October 2015

Seeking shoe closure: Laces vs alternatives

The footwear industry is teeming with alternatives to traditional shoelaces—including Velcro, no-tie elastic systems, and clutch reel technology—that may offer advantages for certain individuals. But for many people, experts say, laces will work just as well.

10FOOT-closures_shutterstock_158371310By Shalmali Pal

In 2013, a study conducted by a UK department store had some people tied up in knots. The report by the retailer Littlewoods indicated that school-aged children learned to tie shoelaces closer to age 10 than the usual ages of 6 to 8 years.1

The main reason for this was the growing popularity of footwear with alternative closure systems, such as Velcro, straps, no-tie shoelace replacement systems, and slip-ons, according to the retailer. The “data” had some healthcare professionals lamenting the delay of a basic life skill—one podiatrist was quoted2 as saying, “We are fitting shoes to kids who are five, six, seven, eight, and are on their iPads and have no interest in the [shoe tying] process.”

Regardless of the age at which the skill is mastered, in the grand scheme of things, anything having to do with footwear fastening is “fifty one on our list of the fifty most important things we need to think about,” said David Armstrong, DPM, MD, PhD, director of the of Southern Arizona Limb Salvage Alliance at the University of Arizona in Tucson. “We have so much going on in our lives—why would we pay attention to something like our shoe laces?”

Yet the average person is probably taking several thousand steps a day, leading to a fair amount of repetitive stress across the foot. And closure systems can play a role in ensuring that footwear is effectively doing its job, Armstrong pointed out.

Children should be able to tie their own shoes when they are aged around 6 years and have the right fine motor and cognitive skills, but that’s no longer the norm.

The footwear industry has made an effort to encourage people to pay more attention to shoe closures by offering alternatives to lacing, including the ones mentioned above. But are these types of closures destined to replace shoelaces, or is there still a place in the footwear world for the traditional lace-up?

LER took a closer look at the oft-forgotten shoe closure, focusing on three populations: Children, adults with and without foot health issues, and perhaps the pickiest group of all, athletes.

Laces for learning

10FOOT-closures_iStock_10965496The findings of the Littlewoods research need to be taken with a grain of salt—the company never released details on the number of participants who took part in the report or the methodology used to draw the publicized conclusions. Littlewoods did not respond to requests from LER for specifics on the report.

But the suggestion that kids learn to tie laces later in life didn’t come as a surprise to Russell Volpe, DPM, a professor at the Foot Center of New York, an affiliate of the New York College of Podiatric Medicine in New York City. He agreed that children should be able to tie their own shoes by when they are aged around 6 years, when they have the right fine motor and cognitive skills, but that’s no longer the norm.

“My sense is that they are just asked to begin learning this skill at an older age because parents opt for the Velcro closure for the inherent convenience and ease of dressing and getting out of the house with these simple closures,” Volpe explained.

Learning to tie laces may be a boon for fine-tuning cognitive and motor skills, and but how important is the closure to the overall value of a shoe in terms of a child’s foot development? Are alternative closure systems any worse or better for foot health?

For Volpe, the type of closure isn’t as important as how “firm” the closure is—as long as the closure does its job and secures the shoe to the foot, it’s very unlikely to cause a child harm or injury.

“I have seen issues where the Velcro closure wears out and the shoe does not stay closed,” he said. “But most of the time, children will outgrow a shoe before the closure wears out.” However, if parents go the hand-me-down route with shoes, they should be advised that worn-out closures can be a problem.

While laces are best for keeping the shoe firmly placed on the foot, a good Velcro or other closure type, such as elastic no-tie shoelace replacement systems, can do the job just as well, Volpe said. However, he does advocate for laces on shoes for children who require foot orthoses.

“Foot orthoses require room in a shoe, even with an insole removed, as they raise the position of the foot in the shoe,” he explained. “Because of this, a good, firm closure of the shoe over the foot-orthosis unit is important for the orthosis to function optimally and to keep the foot in the shoe during gait.”

Even if a child has undergone corrective surgery for conditions such as clubfoot or Charcot-Marie-Tooth disease, there are no special shoe requirements once the postsurgical recovery and rehabilitation period has ended, according to Peter Salamon, MD, a pediatric foot and ankle surgeon at Alpine Orthopaedic Medical Group in Stockton, CA.

“The goal with the surgery is to make them like a typical child, so no special footwear is needed,” said Salamon, a spokesperson for the American Academy of Orthopedic Surgeons. “As long as the shoe is comfortable and offers protection, I would suggest a shoe that the child is willing to wear, whether that’s a laced shoe, Velcro, or slip-on.”

