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Emphasizing Proper Shoe Fit And Better Shoe Choices For Children

One of the most common questions I get from parents is, “What is the right shoe for my child?” I have different answers to this question based upon the age of the child and the activity for which the child will be using the shoe.

For children under my care, I will often make specific recommendations to help with a particular gait issue. I keep recommended shoe lists in my office to offer general advice to parents on what constitutes a good shoe for a child at key ages. When a specific shoe type or design is part of my therapeutic plan, I offer a detailed description to the parents and I will write a “prescription” for the shoe, even if it is not an orthopedic or special shoe, so they have written notes to refer to when shopping.

I like to recommend specific stores that know my patients and me. These are stores that have a good track record of providing appropriate shoes for children, offering a good selection and recommending shoes that work well with my other therapies such as foot orthoses. I try to stay clear of recommending a specific shoe and I will concentrate on the properties of the proper shoe for a particular child. I find if I give parents a specific shoe to purchase, they may end up on a wild goose chase to locate that particular shoe.

However, what is really on my mind concerning children and shoes is how often the wrong shoe is contributing to a foot problem and how often the parents do not realize the shoe is a key culprit. I see this scenario occasionally in children of primary school age and younger. I start to see this problem more frequently in teenagers once they are in middle school and high school. The primary culprits here are ill-chosen or ill-fitting shoes, and parents beginning to lose control over the choices their children make as they become teenagers and beyond.

Sometimes fashion and trends are at work, and the child is simply choosing the shoe his or her friends are wearing even if it is unwise. The most glaring example of this is the ever popular Uggs, which can be seen on the feet of pre-teen and teenage girls everywhere, even when the temperature climbs into the 70s. Why? It is because they are soft, padded, comfy and cool. Never mind that they offer little or no support for the rearfoot and arch. They may be great on a snow day in January but they just do not work for feet during an afternoon at the mall.

The ballet slipper style shoe is another example of a shoe that may be contributing to pathology or symptoms on the wrong foot. These shoes are often pretty and feminine, and are popular with girls of all ages. In a so-called “normal” foot that is not overpronating, these slippers may be fine for short periods when activity is minimal. In the hyperpronator, however, these shoes are the equivalent of going barefoot with a sheath over your foot and may easily lead to overuse symptomatology and premature fatigue.

When Teenagers Present With Adult Digital Problems

Another scenario that I am seeing with alarming frequency is teenagers presenting with digital problems. These include painful bunions, corns, hammertoe, mallet toes, claw toes, interdigital corns with bursitis and other related symptoms. Teens often present with digital problems, saying they want surgery to fix their toes.

You might be thinking, aren’t these typical forefoot problems of older patients, not teenagers? Well, more and more teenagers are turning up with these problems because they are wearing ill-fitting shoes that are cramping, bending and squeezing their toes. I am not talking about high heels, pumps and other fashion footwear in which we see crowding of the toes as a result. These kids are causing these problems with sneakers and other so-called “comfortable” shoes.

So what is at work here? First, teenagers can be lazy and they may not let their parents know when a shoe is getting tight or small. Parents are much less involved in such matters in teenagers and often they just do not realize what is happening.

Of even greater concern -- and I am amazed at how often I see this, particularly in an inner-city setting -- are children who choose to stay in small shoes to make their feet look smaller, even if they will not admit the reason. You might think this problem would be more common in females but not necessarily. I have seen it with many adolescent males who may not “like” the size of their feet as they are maturing. These kids get that sheepish look on their faces when you suggest what you think is going on here.

Final Notes

Needless to say, when I am evaluating and treating digital problems in this population, I spend some time on the shoes. Evaluating the shoe, how it fits and types of changes in the shoe may help to alleviate the presenting symptoms. In some cases, the shape or height of the toe box has to be adjusted but in quite a few cases, simply getting a shoe in the correct size goes a long way in relieving symptoms associated with squished toes.



When you are emphasizing proper shoe fit, do you talk to your patients about the difference between a "C"-shaped foot and a "straight" foot, and the implications this has for proper shoe selection?
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