Today we're happy to feature a guest blog by Dr. Anna K Weber, DPM. Dr. Weber is a respected pediatric podiatrist, local mom, and one of our favorite people! Her suggestions match perfectly with our fitting philosophy. We could think of no one more qualified to give medically sound advice on children's foot and shoe needs. She will be at our store on February 4th from 10am-noon to give FREE pediatric foot screenings and advice. Until then, here's her take on kid's foot health and good fitting shoes.
There is some controversy regarding the role of shoes in the early development of foot function. When I was a kid in the 70s and early 80s, there was no debate. You just wore saddle shoes, a new pair every year. Now, with so many brands and styles to choose from, it can be confusing for a parent to know which shoes are best for their kids. Below are some helpful guidelines that shed some light on this often confusing topic.
Pre-walkers, Early Walkers and Toddlers – The Importance of Fit and Function
One thing that’s important to remember is that children’s feet are in an important stage of growth and development. They do not yet have hard, solid bone, but rather a relatively soft cartilage that is the precursor to bone formation. Their feet are soft and pliable. For this reason, it is extremely important to avoid tight or ill-fitting shoes as they can actually cause the feet or toes to deform. Additionally, tight fitting shoes can cause ingrown toenails even in pre-walkers and beginning walkers. There should be plenty of room for the child to wiggle his or her toes within the shoes. Another good “rule of thumb” is that there should be a thumb’s-width space between the end of the toes and the tip of the shoe. At this stage of rapid growth, feet should be checked every 2-3 months.
Studies have shown that children’s feet actually develop best when they are barefoot; however, their delicate, tender skin needs to be protected from environmental elements. To resolve these conflicting requirements, good early walking shoes are intentionally designed to mimic barefoot walking. They should be flexible, soft and lightweight. They should not have any arch support or heel height. Unlike adults, growing children need a flat-soled shoe to allow their feet to strengthen and their arches to develop naturally. Severe or pathologic flatfoot is one exception to this rule and is discussed briefly below.
Pre-school and Beyond
Once children are up and running, and as their gait evolves into a more mature “heel-to-toe” pattern, their shoe requirements will gradually change. They can still safely use a lightweight and flexible shoe, but it is also now safe (and often preferred) to use a firmer shoe or an athletic style shoe. The same rules apply with regards to shoe fit. At this stage, foot size should be checked every 4-6 months, and there should still be ample room for growth at the end of the shoe.
During this stage, it is also important to keep an eye on the shape of the shoe, as children’s shoe trends tend to push towards more stylized shapes that are not as well suited for healthy development. The shape of the shoe is determined by the last which is the model from which the shoe is made. Straight-last shoes are desirable at this stage, as a curved last (one in which the fore part of the foot is angled inward with respect to the heel) can force the unformed foot into an in-toed position. The shoe should also have a rounded, roomy toe box, allowing the feet to develop in a natural and unrestricted fashion.
A Word about Flat Feet
Flat feet are absolutely normal in infants. During the first 1-2 years, the arch is immature and undeveloped, and there is also a normal fat pad which obscures the arch. As the child grows and develops, so too do the muscles, tendons, ligaments and bones, until by the age of five or six, an arch should be apparent. Moderately flat feet at this age still often develop proper arches as the child progresses through adolescence and into adulthood. Deciding which flat feet are severe enough to warrant further evaluation can be a difficult decision. If a child seems to have unusually flat arches, complains of pain, or limps during activities, they should be evaluated by a pediatric foot and ankle specialist. Depending on the severity of the flat feet, custom insoles (orthotics) may be recommended. This is also one instance in which a more rigid and supportive shoe with a more stable base of support may be indicated. Additionally, arch support within the shoe may be recommended for the painful or severe flat foot. A good foot and ankle specialist knows the importance of shoe gear in this patient population and will recommend that the child visit a specialty shoe store for assistance with shoe selection.
The Importance of Shoe Fitting
The importance of proper shoe fit cannot be overemphasized. Remember that pre-walkers through toddlers should have their foot size checked every 2-3 months. From about the age of three, foot size can be checked every 4-6 months. Once the foot is measured, there is still variability in sizing. Shoe fit should be checked for proper length and width. With the child standing, there should be a thumb’s-width of length between the end of the toes and the tip of the shoe. There should also be room to insert your little finger between the child’s heel and the counter of the shoe. This will ensure that there is room to grow, as the foot grows backward as well as forward. The widest part of the foot is across the ball of the foot. Shoes should be checked to make sure there is no bulging in this area, which would indicate tightness.
For all age groups, shopping at specialty stores goes a long way towards keeping feet healthy and preventing problems. A specialty store will carry a wider selection to accommodate different shapes and sizes. Experienced shoe-fitters can help guide you to the best fit for your child’s growing and developing foot.
Dr. Anna Weber is a podiatrist that treats pediatric foot and ankle conditions in Denver. She has volunteered on medical mission trips to El Salvador, where she and a team of surgeons treat children with severe foot and ankle deformities not commonly seen in the U.S. She has also trained with the late, renowned orthopedist Dr. Ignacio Ponseti and utilizes his casting technique for the treatment of pediatric clubfoot. She has recently relocated to Denver from Chicago and is happy to have found Little Feet for her patient’s (and her own children’s) shoe needs. Dr. Weber can be reached at annakweber@yahoo.com for any specific questions you may have concerning your child's foot health.