What medical doctors want every shoe retailer to know

Children’s footwear execs have pebbles and even hairs to thank for getting kids into shoes at a young age. Otherwise small children would be better off wearing no shoes at all, according to most medical experts. Barefoot is better, they say, because shoes often prevent children from walking in a way that’s natural for them.

Since most pre-walking and beginning walking children don’t necessarily need extra foot support, shoes for them are looked upon mostly as a method of protection. “You do have to be careful about the environment in the house,” says Glenn Gaftswirth, doctor of pediatric medicine and director of scientific affairs at the American Pediatric Medical Association in Bethesda, Maryland. “Even short hairs from a dog can irritate feet,” he says. And toes can easily be entwined with hair and thread.”

While most parents learned to walk in a tight, white demi-boot that came in one width and had a sole about as flexible as a sheet of plyboard, this type of shoe has been almost totally replaced by a broad selection of styles, offered in several widths and in flexible, yet supportive, uppers and soles. In fact, there are so many types of shoes for plantar fasciitis pain available for kids now that many parents are clueless about what they should look for when making a purchase.

Helping parents find the proper shoe for their child’s foot should be priority number one for every footwear retailer. There is definitely no place for an Al Bundy-type shoe salesman in the kids’ bootery. Retailers who know this best often require salesman to complete comprehensive courses on fitting before they are allowed to work on the floor. It’s considered a wise investment, because when a knowledgeable salesman can help a parent make a wise selection, that parent usually becomes a loyal customer, one who will come back frequently since a child’s foot can change sizes up to 34 times before the age of 10.

Medical experts contend that price and look aren’t the best selection methods; checking for quality and proper fit is. But signs of a quality children’s shoe aren’t always obvious to the eye. “The shoes need to be made of quality material, such as natural fibers or leather, so that the foot can breathe,” Gaftswirth says. “Vinyl tends to keep air from circulating and keep the feet from stying dry.”

Gaftswirth says that even patent leather–a very popular material for girls’ dress shoes–is not the ideal choice, because it also does not breathe. “Kids tend to sweat a lot, and perspiration can cause skin rashes and athletes feet,” he says. “Materials on shoes need to allow a good exchange of air.” Of course there are exceptions to acceptable materials for children’s shoes. “A lot of plastic and rubber shoes are designed to protect against the elements,” Gaftswirth says. “Boots should be water repellent, but it’s not the kind of shoe that’s worn on the foot all day in doors (so breatheability doesn’t become a problem).”

Additionally, vinyl and hard leather every-day shoes can cause pressure points on the foot, which can cause blisters or scratches, he says. That’s not to say that children don’t need tennis shoes for bunions that are sturdy enough to give them ample support. “One of the first things retailers should advise is a shoe with a proper arch support,” suggests Vincent Giacalone, doctor of pediatric medicine in Westwood, New Jersey. “Even though it’s highly unlikely that lack of a shoe arch will cause a child to have flat feet, it can definitely help support an arch, which is among the first stages of foot development.” A stable heel and a rigid shank on the shoe is also necessary, he says. The stable heel allows for easy walking, and a rigid back keeps the foot from slipping inside the footwear.

Retailers shopping for children’s shoes also should look inside the shoe to make sure there are no loose threads or bumps, which can irritate children’s feet, say the medical experts. “Parents and retailers should slip their hands into the shoes and feel the lining,” Gaftswirth says. “Even some stitching can cause irritation, because young skin is more sensitive than that of an adult’s.”

The pressure on the foot when a child walks is also greater than what an adult experiences. Gait studies of children’s walking patterns at Ohio State University reveal that the force is much greater. It appears that infants walk in a “land-and-lift” action–they pound the foot on the ground and then lift it up again as opposed to adults who hit the heel and fall forward to the ball and toe, which is more gentle on the feet.

Flexible soles that follow the natural walking pattern of the foot combined with proper cushioning can reduce the impact to a child’s foot, according to Jeff Pisciotta who has spent the last 12 years studying clinical gait patterns and who is now manager of advanced product technology and biomechanics at Stride-Rite.

Most of his studies are based on the patterns of the bare foot. And while he says that the debate over the importance of arch supports has not been settled, some studies show that children probably don’t need special orthopedic features in a shoe unless they have an existing medical problem. Pisciotta explains that as a child develops, fatty areas where the arch is start to disappear, thereby starting natural arch formation by the time the child reaches the age of four. He adds that a small amount of support in that area might be helpful to maintain proper balance. However, he says that many experts still disagree on whether a support can help the arch to develop.

Even so, most studies show that too rigid a support can be harmful. In independent studies done by the French shoe maker Babybotte, which is known for its proper shoe fit for children, it is suggested that the shoe should not inhibit the development of the longitudinal arch, since foot bones in young children are extremely fragile and can be easily damaged. And in a Pedriatrics magazine article written by Lynn Staheli, a doctor from the department of orthopedics of Children’s Hospital and Medical Center in Seattle, rigid support of children’s shoes is questioned. He points out that in 1989, two controlled studies–Wenger et. al. and Gould et. al.–showed that arch development occurred regardless of footwear. What’s more, in the same article, he cites studies that say flat-footedness in adults is a benign condition.

