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As children gear up for another summer, moms and dads will be looking towards new shoe purchases for school in the fall. The shopping cart will undoubtedly contain new shoes, shoes for gym and athletics and shoes for class. The “right” shoes should be purchased, but what is the “right” shoe? Price is certainly a consideration, but what else? Is an expensive shoe always the “right” shoe?
First, let’s make a distinction between healthy feet and painful feet. If a child’s foot is persistently painful, there is something wrong and this needs to be evaluated to determine what it could be. If a child’s foot is healthy and pain-free, then the goal of the footwear is to make sure that it stays that way. A second goal is to ensure that the foot develops properly.
Of greatest importance is fit. The shoe needs to be the right size and width. This is usually fairly easy to do with in any quality shoe store by an experienced clerk. Leave at least a ½ inch gap from the end of the toe to the end of the shoe. Using a fairly compliant upper, made from leather or other breathable expandable material is important.
Let’s take the question of foot development and shoewear first. Whether you believe in evolution or not, the foot is adapted to development in the absence of shoes. Our ancestors did not have the benefit of custom orthotics or advanced shoewear. Their feet developed without shoes or, at most, in moccasin-type shoes or sandals. A very interesting study was done by Drs. Rau and Joseph in India in 1992 evaluating the feet of children that grew up wearing shoes and those that did not. The rate of flat feet in the children that wore shoes was 8.6% while the rate in children that wore no shoes was 2.8%. If flat feet are considered an abnormal foot development, and this may or may not be true, then the best shoes for children are no shoes.
This is the U.S.A. and shoes are more or less required much of the time. The weather does not allow us to be unshod for many months of the year. Our children have also grown up with shoes and, therefore, their feet have adapted in very important ways to this. The muscles may be weaker due the lifelong usage of shoes and may not be resilient enough in many ways to be comfortable without shoes. We need to make our shoe wear decisions based on the amount of activity we are anticipating, what the feet have become accostumed to, and style.
If a low level of activity is anticipated, then nearly any shoe is appropriate. If long periods of standing, walking, or sports are necessary, the shoe should be snug enough around the midfoot and heel to avoid rubbing on the skin and have a heavier weight sole which protects the foot from motion by being stiff. One reasonable test to judge the stiffness of the sole is to grab the heel in one hand and the toe in the other and try to fold the shoe. If it folds easily, it will not protect the midfoot joints and small muscles in the foot from work. If the child is used to a high degree of activity and usually wears flexible shoes, then a flexible shoe may be reasonable. If the child normally wears tennis shoes, is rarely barefoot, or is unused to the rigors of athletics, then a firmer shoe may be more comfortable.
Like the muscles and bones the foot contains, the foot will develop resilience according to the amount of force that it is used to. Activity, and the affect the shoes have on the stress the foot is accustomed to, should be increased slowly to avoid overuse injuries. These simple principles are all that you need to ensure that gets the “right” shoes.
-Brett Fink, MD, Indiana Orthopedic Center, Indianapolis, IN, (317) 588-2663, co-author of The Whole Foot Book, A Complete Program for Taking Care of Your Feet.
Posted in Medical Tips and Pearls, Uncategorized
Tags: children, feet, foot, shoes
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