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I am not a podiatrist but i hope that you will oversee whith that and advice me in an important matter. The foot health site is hardly the right forum since it is not about some personal foot problem but a professional matter.
I am a Swedish nursery teacher, working whith children from fifteen months untill they go to school at the age of six.
The matter is shoes. I argue for letting the children go barefoot inside and in the playgarden (when its warm enough, of course) and that it will hurt their feet to allways be forced to wear shoes. In Sweden, the nurseries have very diversing policies about it. But I, having worked in many nurseries, find that the majority does not allow the children to go barefoot outside and very many tries to have the children use shoes all the time even inside. In some places, the shoes should be extremely ill-fitting before the children are allowed to take them of.
The reason they give is the risk of catching a cold if going barefoot inside and the risk of hurting their feet on sharp things outside. In my opinion, glass in the play garden should be cleaned away and not used as a reason to force the children to wear shoes a year or more later! In Sweden, all children are vaccinated for tetanus so I do not really see the reason for fearing some stick or sharp stone if the children don’t fear it.
In Sweden, most nursery-gardens have sand, grass, shrubbery, asphalt and, if lucky, some little piece of natural ground.
What are you professionals saying about it? Am I totally wrong and it does not really matter as long as the shoes are well-fitting? What should good shoes be like?
Or am I right and should go on pushing for letting the children go barefoot? Then I need some professional references. Is there any medical research that I could learn from?
I would have to say that it is not impossible for a person to catch a cold whilst walking barefoot indoors however the two events would not be related to one another.
The issue of shoes and children is not without controversy. However, the rule of thumb has always been that children should start wearing shoes when they start to walk independently (that is, not holding on to furniture etc). One of the reasons behind this is that it is very difficult to correctly fit shoes until the feet become truly plantargrade - until then their feet tend to be a chubby ball shape that is hard to accurately measure and fit.
Once walking, shoes offer protection and some stability - although the foot should function fine without them. The aesthetics of shoes often become the more important force behind the decision to use them. We have this idea that young feet 'need' them. But, in the absence of potential dangers (such as glass on the ground), or extremes of temperature, it is fair that children could probably get away without shoes, (assuming they do not need any specific intervention which requires footwear).
Perhaps the most important issue is that of fit. A badly fitted shoe may indeed have the potential to cause damage (although this has never actually been proven, there is some research going on in Sydney to investigate this issue). My experience with children and shoes (I have worked with schools and children's shoe manufacturers) indicates that in general the quality of shoe fit is very poor. This may arise because:
(a) the shoes were incorrectly selected for size, fit and style initially
(b) the shoe no longer fits the foot
(c) the shoe has been destroyed by inappropriate wear
In regards to point (c), this is commonly seen in the older child who chooses not to unlace and relace shoes, but forces the foot in to a pre-tied shoe, thus destroying the heel counter and stretching the upper.
So - should children be required to wear shoes? Yes - if it is needed for protection, but otherwise I do not believe so. And most of all, when children are wearing shoes, they really do need to be well made, appropriately styled and correctly fitted.
There is pitifully scarce literature on this subject, so if anyone can come up with some I'd be delighted to hear of it! Most research is based on orthopaedic footwear as a treatment intervention, there is not much on the healthy foot and shoe.
cheers,
Felicity
The Following User Says Thank You to Felicity Prentice For This Useful Post:
I'm no professional, but I agree that I think children should be wearing shoes if they are walking on their own, otherwise, why weigh down their feet? I doubt theres any chance for harm if they are just wearing them, but if you are worried about them getting their feet cold, you can let them wear socks or booties. I know when I have kids I will probably be just like you and worry about every little thing.
__________________
"A man who knows nothing and knows he knows nothing knows more than a man who knows nothing but thinks he knows something" ~Socrates
I haven't go the references on me, but i know of studies showing populations such as some in the third world who have a far superior foot structure than us in western society who live in shoes. I believe shoes are good for protective purposes.... in todays society who knows what is left in streets etc,.... however i think shoes are not a necessity otherwise.