After flexible footwear, size and width selection is the next point retailers should address when it comes to satisfying the shoe shopper, say the doctors. Since many manufacturers now offer shoes in several widths, fragile feet don’t have to be crammed in a too-tight shoe. “A wide range of running shoes for overpronators is the most important thing to have in a store,” Gaftswirth says. “The main problem that parents have is fitting the foot, so it’s important to have a variety of sizes; that’s the mere academics of fitting the shoe.”

Shoes that are too tight either in width or length can cause flexible young bones to become twisted or distorted when the child is an adult. As the American Pediatric Medical Association notes in its literature on children’s feet, the lack of a complaint in a youngster doesn’t necessarily mean a foot problem doesn’t exist, since the feet grow so fast that pain usually doesn’t occur until after the damage is done. That’s why experts say salespeople should take extra care in fitting children.

Babybotte’s independent studies say that the goal of die salesperson should be to “provide the best physiological comfort for as long a time as possible, in the conditions of use that were determined.” It adds that if a shoe is too short, it prohibits the foot from being elastic during walking and can cause balance problems as well as deformities in the foot.

Likewise, there are problems if the shoe is too long. One of the most common mistakes parents make is that they think they should buy shoes that are too big, thinking that the child will grow into them much like they do clothes that are purchased too big. But oversized shoes can cause a child’s foot to slip and roll over. In addition, a shoe that is too long can lose its shape quickly.

As a general rule, to determine the correct fit of a shoe, the foot should have a thumbnail’s width between the longest toe and the end of the toebox on the longer foot; the foot should fit into the widest part of the shoe without hanging over the side of the shoe; and there should be no heel slippage.

In most cases, according to the Babybotte study, a shoe that is correct in width but slightly too long will accommodate most feet. Additionally, it points out that leather shoes will “give” slightly in width, but not in length. If the toes spread, the wide, yet long shoe would be the correct choice, according to Babybotte. However, if the child’s instep is very high, a shoe that is correct in length but more than ample in width is the correct choice. In no case should a salesperson recommend a pair of shoes that is too long and too wide at the same time, or a pair that is too short, the study says.

Giacalone cautions that special considerations also have to be made when checking the length of the shoe. Many times the salesperson fitting the shoe only checks to see that the big toe is situated comfortably, but sometimes the second toe can be a half an inch longer than the big one, he says. According to Babybotte studies, 22.3 percent of all people have a second toe that’s longer than the first.

On the issue of fitting, Gaftswirth points out that it’s especially important that both feet be measured in both a sitting and a standing position during the fitting. Many times children’s feet are two different sizes–a condition that is accentuated even more once pressure is applied. In addition, the time of day can make a difference in the fit. “A slip-on shoe that fits easily in the morning might be too tight in the evening,” Gaftswirth says. And when fitting, it also helps to make a conscious effort to have the child try on the shoes with the weight of socks they’ll be wearing. That’s something the person fitting the shoe can easily control.

As for the style of shoes, slip-on styles don’t always provide a perfect fit, but this may be insignificant if the child is only wearing the shoe for a short period of time, says Gaftswirth. But shoes that will be worn for extended periods of time, such as during the school day, or for physical activities need to be comfortable and offer good support. Lace-ups might be a better option, since they allow more flexibility and support. He says Velcro fasteners are another option, but they are not as ideal for vigorous activities. And they can also keep preschool-aged children from learning to tie their shoes.

Along with the selection of styles and sizes and carefully trained sales help, a broad grouping of price points should be available, because expensive shoes aren’t always synonymous with quality shoes, say the medical experts. “There are shoes out there that are not that expensive but are still well made. A lot of consumers go in stores and complain that their kids want $150 shoes. But parents don’t have to spend that kind of money on shoes to get quality,” Giacalone says. “A lot of kids like the social status in the high-price-tag shoes, but a lot of those shoes really cost so much because of the money it costs to advertise them, not necessarily because of the way they’re made.”

Gaftswirth agrees: “You don’t have to look at prices to find good products. That’s not necessarily an indicator it’s the best there is. It’s the basic features–flexibility, proper support and fit–that’s the most important.”

FITTING TIPS

* Gather as much information as possible from the parent: Age of baby?; is baby crawling, walking, etc.?; How long has current size been worn?; What environment will the shoes be worn in?

* If the child is wearing a pair of old shoes, check them to see the child’s wear pattern. Are the shoes outworn or are they outgrown? If the vamp is wrinkled, the shoes were too long. If the lining and the sock lining are abnormally dark and brittal, the child probably perspires more than average. With this kind of information, suggest an appropriate shoe.

* Measure both feet in standing and sitting positions. Many times children’s feet are two different sizes.

* The time of day can make a difference in the fit of a shoe.

* Watch the child walk in the shoe, and check for durability, cushioning and stability.

* In addition to checking if the big toe is situated comfortably, check the second toe also. In almost a quarter of the population, it is longer.

* Have the child try on shoes while wearing socks in the weight he plans to generally wear.

* As a rule, the foot should have a thumbnails width between the longest toe and the end of the toebox on the longer foot; the foot should fit into the widest part of the shoe without hanging over the side of the shoe; and there should be no heel slippage.

* Leather shoes will “give” slightly in width but not in.

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