Finding the right fit
Medical student spearheads study to gather data on foot measurements to help people with Down syndrome
Whether at home in Miami or traveling abroad, brothers Michael and Connor Griffiths enjoy spending time in the outdoors with their family.
Photo courtesy of Connor Griffiths
Nov. 20, 2024 — Growing up, Connor Griffiths was keenly aware of the impact shoes make on quality of life.
While on hiking trails during family trips to the mountains of Canada, he would watch his older brother, Michael, who has Down syndrome, fill with joy from being immersed in nature. And on the flip side, though Michael would never complain, Griffiths would see the blisters bubble up on his brother’s feet due to walking in ill-fitting sneakers that couldn’t properly accommodate his shorter and wider feet. The family learned to adapt, shortening hikes and spacing out activities to give Michael a much-needed break, but Griffiths often wondered if a better solution existed.
Now a first-year medical student at the University of Florida, Griffiths is spearheading a study to gather data on foot measurements of people with Down syndrome, who tend to have wider and shorter feet than others.
Though foot measurement data exists for children with Down syndrome — which affects about 5,700 babies born in the United States annually — it is more difficult to find for adults. Griffiths’ goal is to share this data with shoe manufacturers to demonstrate a need for additional shoe sizes and the commercial viability of mass-producing them. On the academic side, he also hopes to encourage future research to serve people with Down syndrome.
The first step
During his undergraduate studies at Florida, Griffiths and his younger brother, Blake, came up with a plan to design a custom shoe for Michael. Though custom shoes created by shoemakers are available, they can be cost-prohibitive, Griffiths said, and they don’t always fit extra wide feet.
From the family’s home in Miami, Griffiths got to work making a 3D model of a midsole — which he used to create a plastic mold for a foam midsole — while Blake focused on making the fabric components. Through much trial and error, the brothers realized the midsole foam just wasn’t working the way it needed to: The coloring was off, it was too porous, and the consistency didn’t feel right compared with normal shoes.
“We didn’t know the ins and outs of shoemaking,” Griffiths said. “We realized a lot of other people with Down syndrome are in a similar situation as Michael, and to help more people than just him, custom-making shoes on our own wouldn’t be feasible.”
Clockwise from left: The 3D printed shoe midsole that was used to make the mold for the custom shoe the brothers worked on; the midsole foam after it set in the mold; and the fabric that Blake made for the custom shoe.
Photos courtesy of Connor Griffiths
A foot in the door
Shoe production on a commercial scale typically begins with a mold created from costly materials, which means companies need to invest a few thousand dollars to make each mold, Griffiths said.
“You have to order at least 200 shoes, for example, for companies to put in the work of making a new mold,” he said.
Michael wears the new Hitchcock Shoe size while on a family hiking trip.
Photo courtesy of Connor Griffiths
Once he realized that making shoes on his own was not the answer to helping his brother or others facing similar obstacles, Griffiths pivoted from designing 3D models on his computer to reaching out to shoe manufacturers around the world.
That’s when he heard from Thomas Bright with Hitchcock Shoes, a family-owned business in Massachusetts that specializes in making wide shoes. Instead of creating new molds, the company began with small-scale production, using an existing mold of the smallest, widest shoe they offered and adding fabric to keep the sides of the foot contained.
“They altruistically agreed to help make a couple of sizes for the Down syndrome population — size 5 6E and size 5 8E — the shortest, widest sneakers available, based on my research,” Griffiths said.
These days, Michael wears the size 5 8E option from Hitchcock Shoes, which has made a significant difference in his comfort and has minimized the formation of blisters.
Still, Griffiths knew an even better solution was within reach. Through discussions with Bright, he learned that, if data — such as the circumference of the ball of the foot, the foot length, and the width of a large swath of people with Down syndrome — were available, shoe companies could better determine which sizes would be most commercially viable.
From left: The first Hitchcock Shoes sneaker Michael wore, showing how wide his foot is relative to the shoe, demonstrating the need for a wider size; The size 5 8E sneaker Hitchcock Shoes produces that Michael now wears.
Photos courtesy of Connor Griffiths
A measured approach
Griffiths decided once again to take matters into his own hands, launching a research project to collect data on foot measurements of adults with Down syndrome. He contacted faculty members around the UF Academic Health Center and was put in touch with Mark Bishop, P.T., Ph.D., FAPTA, a professor in the Department of Physical Therapy at the College of Public Health and Health Professions. Bishop demystified the research world for Griffiths, outlining the steps to get his study off the ground.
“Connor is very determined,” Bishop said. “It was obvious he had thought a lot about the topic, done quite a bit of research, and had thought about how he could contribute. Everything was so close to fruition, but he was running into some regulatory barriers — not to collecting his information but to publishing and disseminating it to influence shoe design.”
Bishop served as a mentor to Griffiths, walking him through the Institutional Review Board process required for research studies at UF.
After the project was approved in December, Griffiths looked into leveraging 3D foot scanners to provide consistent measurements and reviewed existing literature to find large-scale studies on foot sizes. He spoke with Ales Jurca, an expert in Sweden who had published a major paper on the topic, and was able to borrow a 3D scanner from his company for one year to conduct his study in Florida.
Connor, Michael and Blake Griffiths.
Photo courtesy of Connor Griffiths
Since receiving the scanner in January, Griffiths has traveled solo around the state — from Miami to Orlando and cities in between on weekends and during breaks in his busy medical school schedule — to visit facilities that provide continuing education and employment training for people with Down syndrome. He aims to collect foot measurements from about 150 participants by December and has nearly hit his goal, with about five sites left to visit and about 40 participants needed.
Once the data is collected, Griffiths will get back in front of his computer to churn out a paper, co-authored by Bishop and Jurca, and get it ready for publication and dissemination.
“Hopefully scientists will see, based on the results, that these foot sizes are shorter and wider than normal,” Griffiths said. “There used to be only six measurements available, and after this study there will be 150, which will hopefully demonstrate the need for an even bigger sample size and the need to expand the study.”
For Griffiths, his biggest hope is that his efforts can help Michael and others with Down syndrome stay active and be more comfortable while participating in activities they love.
“Think about finally having shoes that fit you — or imagine always wearing shoes that are too long for you or don’t fit properly,” Bishop said. “If Connor can convince one or two shoe manufacturers to modify their designs or incorporate his measurements, he will impact the quality of life of people with Down syndrome.”