As for more high-tech closures, such as the clutch reel system, they are not a requirement for kids, even those whose wear orthoses, Volpe said, though he noted that there could be exceptions.

“Moving to a clutch reel closure may be an option in a child who is having difficulty keeping a simple laced shoe on with an orthosis in it,” he acknowledged. “The additional anchor of the clutch reel closure may be enough to ensure a good fit.”

Clutch reels and the diabetic foot

Clutch reel systems have become popular with athletes and may have benefits for patients with diabetes and other conditions. (Photo courtesy of venturethere.com.)

Clutch reel systems have become popular with athletes and may have benefits for patients with diabetes and other conditions. (Photo courtesy of venturethere.com.)

Clutch reel closure systems feature steel laces, nylon guides, and a mechanical reel that allows the user to adjust the fit by turning a knob. One benefit of this system is that it gives the wearer a better idea of whether the shoe is on too tight or not tight enough, especially if the optimal level of tightness is preset by a foot health professional, Armstrong said.

That’s exactly what Armstrong and his colleagues, including Bijan Najafi, PhD, are doing in an ongoing study that compares shear stress on the feet of patients with diabetic peripheral neuropathy with an orthopedic shoe outfitted with a clutch reel closure versus a regular shoe with laces. Their theory is that a reduction in shear force associated with the clutch reel technology will ultimately translate to better foot health, especially in patients with diabetes who are at risk for ulceration.3

The researchers used a thermal response to stress test to assess shear force, and compared three shoe closure conditions: loose laces, tight laces, and optimal with the clutch reel, explained Najafi, director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at the University of Arizona.

In the study, a clinician predetermined the level of optimum shoe fit. The wearer had only to turn the knob to the set level of tension. If they went past the predetermined setting, the knob would simply spin, but wouldn’t cause the shoe to tighten excessively, Armstrong explained.

“Our results suggest that too-loose and too-tight conditions significantly increase thermal response to stress when compared to optimum shoelace closure, but when using the clutch reel we could even reduce thermal response compared to what our subjects thought to be optimum shoe lace tightness,” Najafi said.

The diabetic foot and the clutch reel closure would seem to be a perfect match. Patients with diabetes often have circulatory restrictions in the lower extremities, which increase the risk of foot ulcerations. The clutch reel system would theoretically eliminate the guesswork that goes with adjusting laces, according to Najafi.

“Having the opportunity to adjust to an optimum closure, retain it during daily physical activities, and ensure that patient cannot make their shoelace either too tight [which may limit skin perfusion] or too loose [which may increase shear force] could revolutionize diabetic footwear and contribute to reducing the risk of diabetic foot ulcers,” Najafi said.

However, the researchers have only analyzed two patients thus far, and he stressed that more study is needed to confirm this theory.

In the meantime, the patient feedback on the clutch reel has been positive, reported study coauthor Ana Enriquez, an iCAMP research assistant.

“We’ve gotten comments that the shoes are comfortable and that the reel closure made it easier to don and doff the shoes,” Enriquez said.

Ease of wear, ease of fastening, and limited effort to maintain a consist fit are major factors in ensuring patient compliance with prescribed footwear, Najafi added.

“Our ongoing study tries to address this. We will assess perception of benefit, user-friendliness, ease of use, as well as patient adherence in our study,” he said.

Complicating the simple?

A heel lock modification, sometimes called a runner's loop or lock, utilizes the top two shoelace holes for a better fit. (Photo courtesy of Rob Conenello, DPM.)

A heel lock modification, sometimes called a runner’s loop or lock, utilizes the top two shoelace holes for a better fit. (Photo courtesy of Rob Conenello, DPM.)

Use the terms “shoelaces and running” or “shoes and biking” in an online search engine and one thing becomes very clear—many athletes are obsessed with shoe fastening devices. There are discussions of lace alternatives, blogs reviewing those alternative closures, and YouTube videos with instructions on making the most of a chosen fastening system.

Of course, athletes have good reason to be captivated by closures—a good footwear fit can enhance an athlete’s function, while a less than ideal shoe fit may spell trouble.

“You want a shoe that is going to optimize performance, so the closure should enhance the shoe’s fit and function,” said Rob Conenello, DPM, immediate past president of the American Academy of Podiatric Sports Medicine, and a podiatrist with Orangetown Podiatry in New York. “You don’t want a closure that’s new and trendy if it takes away from performance.”

Over the years, athletes have moved away somewhat from traditional lacing, gravitating toward other options, such as elastic-covered lock laces or clutch reel systems. Conenello said he understands the appeal of these fasteners, but he’s not entirely convinced that they offer more bang for the buck.

