorter et al. / Physical Therapy in Sport 4 (2003) 87–92
Table 3
Male and female differences for fluid volume changes during walking and running
Mode of exercise ðN ¼ 15Þ % Volume changes Mean volume (ml) Standard error t value p value
A. Male
Pre-walk 0 762.40 50.93 1.031 0.320
Post-walk 768.53 52.66
Pre-run 3 761.13 53.40 2.216 0.044
Post-run 781.07 50.23
Pre-walk 0 762.40 50.93 0.128 0.900
Pre-run 761.13 53.40
Post-walk 2 768.53 52.66 2.645 0.019
Post-run 781.07 50.23
B. Female
Pre-walk 4 520.38 41.50 3.794 0.003
Post-walk 540.46 44.00
Pre-run 4 530.85 44.36 4.514 0.001
Post-run 551.38 41.91
Pre-walk 2 520.38 41.50 1.939 0.076
Pre-run 530.85 44.36
Post-walk 2 540.46 44.00 2.225 0.046
Post-run 551.38 41.91
Alpha level 2p ¼ 0:05:
4. Data analysis were noted between pre-walk and post-walk volumes ð p ¼
0:320Þ or pre-walk and pre-run volumes ð p ¼ 0:900Þ:
Fluid volume data were analyzed using the SPSS Females showed significant changes in pre-walk and post-
statistical package for Windowsw, release 10.0. Means walk volumes ð p ¼ 0:003Þ; pre-run and post-run volumes
and standard errors were calculated for the outcome ð p ¼ 0:001Þ; and post-walk and post-run volumes ð p ¼
variables. Given the normal distribution of data, paired t- 0:046Þ: No changes were noted between pre-walk and pre-
tests were used to compare differences in outcome variables run volumes ð p ¼ 0:076Þ:
between pre and post-test means for both groups. The alpha
level was set at 0.05. 5.3. Correlation between differences in foot and shoe sizes
and volume changes in running
5. Results A weak positive correlation was noted between changes
in volume during running and the differences between foot
5.1. Comparison of fluid volume changes during size and shoe size (r ¼ 0:39; p ¼ 0:038) (Table 4). In other
walking and running words, there was a greater volume change when the shoe size
was greater than the foot size. The correlation was calculated
Comparisons of pre and post data for walking and by first finding the differences between foot size and shoe
running groups are reported in Table 2. Significant mean size. This difference was then correlated to the difference
increases in fluid volume were noted after walking ð p ¼
Table 4
0:005Þ and after running ð p ¼ 0:001Þ: No difference was Correlation between differences in foot and shoe size and pre to post
noted between the pre-walk and pre-run groups ð p ¼ volume changes in walking and running
0:484Þ: A significant difference was noted between the
groups in post-walk and post-run values ð p ¼ 0:002Þ: Pre to post running Difference between foot size
volume changes and shoe size
5.2. Gender differences Pre to post walking 20.11a (0.579)b 20.09a (0.668)b
volume changes
When participants were divided by gender (Table 3), Pre to post running 0.39a (0.038)b
males showed significant changes in pre-run and post-run volume changes
volumes ð p ¼ 0:044Þ as well as significant changes in post- a
Pearson correlation coefficient.
walk and post-run volumes ð p ¼ 0:019Þ: No differences b
Alpha level 2p ¼ 0:05:J.W. McWhorter et al. / Physical Therapy in Sport 4 (2003) 87–92 91
Table 5 Differences in fluid volumes after walking or running
Paired samples test of foot size and shoe size activities were also found to be significant based on gender
Paired Paired Paired t df Sig. (Table 3). A review of the literature failed to identify any
difference difference difference (2-tailed) studies of post exercise foot and ankle volume changes
mean SD SEM based on gender. The one study by Chalk et al. (1995)
demonstrated a slight non-significant reduction in foot
20.554 0.416 7.86E-02 27.044 27 0.000 volume in female inter-collegiate volleyball players after a
Alpha 2p ¼ 0:05: 2-hour rigorous session (Chalk et al. 1995).