Just my 2 cents.
__________________ My karma ran over my dogma .....
No shoes for children. Unless they walk on sharp lava, dirty streets, or are going to a wedding. In Kindergarten, first grade - certainly not. Shoes are for protection from sharp objects, fashion, comformity or orthotic necessity. Children need only heed the demands of the first. Anyone who says otherwise is certainly selling something. That's dogmatic, but I believe it sincerely.
Ok, I ignore shoes unless my own children need to go outside-protection.Yes, i put socks on the toddler until he fell in love with shoes about age 18 months because big brother has them and my toddler has a love for order-personality issue. I find most mothers struggle to put a shoe on in warm Australia, and we devise a plan and lots of adult and friends reinforcement if feet intoed for example, and need orthotic treatment.
In short- socks are great for cold, shoes are for protection.
>Is there any medical research that I could learn from?
No.
The establishment's legal duty of care would support all necessary protection is undertaken with patrons whilst on private property. To reduce liability shoes may be a protective mechanism considered essential by the owners and hence this becomes a condition of entry. To not comply would debar you from the group. The same thing is seen in public access to privately owned spaces such as shopping malls where barefooted people are prevented from entering. There is no reason for this other than trying to prevent certain people (usually lower social economic types) from mixing with middle class clientele who use the premises. This bias against barefeet was evident in ancient Rome and sumpuary laws (legislation what certain people can or cannot wear) throughout history.
Conventional wisdom would support the vast majority of the population can go unshod until the femur derotates (about 7 years of age), but convention determines (expensive) shoes are worn. As Felicity outlined, fit and suitability to activity are critically important for the growing foot.
Kathy Stansfield calls herself the “queen of baby shoes.”
The Wrightsville Beach mom goes ga-ga over the Pediped line – Mary Jane booties with pink cheetah fur, sparkly ruby slippers and metallic pink shoes with little star cut-outs across the toe for $30 a pop.
“Oh, my God, they’re too cute. Too cute,” she said, laughing.
A shoe-lover herself, Stansfield doesn’t mind spending a chunk of change on stylish footwear for her little ones. Her most expensive purchase: $136 for a pair of Dutch maker Oilily shoes.
But they were for her 2-year-old daughter, “so it’s okay.”
Stansfield knows she’s not the only parent who finds today’s baby and toddler shoes so irresistible. Visit upscale boutiques or online stores like Zappos.com, and you’ll find that little kids’ shoe collections are starting to rival Mom’s – both in style and price.
Designers from Ralph Lauren to Dolce & Gabbana are coming out with lines of infant and toddler shoes. And with the prices they charge, baby shoes these days should maybe be dipped in gold, not bronze. At Nordstrom.com, a pair of Dolce & Gabbana metallic pink high-tops cost $215. At Zappos.com, a pair of sequin-encrusted leather “Disco Tex” ballerina shoes from Roberto Cavalli sell for $179.99.
Even retailers like Old Navy, Target and Payless have gotten their low-priced, high-style feet in the door. Payless, for example, recently unveiled a designer line of toddler shoes by Lela Rose for people with primo tastes but not primo bank accounts. Her Little Lamb Captoe Bootie, made of chocolate suede leather with pink ribbon accents and velcro, costs $17. (Payless stores in Wilmington have yet to carry Rose’s collection.)
Swedish shoemaker Hanna Andersson makes buying for baby a little easier with matching toddler and mommy clogs. Most toddler clogs cost about $50, with the mama version just $10 more....
Plus, just about every reputable retailer and shoemaker, not to mention podiatrist and pediatrician, will tell you that barefoot is best for baby, even as he or she starts walking.
That’s because the foot and its muscles develop through the preteen years. They do it best without restrictions, said Marlene Reid, a podiatrist and spokeswoman for the American Podiatric Medical Association. Toes and soles also need a free range of motion for a baby to learn how to grip and balance....
We often get parents and grand parents coming to us for footwear, as junior has taken the first steps, we tell these people to go away and come back in 2-3 months or when the little one is walking with hands down near waist level, meaning they have true balance and gait, hands at chest level means they are still finding balance and have a side way action in their motion with the head tilted forward.
