As the school year progresses here in the Greater Phoenix Area, it's easy to overlook the daily burden our children carry – literally! While we often worry about the weight of textbooks on young backs and shoulders, recent scientific studies are shedding light on a critical, often-missed connection: how heavy school backpacks significantly alter a child's gait and impact their delicate foot health.
As a pediatric sports podiatrist, I've seen firsthand how these daily loads can contribute to foot and ankle pain. Now, a trio of compelling new studies, including a systematic review, provides even stronger evidence, emphasizing why parents need to be vigilant. At Arya Foot & Ankle, we are committed to educating the community on these important health matters. Let’s get started.
The Science is In: Backpacks and Their Impact on Your Child's Walk
Three recently published articles, set to appear in 2025, offer crucial insights into this issue:
- Agarwal et al. (2025) - A Comprehensive Review: This systematic review meticulously analyzed existing research on how backpack carrying affects plantar pressure (the pressure points on the sole of the foot) and gait patterns in children. The authors concluded that backpacks indeed induce significant changes in gait kinematics and kinetics, affecting how children walk and the forces acting on their feet. This comprehensive overview underscores that the issue is widespread and consistently observed across multiple studies.
- Tomal et al. (2025) - Dynamic Gait in Young Children: This study specifically investigated the influence of backpack load on the dynamic gait parameters of 7-year-old boys and girls. Using advanced sensor technology, the researchers observed that increased backpack weight led to measurable alterations in how these young children moved. This means their strides, balance, and the way they propel themselves forward were all modified under load, placing different, often higher, stresses on their lower limbs.
- Laštro et al. (2025) - Activity Levels and Pressure Distribution: This research explored how carrying a school bag impacts the distribution of force and plantar pressure during gait, also considering children's physical activity levels. The findings suggest that backpack loads significantly alter how pressure is distributed across the foot during walking, potentially leading to specific areas of overload. This implies that different activity levels might influence how children compensate, but the fundamental impact of the backpack remains.
In essence, these studies collectively confirm that school backpacks are not just passive accessories; they are active agents that can modify your child's natural walking pattern and increase the mechanical stress on their feet.
Why This Matters for Your Child's Feet
When a child's natural gait is altered due to a heavy or ill-fitting backpack, a domino effect can occur:
- Increased Plantar Pressure: The research highlights that specific areas of the foot, such as the heel or forefoot, may experience abnormally high pressure. Carrying a heavy backpack can significantly contribute to heel pain in children, a common condition often mistaken for simple "growing pains." Unlike adult heel pain, which is typically due to plantar fasciitis, children's pain is more likely calcaneal apophysitis, or Sever's disease. This is an inflammation of the heel's growth plate, a sensitive area where the Achilles tendon attaches. When a child leans forward to compensate for a heavy backpack, the added stress increases the tension on the Achilles tendon, causing a continuous pull on the growth plate. This repeated strain can lead to inflammation and pain, making a proper diagnosis by a pediatric podiatrist essential to differentiate it from plantar fasciitis and ensure effective treatment. The increased plantar pressure can also contribute to metatarsalgia (pain in the ball of the foot).
- Changed Foot Pronation: The way the foot rolls inward during walking (pronation) can be affected. Excessive pronation, or sudden changes in pronation patterns, can strain the arch and ligaments, leading to arch pain or exacerbating underlying foot conditions.
- Achilles Tendon Strain: Compensatory leaning forward can increase the workload on calf muscles and the Achilles tendon, potentially leading to Achilles tendinitis – inflammation and pain in the heel cord.
- Balance and Stability Issues: Altered gait can reduce balance and stability, making children more prone to trips, falls, and ankle sprains, especially when navigating crowded school hallways or uneven playground surfaces.
- Long-Term Biomechanical Changes: Persistent alterations in gait during crucial developmental years could potentially lead to long-term biomechanical issues affecting not just the feet, but also the knees, hips, and spine.
