Although the summer will soon be winding down, the activities of children dictate year-round use of athletic footwear. When assessing and treating pediatric patients, and answering the questions of their parents, clinicians often face the challenge of evaluating and recommending features in a good pediatric athletic shoe. Certainly, using orthoses can help encourage normal development of the foot. However, in order to improve function and the patient’s activity level, one must also consider the features of athletic footwear in order to optimize the effectiveness of the orthotic prescription and maximize the potential benefit of the therapeutic intervention. The basic principles for choosing athletic footwear in children are simple. The shoe must be up to the task and designed to support the high activity level of the child until he or she outgrows the shoe. Some parents may see cost as a deterrent and may be tempted to cut corners on athletic footwear for their children, reasoning that children will outgrow the shoes in a short time anyway. However, given the high activity levels and varied demands children place on their feet, clinicians should emphasize the importance of quality and craftsmanship as key features. The shoe should offer good cushioning, support and protection when it is intended for athletic use. These shoes should have ample forefoot width and toe-box room in order to reduce crowding. When assessing the child’s current athletic shoes, check for proper length, width and depth. The counter should be firm in order to minimize untoward medial and lateral movements of the rearfoot. Check the heel for minimal up and down slippage. The shank should be moderately rigid with increasing flexibility across the ball to allow for the emerging heel-to-toe gait in the toddler. The shoe should not have a rigid sole even in the youngest walker as these tend to hamper early gait and may lead to increased clumsiness. A high-top shoe may be beneficial in toddlers who may have trouble keeping their shoes on. The closure can be laces or Velcro. Many parents prefer the convenience of Velcro closure with children who are not yet tying their own shoes. If the shoe has a Velcro closure, be sure the quality is not compromised and that it has the aforementioned features of a good athletic shoe. The slip-on shoe, popularized by Merrill™, is now widely available in children’s sizes in a variety of styles. While these shoes offer the ease of simple donning and doffing, they should not be a first choice when one desires maximum support of the child’s foot for athletic use and particularly if one has prescribed a motion controlling orthosis. In some cases, it may be necessary to remind parents that handing down athletic shoes from one child to another is never a good idea. Each child creates individualized wear patterns in a shoe and inappropriate use of another child’s shoe can place undue stress on a child’s feet.
What You Should Know About Foot Growth In Young Children
Evaluating and recommending shoes in this patient population is quite different than assessing the shoes of adult athletes, who often continue wearing sneakers long past the time when they are effective and healthy for the wearer’s feet. Given the expected rate of growth in children, the pediatric patient will often outgrow the shoe before the shoe is worn out. Children’s feet grow in spurts and they will require a size change in their footwear every three to four months. On average, the feet of children who have just started walking will grow one-half shoe size in two months. Toddlers from the age of 16 to 24 months will have an average increase of one-half shoe size every three months. The 2- to 3-year-old grows approximately one-half shoe size every four months and children over the age of 3 undergo increases of one-half shoe size every four to six months. Four- to 8-year-olds outgrow shoes every six months on average. When it comes to kids who range in age from 9 to 12, they may experience size changes anywhere between six months to a year. Although these general guidelines on the growth of the child’s foot are useful, it is best to advise parents to visit a reputable store and have the child’s feet measured for proper fit. Also point out to parents that it is better to shop for their children’s shoes later in the day in order to allow for expansion of the foot through the day. This also helps ensure a proper fit. In addition to actual sizing, one should check the fit of a child’s shoe with the child standing. This helps to capture the maximum length and width. One should also ensure there is approximately the width of a thumb distance between the end of the longest toe and the toe box, and there is room the size of a pencil or little finger between the top of the heel of the shoe and the child’s foot. Keep in mind that two-thirds of children wear shoes in D and E widths with more boys wearing E widths and more girls wearing D widths. Also be aware that the feet of toddlers tend to be thicker on the dorsum. Therefore, shoes may appear to fit because there is adequate toe room but may still be too tight across the top of the ball of the foot. In these cases, it may be appropriate to change the model of the shoe in order to allow for more volume across this part of the foot.
What About Insole And Outer Sole Materials?
Recommended shoe materials include leather, canvas or the newer mesh materials. The guiding principle is the shoe should breathe. This is especially the case with athletic shoes as the children wearing them will likely perspire more. Using synthetic materials such as plastic for the upper is not recommended. The insole of the athletic shoe should be made of absorbent material and offer some cushioning. Removable insoles are preferred, particularly if one has prescribed a custom or prefabricated orthosis. Removing the insole will optimize the fit of the device in the shoe and allow the orthosis and rearfoot post combination to sit flat on the floor of the shoe. Outer sole materials should offer traction, cushioning and flexibility, especially across the metatarsal break in the ball of the foot. While good traction is important in the child’s athletic shoes, certain shoes may offer too much traction for certain activities or sports and increase the likelihood of falling. Newer brands such as Geox have breathable outer soles. This can be a very useful feature in the child’s athletic shoe, particularly if perspiration or heat is an issue. Geox markets a substantial children’s athletic shoe line known as Magic Geox, a favorite of experts who fit and sell shoes for children. One such expert, Ed Schwartz of Tip Top Kids in New York City, finds the Geox athletic shoe has several features that make it a top choice for the active child. In addition to the aforementioned breathable outer sole and popular Velcro closures, Schwartz also states that the Geox shoe has a “much deeper counter,” making it an ideal shoe to facilitate the fit of an orthosis. Geox makes several models of athletic shoes for toddlers and children. These models feature an upper comprised of a combination of materials such as mesh, durabuck and suede. They also offer breathable soles with well-designed outer soles and facilitate good overall traction.