We suggest good socks with the little rubber dots on for grip whilst inside, as for outside we always suggest in their own yard at least (where it is grassy, clean and tidy?)bare foot is great.
As for third world children not using footwear and having better foot structure, are they walking on concrete all day at school? Most of our children do.
Rules and insurance insure that most children need to wear footwear these days, the foot needs exercise, this can be achieved with a mixture of different footwear (last shape,heel height and style ect.) and bare foot activity, unless they have a foot/ lower limb pathology that suggest otherwise
The Herald-Argus are reporting: If the shoe fits ... It's more than 'Baby needs a new pair of shoes' when you ask the shoe experts
Quote:
Stephanie Lewis of La Porte knows how to keep shoes on her children’s feet.
Her three sons, Alex, 5, Chase, 3, and Cameron, 1, were all in for a fitting recently at Magro’s Family Shoe Store, 1806 Franklin St., Michigan City.
But how does a parent find the right shoes for each stage of a child’s life?
Ask a pedorthist.
“(The foot) will grow straighter as long as it has guidance,” said John Magro, a certified pedorthist at Magro’s.
Children need the proper shoes usually between 6 and 14 months, depending on when the child tackles the world from a taller perspective, he explained.
“Our philosophy is that if they are younger and they are crawling, any foot covering is fine,” Magro said.
Once babies start walking, the booties that come with many infant outfits are pointless because they do not offer the needed support.
“We recommend in the house (to wear shoes) all the time (because) when they are growing they need support,” Magro said.
Within the first year, a baby’s feet will grow approximately one-third of its adult size, said Dr. David Olson, a podiatrist for 35 years.
“That’s the reason we have you not wear shoes (before they are walking) because the foot grows so fast you don’t want to stunt their growth or cause blisters,” explained Olson, whose practice is located in La Porte.
When Lewis’ children started “cruising” the furniture and walking behind toys that offer support, she put them in shoes.
“Shoes are really annoying on those who crawl most of the time,” Lewis said, referring to the unbendable materials in some shoe soles.
The doctor recommends lightweight shoes with higher tops for more ankle support.
“You can get a nice leather shoe that’s thick and comfortable and does not drag like a tennis shoe,” Olsen said.
When they started walking, Lewis said she has learned not to buy generic brands because they do not hold up as well as name brands.
“I like to know he has the support he needs,” Lewis said, referring to her youngest son, who has been experimenting with his balance.
Magro offered two tricks for putting on shoes: tickle the pressure point on either side of the top of the knee because it causes the child to relax, or pull the toes of the sock over the top of the foot to straighten out curled toes.
It can also be difficult to tell whether a baby’s shoe still fits since the child cannot say so. Olson advises turning the shoe upside down and placing the foot on the back of the shoe to see where it falls.
This was missed earlier in the year. Its from April 2007, ConsumerReports.org Baby footwear: Lose the shoes
Quote:
Shoes complete the outfit for kids, but wait until your child begins walking--usually at 10 to 14 months--before buying her first official pair of shoes. That’s when a child really needs them. Jane Andersen, D.P.M., a spokeswoman for the American Podiatric Medical Association, recommends picking a first shoe with flexibility, which helps the foot develop its arch. “Try to bend the shoe in half,” she says. “If it bends easily, it’s a good shoe.” The best shoes also have traction on the bottom so your baby won’t slip easily. A shoe doesn’t have to be expensive to be flexible, but in Anderson’s shopping experience, the most flexible shoes are higher-ticket brands. In our opinion, that might include Merrell (available at www.shoes.com), Nina Kids (available at leading e-tailers such as www.zappos.com), Pediped (www.pediped.com), Stride Rite (www.striderite.com), and Umi (www.umishoes.com). And, adds Andersen, stores that sell higher-ticket brands generally have experienced sales help to make sure you buy the right size. You’ll want some room at the toe, but not so much that your child will trip. Also, keep in mind that toddlers kick off anything and everything, so look for flexible shoes that lace. They’re harder to take off than shoes with Velcro closures.
