Footwear has a role in ensuring the best futures for children. Our feet keep us active, social and enable us to lead happy, healthy lives. Choosing footwear for children of the right size and fit is thought to provide comfort and prevent toe, skin and nail problems, infections, falls and injuries to joints. Making the right footwear choices for children is also about forming good habits in choosing footwear which will continue into adulthood and pass through generations.
Fitting
All children’s footwear should be measured for length and width. Ideally, footwear should be fitted by an appropriately trained shoe fitter. Feet grow at different rates, depending on age. Generally, a child under the age of 4 should be measured every 8 weeks, and children of 4 years and upward should be measured every 3 months.. If there is difficulty getting the shoes on, the shoes have wear marks, there is pain, or the skin is being rubbed the shoes and fit should be checked. First shoes are for confident walkers who want to walk outside or, need their feet protected from objects on the floor.
The Children’s Foot Health Register provides a list of shoe retailers, that have staff trained to fit shoes and carry stock in whole and half sizes, in up to four width fittings. They can also advise on first shoes. See the website at: www.fitkidsshoes.org.
It is also worth noting that stitching and layers of material can affect how the footwear moulds around the foot, so check around bony areas, like the big and little toe joints, as stitched areas retain their shape and do not conform to the shape of the foot.
Fastenings
Fastenings such as laces, Velcro and T-bars are recommended so that the foot is safe and secure in the shoe when children are active. If a shoe is not comfortable and secure, it can lead to the footwear rubbing and cause soreness on the skin and nails. Foot sliding movement in the shoe may cause the toes to curl and grip to reduce this foot slippage and has the potential to cause problems to the toes.
For some children, fastening shoes can be a challenge no matter how hard they practice. Alternative fastening such as magnetic or silicone laces, toggles and elastic can help children to become independent in fastening their own shoes. Podiatrists and occupational therapists are able to find solutions to these challenges.
Material
The area of the shoe that cups the heel (heel counter) should be firm and unable to collapse, as the heel counter helps to secure the foot in the shoe when moving. Encouraging children to unfasten their shoes before putting them on will prevent this area of the shoe getting flattened and damaged. It can also prevent the heel skin being irritated from poor fit.
Footwear should be made of breathable materials such as leather, natural materials or a material like Gore-Tex™. Breathable shoe material allows the air to circulate and keep the feet at a comfortable temperature; it is also thought to help prevent infections. Examples of non-breathable materials are plastic, nylon and rubber. For those fun family activities, like splashing in puddles and walking in the mud, rubber wellington boots (which are not breathable) are perfectly fine and children usually love to wear them.
Stability
Fit, fastenings and materials are important and help keep the shoe comfortable and secure on the foot. Another area to be mindful of is the stability of the shoe. This is checked by looking at the footwear’s sole for shape and size. Shoes with a wider base of support can provide more stability for children rather than narrower soles; this is like the difference between walking on a wide path or a tightrope. Footwear that provides stability can help prevent injuries such as ankle sprains, which can lead to problems in later life such as arthritis and mobility challenges.
Suggesting the height of the footwear’s heel is not a simple one. Shoes will come with varying heel heights and these are included as fashion and design elements. Heel height is not just a feature of high heeled shoes; trainers will have a slight heel whereas plimsolls will be flat. It is important to remember that because children have different foot sizes, a set heel height will cause a different slope in different feet. A general guide is that heel height should be no more than 4cm and in the under 5s it should be half of this. When the heel height is greater than the recommended height of 4cm, it may increase the width of the forefoot, increase the pressure applied to the knees, increase the risk of ankle joint instability and ankle sprains.
The shoe’s construction
Children are generally very active, so the quality of the shoe matters because it needs to be durable to counter excess wear and tear. The sole needs a grip to prevent injury from slipping. The sole material’s firmness also decides how long the shoe will last, for example soles that are soft enough to press your finger into will last less time. Softer shoes tend to be cheaper and can prove a false economy. The sole also provides the base of the inner shoe and can influence comfort of the foot.
Some lighter and cheaper shoes are made like a grid or ‘waffle’ construction, so less material is used. To check if the sole has this feature press your thumb firmly around the inner sole of the heel; the insole may conceal this feature and may need to be removed first. As the surface is not flat it can irritate the heel and cause pain. When children experience pain, they will find activities more challenging and may start to be less active.
There is debate around whether a shoe’s sole and design needs shock absorption material and support. Typically developing children should have the ability to absorb shock and provide enough support with their body’s senses, joints, muscles and ligaments. Shoes are not considered to have a role in the development of the arches of children’s feet; these will naturally develop on their own and, at different ages for each child. This advice may differ if children have pain due to arthritis, a neurological or orthopaedic condition. In this case appropriate footwear is best discussed with a healthcare professional such as a podiatrist or orthotist.
For many parents, buying footwear for children is an expensive process and can include buying a good shoe for everyday wear and for different activities, such as sport and parties. The need for new shoes can also come when the family budget is tight, so for some families, the solution is to buy one good shoe that is active ready and a blend of both a formal and informal shoe.
Selecting footwear should follow the simple rules of being comfortable, well fitted, secure, safe and durable. As our feet help keep us active, mobile and enable us to lead happy, healthy lives into adulthood, choosing the right footwear is important. Children’s footwear should allow them to take part in all the activities they choose and facilitate exploration and learning.
Authors
Chris Ansermoz - Gloucestershire Care Services NHS Trust
Stephen Coombs - Cardiff and Vale UHB
Nina Davies - Leeds Community Healthcare NHS Trust
Miranda Ford - Kent Community Health NHS Foundation Trust
Matthew Hill - Staffordshire University
Simon Jones - Stockport NHS Foundation Trust
Dr Stewart Morrison - University of Brighton
Dr Jill Phelan - University of Salford
James Welch - CSH Surrey
Associate Professor Cylie Williams - Monash University
© March 2019
The College of Podiatry Children’s Podiatry Special Advisory Group. www.cop.org.uk
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