This is the first study to investigate footwear requirements for secondary school students across Australia. Nearly all principals that participated in this study report that their school has guidelines on footwear for students to wear to school. Those principals that did not have guidelines for school footwear were based at a government school. Students spend an average of eight hours per day in their school shoes three days per week. Students are typically expected to wear an all-black closed in shoe with appropriate fixation (i.e., buckles or laces) with no differences in the shoes recommended between government and non-government schools. For the small number of schools that do not provide footwear guidelines, principals report that parental pushback and student resistance are the major barriers to implementation.
Footwear comfort is highly valued by students and parents when selecting the shoes, they, or their children, choose to wear to school. These findings are consistent with studies performed in primary school aged children (8, 25), as well as adult runners (15, 18) and adults with inflammatory arthropathies (17, 32). Parents of secondary school students consider their child’s opinion very important when selecting shoes. In contrast, more than half of students do not consider their parent’s opinion important. The majority of secondary school students who responded also did not consider the opinion of peers or friends important. This contrasts with previous literature on clothing choice in adolescents which suggests that peer opinion is highly influential on behaviour, particularly in older adolescent cohorts (20, 21). Consistent with previous research in adolescent clothing choice, female students were twice as likely than male students to value appearance of the shoe important to footwear choice (33). For students, appearance of the shoe and comfort were the most important factors when selecting the shoes worn to school. The perception of comfort may be influenced by the appearance of the shoe as well as individual physiological factors, gender, wear time and psychosocial and developmental needs (24, 25, 34). As adolescence is a period of significant physical and psychosocial change, clothing, and by extension footwear, may provide adolescents with an opportunity to express their identity (35) which may go some way to explaining the high value placed on appearance by our cohort.
Less than a quarter of parents and students feel that foot health is considered important when principals, or heads of school, design school footwear guidelines. However, our findings suggest that principals do believe these factors, along with occupational health and safety requirements, are important when designing footwear guidelines. Most parents and students believe that principal’s place greater importance on student uniformity and tradition when recommending school footwear for students. Previous research has demonstrated similar findings between principals and parents (29). Parents of primary school students were highly supportive of students wearing sports uniform daily in comparison to principals, who placed greater emphasis on school presentation. In our study principal’s report that they consider foot health, comfort, and presentation of the school important however, there is likely some differences in which factors take priority when developing school footwear guidelines. It is not clear whether our findings would have differed if participants were required to rank the factors in order of importance to footwear guideline development. Considering that 63% of students and 84% of parents indicated that school guidelines are important to footwear choice, a greater understanding of footwear guideline development may better support their decision making.
Lower limb pain was commonly reported by participants in this survey, specifically at the knee and foot. Musculoskeletal pain of the lower limb is frequent in adolescents (3) and, according to the results of this study, may be influenced by shoes worn to school. Shoes are considered important to the prevention of running related injuries by adults (15). Running biomechanics, foot function, and balance can be influenced by shoes worn in adolescents and children (7, 9). Footwear with elevated heel heights and stiff midsoles have been shown to elevate knee joint loading in adults and adults with anterior knee pain (36, 37). However, there is no prospective evidence that demonstrates the effect that footwear has on pain and/or injury risk in an adolescent cohort (38). Recommendations from healthcare practitioners were not considered very important by most participants included in this survey. Considering that school shoes are the most common shoe worn by adolescents during the school week, identifying the effect that recommended school footwear may have on musculoskeletal health and lower limb biomechanics is needed.