CHILDREN FOOT HEALTH
A Guide to Children Shoe Fitting
Most children learn to walk at about the time of their first birthday, although some learn months earlier or later. As your child begins to walk, you may have your first questions about what shoes he or she should wear. A growing child will need new shoes frequently and more questions will arise.
You should ask yourself the following questions when selecting your child’s shoes:
- How does the shoe fit?
- How is the shoe made?
- Is the type of shoe appropriate for your child’s age?
Pay attention to the shoe’s proper length, width and depth when fitting your child’s shoe. Poorly fitting children’s shoes can cause toe problems, ingrown toenails, hammer toes, calluses and bunions. Children’s feet grow in spurts and they require new shoes every three to four months. Most early toddlers (under 16 months of age) grow more than one-half a foot size in two months. Toddlers from age 16 to 24 months grow an average of one-half a foot size every three months. The young child, 24 to 36 months old, grows approximately one-half a foot size every four months, and children over 3 years of age experience increases of one-half a foot size every four to six months.
Remember, shoes should be comfortable from the start. If new shoes need to be “broken in,” it means either they were not properly designed or not properly fitted for your child’s foot.
Shoes consist of four parts: the upper part, the insole, the outer sole, and the heel.
The upper part of the child’s shoe should be made of leather, canvas, or the newer mesh materials. Children’s feet perspire greatly, and the upper part of their shoes should be made of breathable materials. Leather or canvas allows the foot to breathe. Avoid man made material, such as plastic.
Make sure the insole is made of absorbent material. You may want padded insoles. Most children do not need a special arch support. All toddlers younger than 16 months have flat feet and only fully develop an arch by the age of 6 to 8 years.
The outer sole provides traction, cushioning, and flexibility to the shoe. Some very sticky and thick outer soles can make young children clumsy and cause falls and should be avoided.
Toddlers do not need heels on their shoes. Flat outer soles make it easier to begin walking. Older children can wear shoes with heels, but they should not be too high (bigger than one inch) as this can cause the foot to slide forward, cramping the toes against the shoe
The Appropriate Shoe
Certain types of shoes are appropriate for your child’s age.
Babies and crawlers do not need shoes. They only need booties, warm wide socks to keep their feet warm, or pre-walking shoes that do not bind their feet. The shoe should be flexible rather than providing a rigid support, and it’s very important that the shoe be shaped like the child’s foot.
Your child can go barefoot in a protected environment such as indoors.
Shoes for toddlers, age 9 months to 3 years, should allow the foot to breathe since their feet perspire a great amount. Avoid synthetic materials that don’t breathe.
For children 9 to 18 months, choose a high top shoe which will stay on the foot better than an oxford or a low top tennis shoe. A leather or canvas tie shoe is more secure, will stay on the foot, and will fit fat little feet better. The sole of the shoe should be smooth like the palm of your hand. A smooth sole means less friction so the shoe won’t grab the floor, possibly causing your child to fall. Choose a light-weight shoe, since children use a lot of energy walking at this age. Toddlers can go barefoot in a protected environment such as indoors.
School-Age Children’s Shoes
Style and shoe fit is important for school-age children. At this age, they can choose from a variety of options including athletic shoes, sandals, hiking shoes, etc.
Look for reasonably priced, flexible, well-ventilated shoes that allow plenty of room for growth. If you have a great deal of difficulty finding shoes that fit, or if your child develops calluses, sores, or other foot problems, consult your physician.
During the first several years, your child’s foot continues to take shape. At this time, problems such as flat foot or high arch may become noticeable, but usually no specific treatment is necessary. If severe, these problems may be symptoms of other, more serious conditions and your child may need a physician’s examination and diagnosis.
Children foot health
The foot is a complex structure of 26 bones and 35 joints, held together and supported by scores of ligaments. A baby’s foot is padded with fat and is highly flexible. Children begin to walk anywhere between eight and 18 months of age. Most toddlers are flat-footed when they first start walking, or tend to turn their feet inwards, because of poor muscle tone and weak ligaments in their feet. This will improve as the feet strengthen. Always see your podiatrist or doctor if you are concerned about your child’s feet or gait
A child learning to walk receives important sensory information from the soles of their feet. Shoes, particularly those with hard and inflexible soles, can make walking more difficult. Your toddler doesn’t need shoes until they have been walking for a couple of months, and then only to protect their feet from sharp objects. It is important to allow your child to go barefoot regularly to help them develop balance, coordination and posture. Have your child’s shoes professionally fitted, which should include measuring each foot for length and width. Children’s feet grow very quickly and their shoe size may need updating every few months. Shoes that are too tight can hamper your child’s walking and cause problems, such as ingrown toenails and bunions.