Understanding How The Patient’s Foot Type Comes Into Play
Clearly, it is essential to consider the child’s foot type when making athletic shoe recommendations. Parents of children with pronated feet will frequently complain they are difficult to fit and require “wide widths.” When it comes to children with overpronated feet, the weightbearing pronated foot is wider by virtue of the adduction of the talus and the abduction of the midfoot. Often, improving the foot alignment with an orthosis will “narrow” that wide foot and make shoe fitting considerably easier. The excessive pronator will benefit from a more motion-controlling shoe with features such as a longer, higher counter, especially on the medial side. Stiffer materials, a firmer or more rigid shank, a medial out-flare to the midsole and other motion-controlling features in the design of the shoe may all be beneficial. A high-top shoe may offer certain advantages in helping to control or reposition a high motion foot type. In a mildly pronated foot, these shoe features may be sufficient to improve the foot posture and function. Patients who oversupinate may have complaints associated with lateral roll of the ankle or lateral weightbearing. These patients will benefit from a shoe with less rigidity and more cushioning. A lateral out flare to the midsole and a wider sole to upper relationship can help limit these untoward motions. A high-top or high profile shoe may also be effective for the patient who oversupinates.
Key Considerations For Older, Competitive Athletes
The older child participating more seriously in team and intramural sports will require specific shoes designed for the demands of those sports. For example, a track athlete will need a running shoe designed for forward movements of the foot whereas a racquet sport player will need a tennis shoe designed to support lateral movements. Soccer and lacrosse players will need a cleat that fits the foot snugly with modified outsoles to grip the turf and support the rapid shifts in direction associated with these sports. One must carefully select cleats for the child athlete. Check the cleat count under the heel and look for shoes with multiple cleats in the heel area. This facilitates better weight distribution and a reduced likelihood of pressure and heel pain. This can be especially important for boys ranging from 7 to 12 years in age given the potential for calcaneal apophysitis. Shorter cleats, of not longer than one-half inch, will reduce knee and ankle injuries in younger athletes. Playing on several teams is increasingly common for children. They may have several different athletic shoes that are each designed for the demands of individual sports. However, a cross trainer may be the best choice for a child in need of a general or all-purpose athletic shoe. If a child wears specific socks with an athletic shoe for a certain sport, the child should try on the shoe with those socks to ensure proper fit before purchase. Although younger children will likely outgrow the shoe before it is worn out, one should assess shoe wear in older, athletic children. Check the soles for medial or lateral wear as these may be signs of intrinsic foot pathology. Look at the shoe on a flat surface from behind for signs of medial or lateral displacement of the upper on the midsole. This may indicate excessive wear and faulty biomechanics. Clinicians should also inspect the sock liner or insole to identify wear patterns and the potential for injury in the active child.
A Few Brand Recommendations
Other recommended brands for children’s athletic shoes include New Balance, which has an excellent reputation among foot care specialists for excellent fit, particularly when it comes to depth and width. New Balance makes several models that fit children well and accommodate orthoses easily. Stride Rite sneakers, such as the Toddler Tech model, are fine choices for the younger child, whose “sporting” activities occur primarily in the playground and park. These sneakers come in various widths, have adequate counter depth and a flexible ball. This feature is ideal for the child wearing gait plate orthoses, which require maximum flex across the ball of the shoe for optimum performance. Ecco is another brand that Schwartz recommends. The Ecco shoe is a stylish combination of a sneaker and a shoe. For toddlers, the Ecco shoe combines many of the features of an athletic shoe with design attributes favored by many parents.
Today, the athletic child has many well-designed footwear options which can improve foot position from the earliest age, encourage optimum function from the first swing set or play group, and support therapy in the child with pathology or dysfunction. Hopefully, this information will help clinicians provide more of a full service approach to patient care and allow more podiatrists to make savvy recommendations to parents on athletic footwear for their children. Dr. Volpe is a Professor in the Departments of Pediatrics and Orthopedics and Chair of the Department of Pediatrics at the New York College of Podiatric Medicine. He has a pediatric foot and ankle specialty private practice in Farmingdale and New York, N.Y. Editor’s Note: For related articles, check out the archives at www.podiatrytoday.com.