“Sometimes we like to complicate simple things,” he said.

No-tie elastic shoe laces or clutch reels offer some advanced technology, but it’s unclear whether they are improving biomechanics, Conenello pointed out.

“I don’t think they give the same form-fitting feel that you get from going eyelet to eyelet with traditional laces. I find those [alternative closures] are good for individuals who need a quick in and out, like triathletes, or those who have difficulty getting in and out of the shoes on their own,” he said.

An example of the latter would be some of the athletes who participate in the Special Olympics International, for which Conenello is a global clinical adviser. Many of them are given lock laces—featuring a sliding, spring-activated device that holds the laces in place—because they don’t have the manual dexterity to tighten and tie laces, he explained.

For Conenello, traditional shoelaces are the best bet, but he says most people don’t know how to use them properly.

“Why not stick with laces, but change up the way the lacing is done? That can be a simple solution with a great benefit,” he said.

Athlete or otherwise, the goal is to achieve what Conenello referred to as “a neat fit.” Everyone learns to tighten shoes up from the distal aspect of the shoe and pull hard until the shoe feels tight, but that isn’t necessarily ideal.

“You don’t want to crank it up like that,” he said. “The shoe should feel secure—comfortable but not tight. There should be what I call a ‘neat fit’ around the forefoot. Also, a lot of people don’t know what the extra [lace] holes at the top of the shoes are for so they don’t use them properly. If the heel feels like it’s slipping out of the shoe a bit, you can thread the lace through those holes and cinch the shoes.”

That technique is sometimes called a heel lock modification, or sometimes called a runner’s loop or lock.

Kevin Fraser, CPed(C), president-elect of the Pedorthic Association of Canada in Winnipeg, also said he stresses the fit of the shoe overall, rather than the closure style. He often sees people being fitted with the wrong type of shoe for their foot type, which can reduce the effectiveness of the shoe’s closure system.

“An example of that would be a person with a very high arch who is fit with a shoe that is too shallow and, as a result, the opening of the shoe doesn’t close and secure the foot properly in the shoe,” said Fraser, who is a pedorthist at Sunnybrook Health Sciences’ Centre for Independent Living in Toronto. “Conversely, [in the same type of patient] if the opening is too narrow, it puts too much pressure on the foot.”

Fraser is also a fan of a laced shoe because it offers more options for adjustment than a Velcro closure. Velcro may be quicker, but doesn’t necessarily provide the type of customized fit that laces do, he said.

“With a lace shoe, you can control the pressure over the foot better than you can a shoe with one or two Velcro strap because you can tighten or loosen the laces,” he explained. “You also have more options in the way you thread and tie the laces.”

However, Fraser did acknowledge that some people may not have the capacity for or even interest in dealing with laces, and practitioners need to take that into consideration. For example, if a patient is given a pair of laced shoes, but then proceeds to don the shoes by “stamping” down the back of each one and turning into a slip-on, it will ultimately destroy the footwear and render it ineffective.

“In those cases, we might sacrifice the better adjustability with the laces by giving them a Velcro shoe, because it’s simpler to use, and that increases the likelihood that they will wear the shoes,” he said.

If a shoe no longer seems to fit properly, Conenello suggested changing the laces instead of changing the shoes, or even seeking out a different closure type.

“If the shoe is in perfectly good shape and hasn’t broken down in other ways, but you’re looking for a better fit, then maybe just consider new laces. Or change the way you are lacing the shoes,” he said. “Again, sometimes we complicate something that is really quite simple.”

Shalmali Pal is a freelance writer based in Tucson, AZ.

REFERENCES
  1. Drummond J. They can use an iPad but not tie their shoe laces! Children are learning vital skill later than ever. Daily Mail website. http://www.dailymail.co.uk/news/article-2318288/Children-learning-tie-shoe-laces-later-popularity-Velcro-straps-shoes.html. Published May 3, 2013. Accessed October 1, 2015.
  2. Kidd R. Tech-savvy kids can use an iPad but can’t tie their own shoelaces. Courier-Mail website. http://www.couriermail.com.au/news/queensland/techsavvy-kids-can-use-an-ipad-but-cant-tie-their-own-shoelaces/story-fnihsrf2-1226810811323. Published January 7, 2014. Accessed October 1, 2015.
  3. Owl J, Marin I, Enriquez A, et al. Laced with uncertainty: The impact of shoe gear fastening on dorsal shear stress. Presented at the American Podiatric Medical Association annual meeting, Orlando, FL, July 2015.
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