To keep your prewalker’s feet warm outside on cool days, look for soft, elasticized baby socks or booties that cling to the feet so your baby can’t kick them off. You don’t have to buy the leather baby shoes you’ll see everywhere, which can easily run you $25 per pair or more, and which your baby will outgrow quickly.
Is there any medical research that I could learn from?
From my PhD thesis: "Rao and Joseph (1992) compared arch height indices (AHI) in children who habitually wore shoes and children who had never worn footwear (1555 shod, 745 unshod). Static footprints were obtained using inked rubber mats. 154 children (6.7%) were diagnosed as flat-footed. A significantly higher prevelance of pes planus existed in children who wore shoes (8.6%) than among the unshod (2.8%) (p<0.001). This result supports the contentions of Didia ad Nyenwe (1988) who believed that shoewearing influenced the development of the medial longitudinal arch. Interestingly, Rao and Joseph (1992) also reported that 710 children displayed ligamentous laxity. The ratio of flat foot in children with ligamentous laxity was 14.4% compared with 3.35% in those who had no ligamentous laxity. The preponderance of flat foot also varied with the type of footwear worn. Rao and Joseph (1992) concluded that shoes which encased the toes were more detrimental to arch development than open-toe sandals or slippers and that the detrimental effects of closed-toe shoes were enhanced in the presence of ligamentous laxity."
__________________ Science is the antidote to the poison of enthusiasm and superstition
Press Release: Manufacturer-listed size for children's shoes seldom correct
Quote:
New research indicates that when it comes to children's shoes, the size listed by the manufacturer is rarely the true size. In nearly all cases, the manufacturers overstate the size, according to findings presented this week at the American Academy of Orthopedic Surgeons annual meeting in Las Vegas.
"The most striking finding of our study was that the majority of outdoor shoes and slippers of children were too small," senior author Dr. Norman Espinosa, from the University of Zurich, Switzerland, told Reuters Health. "Interestingly, the shoe sizes given by the manufacturers almost never matched with the true sizes measured by us."
Another interesting finding, he added, is that the prevalence of hallux valgus deformity among the children studied was higher than previously reported. "This is best explained by the fact that the incidence and prevalence of hallux valgus deformity among children could vary in different countries."
The results stem from a study of 248 school children from an area in Switzerland who had the inner length of their shoes, the length of their feet, and the hallux valgus angle measured.
The manufacturer-listed shoe size was converted into length in millimeters by multiplying the size by 6.67 millimeters. Perfect-fitting shoes were defined as those in which the inner shoe length exceeded the subject's foot length by at least 10 mm, with the ideal being 12 mm. Normal hallux valgus angles were considered as 15 degrees or less.
For outdoor shoes, 33.9% fit perfectly, 52.8% were too small, and 13.3% were too big, the report indicates. The corresponding percentages for slippers were 28.2%, 61.6%, and 10.2%.
Just 7.6% of outdoor shoes had a correctly stated shoe size. For 90.2% of shoes, the actual size was smaller than that listed by the manufacturer. The results were even more striking for slippers: only 2.4% had a correctly stated size and 97.6% were too small.
Overall, 3.3% of children had an abnormal hallux valgus angle.
When shopping for shoes, parents should have their children's feet re-measured by the vendors, Dr. Espinosa emphasized. "Based on this study we know that we should focus on education in order to prevent early onset of juvenile foot deformity."
How much do people think sensory feedback, as well as structure of the shoe (and therefore the possible requirement for decreased use of the intrinsic muscles to stabilise the foot with a structured shoe), plays in the development of the foot? If the patient is in a shoe with a smooth insole, it could be suggested that they don't get the sensory feedback from the floor that they would in barefoot.
Could that mean the foot adopts a more stable (pronated) position, to try to avoid inversion injuries/falling over etc.. Also, could the foot pronate more to try to increase the sensory input coming from the plantar aspect of the foot?
Should small children have shoes?
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