Suggestions for shoes
Shoes for your toddler should ideally have features including:
- Firm, comfortable fit both lengthways and width ways
- Rounded toe
- Plenty of room for the toes
- Flexible, flat sole
- Heel support
- Laces, straps or equivalent to prevent excessive movement or slipping of the foot inside the shoe
The sole of a normally developed foot has an arch, called the medial arch, formed by muscles and ligaments. For the first two years, your child’s feet will seem to have fallen arches. Flat feet are normal in a young child due to weak muscle tone in the foot, a generous padding of fat, and loose ankle ligaments that permit the foot to lean inwards. As your child masters walking, the ligaments and muscles will strengthen and the fat pads in the arch area won’t be so noticeable. By around five years of age, your child should have normal arches in both feet.
Many toddlers walk ‘pigeon-toed’, with either one or both feet turned inwards. In most cases, this is simply a sign of developing posture and balance, and should resolve by itself (without the need for medical intervention)somewhere between the ages of three and five years. However, if the in-toeing is severe, seems to involve the leg and hip as well as the foot, or isn’t improving by the time your child is around one and a half to two years of age, see your podiatrist for assessment. Excessive in-toeing may be caused by a variety of underlying difficulties,such as hip joint problems.
Feet that turn outwards
Very occasionally, toddlers walk with their feet turned outwards. This tends to be more common in children who were born prematurely. In most cases, out-toeing resolves by itself as posture and balance matures, but see your podiatrist if you are concerned.
- Abnormally shaped toes
- Ingrown toenails
- Bunions or other deformities
- Stiffness in the foot
- The child complains of pain while walking
- Severe in-toeing or out-toeing
- Flat feet beyond the age of five years
- A sudden change in the way your child walks
- If your child isn’t walking at all by two years of age.
Where to get help
- Your doctor
- Maternal and Child Health nurse
Things to remember
- Most toddlers are flat-footed when they first start walking because the muscles and ligaments of their feet are underdeveloped.
- Toddlers should go barefoot as often as possible to encourage balance, posture and coordination.
- See your doctor or podiatrist if you are concerned about your child’s feet or gait.
Pediatric Flat feet Advice and Management
A flatfoot deformity is where the arch on the inside border of the foot is more flat than normal. Flatfoot deformities can occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these children have pain related to their flatfoot deformity throughout their lives. It is very important that children with flatfoot deformity be evaluated by a podiatrist to determine if they need treatment to prevent future pain or deformity in their feet.
When the young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.
At the ages of two and three, the child’s foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. The reason that it is important to have the feet examined at this age is because the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.
The flatfoot deformity in children causes a number of changes to the structure of the foot which is easily recognizable by the trained podiatrist. Flatfoot deformity causes the inside arch to be flattened, causes the heel bone to be turned outward, and causes the inside aspect of the foot to appear more bowed outward than normal.Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity.
Since the flatfoot deformity causes some instability of the foot during gait, children with flatfoot deformity may have complaints in the foot such as arch, heel or ankle pain which is generally associated with increased standing, walking or running activities. However, since the excessive rolling inward of the arches of the foot also make the leg and knee more turned inwards, children with flatfeet may also complain of pain in the low back, hip, knee, or leg due to the abnormal mechanics of the foot which is created by the flatfoot deformity.
As mentioned above, the pediatric flatfoot deformity can be diagnosed at a very early age, but is unlikely to be properly diagnosed unless the doctor is a foot specialist, like a podiatrist, and is familiar with the intricacies of the structure and biomechanics of the foot. After speaking with the parent and child, the podiatrist will examine the foot both while the child is not bearing weight but also while the child is standing, walking or running. Often, the family history is also taken since the foot should be examined closely if the child has a close relative who had a painful flatfoot deformity as a child or adult.
During the examination of the child, the podiatrist is looking for abnormal structure or function of the foot and lower extremity, which could lead to either problems during childhood or adulthood. X-rays may be taken of the foot if a significant pathology is noted or suspected. The more severe the flatfoot deformity and the more significant the complaints in the foot or lower extremity, then the more likely the podiatrist will recommend specific treatment for the flatfoot deformity.
If the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by the podiatrist. If, however, the child has a moderate to severe flatfoot deformity and does have significant symptoms in the foot or lower extremity, then treatment is indicated.
Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics. Functional foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child’s symptoms worse.
If the child has a severe flatfoot deformity and disabling symptoms which does not respond to foot orthotics, shoes and/or stretching, then foot surgery to correct the flatfoot deformity may be indicated. Flatfoot surgery is done only rarely for those children with the most severe deformities. Of course, the benefits of the surgery should be considered along with the risks associated with the surgery and a second surgical opinion is always recommended when considering flatfoot surgery on your child.