Both groups of males and female participants demon-
between pre-running volume and post-running volume strated significant increases in volume after running on the
values. Pair samples t-test revealed a significant difference treadmill. In addition, the female participants showed
between foot size and shoe size ðp ¼ 0:00Þ (Table 5). significant changes after walking whereas the male
participants did not demonstrate these changes. When
comparing walking to running, both groups exhibited
6. Discussion similar significant increases in running over walking.
Measured foot size compared to preferred shoe size
The data from this study showed that, in healthy also demonstrated a significant positive correlation. It was
individuals, running and walking resulted in significant found that as the measured difference between foot size
increases in foot and ankle fluid volumes compared to and shoe size increased there was a resultant increase in
resting measurements. Additionally, when comparing run- foot/ankle volume. Consequently, having shoes that are
ning to walking, running demonstrated significantly greater too large could further exacerbate the problems of
changes than walking. These findings agree with other increased foot volume associated with running. In
studies investigating the relationship between foot/ankle addition, the authors suggest having a shoe that is too
oedema and weight bearing activities (Sorenson 1989; Stick short (decreased length) and or too tight (decreased width)
et al. 1992; Chalk et al. 1995; Cloughley & Mawdsley 1995; could greatly compress the foot. This could have the
Lazzarini et al. 1997; Guyton & Hall 2000; Moholkar & detrimental effect of traumatizing the joints of the foot
Fenelon 2001). In addition, it was found that shoe size and the relationship of the metatarso-phalangeal joints to
demonstrated a positive correlation with foot and ankle fluid the shoe break. Therefore, the authors recommend that
volumes. If the shoe size was greater than the measured foot using shoes that are appropriate in size is as important as
size, then there was a greater potential for increased volume choosing shoes for a specific activity, especially in those
changes with running. experiencing oedema problems.
The increase in foot and ankle volumes during running Proper shoe fitting incorporates not only overall length
and walking can be attributed to the increase in blood flow (heel to toe measurement) but also arch length (heel to first
to the exercising muscles. As a result of this increased blood metatarsal head) measurement. Shoes are designed to flex at
flow, there is a shift of capillary fluid into the interstitial the ‘ball’ of the foot. Therefore, correct fitting properly
spaces (Stick et al. 1992; Chalk et al. 1995; Cloughley & positions the first metatarsal joint in the widest part of the
Mawdsley 1995; Gellman & Burns 1996; Lazzarini et al. shoe and provides room for the toes (at least 1 cm from the
1997; Guyton & Hall 2000). This increase in oedema end of the shoe) so they are not confined. In addition, for an
following exercise has been shown to increase foot volume appropriately sized shoe to fit correctly, an adequate lacing
by as much as 8% (Chalk et al. 1995). Stegall has system or adjustable strap is required.
demonstrated an 80 mmHg drop in venous pressure at the In a random sample by the primary author of 5 athletic
saphenous vein in the ankle during running as compared to shoe stores, it was found that the majority of shoe store
quiet standing (Stegall 1966). As a result, it has been vendors would recommend shoe purchases based solely on
suggested that there is an inability of the lower extremities comfort. In this sample, only 1 out of the 5 stores offered to
to maintain a steady rate of venous return following take foot measurements and make recommendations based
vigorous weight bearing activities. on those measurements. The authors believe that it is
This study demonstrated a 3% increase in foot volume common for athletic shoe store employees to recommend a
after 10 min of light running on a treadmill. Walking for the shoe one full size greater than the measured size. The vast
same amount of time resulted in foot volume changes of majority of adults have not had their feet measured for many
approximately 50% less than that for running. An increase years and are purchasing their athletic shoes based on
in running foot volume of this magnitude could result in measurements taken many years prior. In this study, it was
further constriction of venous return with possible patho- found that shoe size was significantly greater than measured
logical consequences in those with compromised circulation foot size. Miller et al. (2000) found that shoe fit was not
(Beskin 1997). The relationship between statistical related to comfort, and therefore, new shoe purchases
significance and clinical relevance of percentage changes should be based on measured shoe size as well as comfort
has yet to be determined. (Miller et al. 2000).92 J.W. McWhorter et al. / Physical Therapy in Sport 4 (2003) 87–92
These findings should give all health care practitioners, Emby, D.J., 1997. Foot ischaemia due to too-tight laces. South African
especially those directly involved in recommending athletic Medical Journal 87 (11), 1560.
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Saunders, Philadelphia, chapter 31, p. 404 –413.
injury. Combining the correct type of activity along with
Jacobbsson, S., Kjellmer, I., 1964. Accumulation of fluid in exercising
choosing the correct footwear (based on accurate foot skeletal muscle. Acta Physiologica Scandinavica 60 (3), 286–292.
measurements) will greatly improve the participant’s ability Khiabani, H.Z., Anvar, M.D., Rostad, B., Standen, E., Kroese, A.J., 1999.
to control oedema and minimize serious foot complications. The distribution of oedema in the lower limb of patients with chronic
critical limb ishcaemia. a study with computed tomography. Journal for
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Results of this study indicate that treadmill jogging for (5), 419– 423.
10 min can lead to significant increases in foot volume as Lazzarini, K.M., Troiano, R.N., Smith, R.C., 1997. Can running cause the
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Nevada, Las Vegas for their assistance in this research Rodgers, M.M., 1988. Dynamic biomechanics of the normal foot and ankle
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