Protecting Little Feet in Phoenix: A Pediatric Podiatrist's Advice
Understanding science helps us take proactive steps. Here's what we recommend at Arya Foot & Ankle given these study findings:
- Adhere to the 10-15% Rule: The "10-15% rule" is a widely recognized guideline that recommends a child's backpack should weigh no more than 10% to 15% of their body weight. This recommendation is based on a consensus among medical and professional organizations, including the American Academy of Orthopedic Surgeons. For example, a child who weighs 60 pounds should carry a backpack weighing no more than 6 to 9 pounds. These 3 studies underscore that exceeding the 10-15% limit can lead to poor posture, altered gait mechanics, and an increased risk of pain and injury in a child's still-developing spine and musculoskeletal system. Encourage your child to only carry essential items. Utilize school lockers if available, and consider digital textbooks where possible.
- Backpack- Proper Fit is Non-Negotiable:
- Always Two Straps: Ensure both padded shoulder straps are used and adjusted so the backpack sits snugly against the back, with the bottom resting above the waist.
- Waist and Chest Straps: If present, teach your child to use these. They help distribute weight more effectively and reduce sway.
- Smart Packing: Place the heaviest items closest to your child's back to maintain a stable center of gravity.
- Consider a Rolling Backpack: For particularly heavy loads, a rolling backpack can be an excellent alternative, completely eliminating the carried weight if allowed by their school.
- Listen to Their Complaints: Any consistent complaints of foot, heel, ankle, or even knee pain should be taken seriously. "Growing pains" are often misdiagnosed. If your child is experiencing discomfort, especially after carrying their backpack, it's time for a professional evaluation at Arya Foot & Ankle.
Don’t forget about your kiddo’s shoes! We see a lot of floppy shoes and Crocs…
REMINDER ON SHOE GEAR: Beyond a well-fitting backpack, the right footwear is a crucial foundation for a child's foot health. Stable shoes with good arch support and a firm heel counter are essential, as they prevent the foot from rolling inward excessively (overpronation), which is a key contributor to heel and arch pain. In cases where footwear alone is not enough, a pediatric podiatrist may recommend custom or prefabricated orthotic inserts that Dr. Arya can do inexpensive hand-modifications on. These inserts are designed to provide targeted support, correctly align the foot, and evenly distribute pressure, effectively reducing strain on the heel's growth plate and the Achilles tendon, and helping to manage conditions like calcaneal apophysitis and Achilles tendonitis.
By being mindful of backpack weight and fit, as well as proper shoe gear, can significantly reduce the biomechanical stress on our children's feet and help them stride confidently and pain-free through their school days here in Phoenix. If your child is experiencing foot pain, schedule an appointment with us at Arya Foot & Ankle today! We offer convenient in-house X-ray and ultrasound services, and we're open during lunch hours, on Saturdays, and most weekdays to accommodate your busy schedule.
Check out those article references here:
- Agarwal P, Sharma A, Rai RH, et al. Exploring the impact of Backpack carrying on plantar pressure and gait patterns in children: A systematic review. J Bodyw Mov Ther. 2025 Jun;42:875-884. doi: 10.1016/j.jbmt.2025.02.009. Epub 2025 Feb 11. PMID: 40325769.
- Tomal P, Fryzowicz A, Kabaciński J, et al. The Influence of School Backpack Load on Dynamic Gait Parameters in 7-Year-Old Boys and Girls. Sensors (Basel). 2025 Jul 6;25(13):4219. doi: 10.3390/s25134219. PMID: 40648474; PMCID: PMC12252491.
- Laštro D, Pilipović Spasojević O, Popović T. The effect of carrying a school bag, the distribution of force and plantar pressure during the gait of children with different levels of physical activity. Work. 2025 Aug;81(4):3258-3271. doi: 10.1177/10519815251330271. Epub 2025 Apr 24. PMID: 40270208.
Photo source: pexels.com
Author
Dr. Shylaja Arya
Dr. Arya is the owner of Arya Foot & Ankle, a podiatry practice that serves the greater Phoenix area with same day, Saturday, and lunch time appointments. She is a level 500 yoga instructor, tennis player, dog mom and shoe lover!
