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Shoes for Children

Choosing good shoes for your children can be hard -- and not just because of the variety of cartoon characters that decorate kids' shoes. The design of the shoe itself can make a big difference to how your child's feet develop, and choosing the right shoe can make a difference in later life as far as foot problems are concerned.

The foot develops best in people who spend their entire lives walking barefoot. There are six advantages to walking barefoot:

• The forefoot (the front part of the foot) becomes more mobile and flexible.
• The plantar skin (the skin on the soles of the feet) becomes thicker and more resistant to minor cuts (although it won't protect against sharp objects, which is one reason people need to wear shoes in developed countries)
• The creases in the plantar skin, and the creases on the dorsum (top) of the feet, become deeper and more pronounced, which also improves foot flexibility.
• The phalanges (the bones in the toes) spread out more and become better aligned, which helps your balance.
• The arches develop as far as they need to for your height and weight. (There is no single good height for foot arches; the proper height depends on your body build.)
• People who always walk barefoot tend not to have corns, calluses, bunions, and fungal infections like athlete's foot, all of which are aggravated by the wrong kind of shoe.

The main reason why people wear shoes in developed countries is to protect the feet from hazards: these include both sharp objects (nails, for example) and the surfaces we walk on (there is no concrete in the wilderness), as well as objects that may fall on or hit our feet. (As another example, no one in their right mind works in a hospital barefoot.) The style issue is, or should be, secondary, but many modern shoes look like they are designed to create foot problems. In particular, shoes that raise the heel compromise gait and may hurt the ankle, and you are much more likely to develop corns and bunions with pointed-toe shoes. Shoes such as Birkenstocks (which, I admit, are just about the only shoes I wear at work) may look clunky to some people, but they are shaped much more like the foot than most "stylish" shoes -- and they do come in children's sizes.

When shopping for children's shoes, keep these things in mind:

• The shoe upper material needs to be porous to allow air to circulate. This prevents excessive moisture from accumulating, which would make it easier for both fungi and bacteria to grow. Canvas or soft leather, or perforated leather, are good materials for uppers; plastic is a bad material, unless it is thoroughly-perforated plastic mesh.
• The heel should not be elevated (see above). The only reason for elevating a heel is in people who have one leg shorter than the other: in these people the shoe on the short-leg foot needs to raise the foot so that the wearer effectively has two equal-length legs. Otherwise, high-heeled shoes are A Bad Idea.
• The front part of the shoe should be wider than the heel. This matches the natural shape of the foot and allows the toes to spread out. As I mentioned above, pointed-toe shoes are also A Bad Idea (and pointed-toe, high-heeled shoes are An Even Worse Idea).
• There should be from 1/2 to 1-1/2 centimeters (about 1/4 to 3/4 inch) of space between the end of the toes and the end of the inside of the shoe. (A good measure of toe room is Mom's thumb: there should be one Mom's-thumb-width of room at the front of the shoe.)
• There should be some support behind the heel. You don't normally have heel support when you walk barefoot, but it does come in handy when wearing shoes.
• The sole should be flexible to allow the foot to flex.
• The shoe should be lightweight. This lessens the load on the foot as well as the leg and the rest of the wearer.
• The sole of the shoe should be textured or patterned to give the wearer some traction on slippery surfaces.

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Copyright © 1998, 2006, 2007 Vinay N. Reddy, M.D. All rights reserved.
Written 04/08/98; last revised 05/07/07