What Experts Say
Shoes for children: a review.
Staheli LT.
Department of Orthopaedics,
Children's Hospital and Medical Center, Seattle, WA 98105.
1. Optimum foot
development occurs in the barefoot environment.
2. The primary role of shoes is to protect the foot from injury and infection.
3. Stiff and compressive footwear may cause deformity, weakness, and loss of
mobility.
4. The term "corrective shoes" is a misnomer.
5. Shock absorption, load distribution, and elevation are valid indications for
shoe modifications.
6. Shoe selection for children should be based on the barefoot model.
7. Physicians should avoid and discourage the commercialization and "media"-ization
of footwear. Merchandising of the "corrective shoe" is harmful to the child,
expensive for the family, and a discredit to the medical profession
Lisa C. Moore
Doctor of Chiropractic Auburn California
During foot development, it is important for bones, muscles,
blood vessels and nerves to have room to grow without restriction.
As the beginning walker stands up and takes his first tentative steps, the
muscles of his feet grip the floor and the toes separate to help the child have
better balance and control. If her feet are confined within a rigid shoe, the
toes cannot operate in this way, nor can the muscles of the foot and ankle
develop the strength necessary to hold her upright.
Throughout a lifetime, foot health depends upon the flexibility of the
structures involved. This begins in infancy and continues as we grow. If we wear
rigid shoes, the bones cannot move freely, resulting eventually in crippling
arthritis.
From a Chiropractic standpoint, spinal health is connected to
foot health. Inflexible feet affect all the joints above, including the spinal
column. Many times, pelvic imbalance originates in foot distortion such as
fallen arches or dropped metatarsal bones. Every step a person takes translates
into either stability or instability for all the structures above. This process
begins with that first step
Soft soled baby shoes allow the beginning walker to grip the floor, developing
strong ankles and flexible foot bones.
This
creates a solid foundation for bone and muscle formation in the rest of the
body, especially the spinal column. A level pelvis and straight spine depend
upon healthy feet through out our entire lives, beginning in infancy.
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Hartford Courant
independent expert, summer 2000.
"Please welcome a new
arrival to the list of obsolete wisdom for parents: Babies walk best in stiff
leather shoes.
Not true, say researchers at Connecticut Children's Medical Center who spent
months studying the way babies learn to walk. With the help of computer-assisted
foot pressure sensors and slow- motion video, researchers learned that, from
their first steps, babies walk with a rocking heel-toe motion, just like adults.
The findings toppled
the long-held conventional wisdom that the first steps are flat-footed stomps.
With that assumption, the stiff, high -topped baby shoe was born, designed by
shoe companies to support flat-footed steps and wobbly ankles.
But babies' ankles,
it turns out, are perfectly stable from the beginning, making the traditional
high topped shoe unnecessary.
The conclusion, said Sylvia
Ounpuu, a movement specialist at the children's medical center who directed the
study, is that barefoot is best for babies."
Footwear
for children
Community Paediatrics Committee,
Canadian Paediatric
Society (CPS)
Paediatrics & Child Health 1998; 3(5): 373
Reference No. CP98-02 (Formerly MS98-02)
Shoes are
selected for protection, not correction. Myths often confuse parents who are
buying shoes for their infants and children.
The Community Paediatrics Committee no longer accepts the old belief that a baby
must wear shoes soon after birth. Keeping a baby out of shoes in warm, dry
conditions is a good idea because walking barefoot develops good toe gripping
and muscular strength. Indeed, there is increasing evidence to suggest that
wearing shoes in early childhood may be detrimental to the development of a
normal longitudinal arch.
Until toddlers have been walking for at least a few months, the only purpose of
footwear is to protect the child’s feet and to offer some grip on a smooth
surface. For pre walkers, shoes are not necessary. Ankle boots do not
necessarily give more support than low-cut shoes, but are useful because they
are harder for children to remove. Shoes must fit the foot properly at the heel
and allow enough room for the toes, leaving about 1.25 cm between the
longest toe and the tip of the shoe, measured
standing up. This allows for sufficient movement of the toes and reasonable room
for growth. Never buy shoes unless the child is present to try them on.
Soft-sole footwear for protection and warmth is appropriate. For early walkers,
shoes provide better fit, stability and safety than sneakers. Used shoes that
have lost their shape should be avoided.
Corrective shoes are a misnomer and are rarely needed in
physically normal children. The appearance of the foot changes with growth.
Ninety-seven per cent of all children younger than 18 months of age present with
flat feet, due mostly to a fat pad under the foot. At age 10 years, only 4% of
children will still have flat feet. Children with mild or moderate flat feet
need no specific treatment or corrective shoes. They should not be restricted
from any physical activities. For severe flat feet, if accompanied by related
pains in the legs or knees, longitudinal arch supports, scaphoid arches, Thomas
heels and other orthotics may be tried.
Simple metatarsus adductus initially may be treated with passive stretching
exercises. If the metatarsus adductus is not reducible, meaning that the
forefoot does not return to a neutral position, splints and/or cast treatment in
early infancy may be required. In toeing with tibial torsion tends to improve
with age. Patients with persistent in toeing with tibial torsion leading to
functional impairment should be referred to a paediatric orthopaedic surgeon.
Children’s feet should be left alone as much as possible. Prescribing shoes to
attempt to ‘correct’ physiological flat feet, knock knees or bow legs is not
useful for the child and expensive for the family. Doctors can avoid over
treatment of mild to moderate variations by explaining this to parents in a
reassuring way.
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