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Should small children have shoes?

Discussion in 'Pediatrics' started by larare, Jul 3, 2005.

  1. larare

    larare Welcome New Poster


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    Hi.

    I am not a podiatrist but i hope that you will oversee whith that and advice me in an important matter. The foot health site is hardly the right forum since it is not about some personal foot problem but a professional matter.
    I am a Swedish nursery teacher, working whith children from fifteen months untill they go to school at the age of six.

    The matter is shoes. I argue for letting the children go barefoot inside and in the playgarden (when its warm enough, of course) and that it will hurt their feet to allways be forced to wear shoes. In Sweden, the nurseries have very diversing policies about it. But I, having worked in many nurseries, find that the majority does not allow the children to go barefoot outside and very many tries to have the children use shoes all the time even inside. In some places, the shoes should be extremely ill-fitting before the children are allowed to take them of.
    The reason they give is the risk of catching a cold if going barefoot inside and the risk of hurting their feet on sharp things outside. In my opinion, glass in the play garden should be cleaned away and not used as a reason to force the children to wear shoes a year or more later! In Sweden, all children are vaccinated for tetanus so I do not really see the reason for fearing some stick or sharp stone if the children don’t fear it.
    In Sweden, most nursery-gardens have sand, grass, shrubbery, asphalt and, if lucky, some little piece of natural ground.

    What are you professionals saying about it? Am I totally wrong and it does not really matter as long as the shoes are well-fitting? What should good shoes be like?
    Or am I right and should go on pushing for letting the children go barefoot? Then I need some professional references. Is there any medical research that I could learn from?

    I will be most grateful for your time.

    larare
     
  2. admin

    admin Administrator Staff Member

    I will just respond to that bit --- thats a physical impossibility.
     
  3. Akbal

    Akbal Active Member

    I would have to say that it is not impossible for a person to catch a cold whilst walking barefoot indoors however the two events would not be related to one another.
     
  4. Felicity Prentice

    Felicity Prentice Active Member

    The issue of shoes and children is not without controversy. However, the rule of thumb has always been that children should start wearing shoes when they start to walk independently (that is, not holding on to furniture etc). One of the reasons behind this is that it is very difficult to correctly fit shoes until the feet become truly plantargrade - until then their feet tend to be a chubby ball shape that is hard to accurately measure and fit.

    Once walking, shoes offer protection and some stability - although the foot should function fine without them. The aesthetics of shoes often become the more important force behind the decision to use them. We have this idea that young feet 'need' them. But, in the absence of potential dangers (such as glass on the ground), or extremes of temperature, it is fair that children could probably get away without shoes, (assuming they do not need any specific intervention which requires footwear).

    Perhaps the most important issue is that of fit. A badly fitted shoe may indeed have the potential to cause damage (although this has never actually been proven, there is some research going on in Sydney to investigate this issue). My experience with children and shoes (I have worked with schools and children's shoe manufacturers) indicates that in general the quality of shoe fit is very poor. This may arise because:

    (a) the shoes were incorrectly selected for size, fit and style initially
    (b) the shoe no longer fits the foot
    (c) the shoe has been destroyed by inappropriate wear

    In regards to point (c), this is commonly seen in the older child who chooses not to unlace and relace shoes, but forces the foot in to a pre-tied shoe, thus destroying the heel counter and stretching the upper.

    So - should children be required to wear shoes? Yes - if it is needed for protection, but otherwise I do not believe so. And most of all, when children are wearing shoes, they really do need to be well made, appropriately styled and correctly fitted.

    There is pitifully scarce literature on this subject, so if anyone can come up with some I'd be delighted to hear of it! Most research is based on orthopaedic footwear as a treatment intervention, there is not much on the healthy foot and shoe.

    cheers,

    Felicity
     
  5. stuart0908

    stuart0908 Welcome New Poster

    Shoes on Children

    I'm no professional, but I agree that I think children should be wearing shoes if they are walking on their own, otherwise, why weigh down their feet? I doubt theres any chance for harm if they are just wearing them, but if you are worried about them getting their feet cold, you can let them wear socks or booties. I know when I have kids I will probably be just like you and worry about every little thing.
     
  6. dawesy

    dawesy Member

    I haven't go the references on me, but i know of studies showing populations such as some in the third world who have a far superior foot structure than us in western society who live in shoes. I believe shoes are good for protective purposes.... in todays society who knows what is left in streets etc,.... however i think shoes are not a necessity otherwise.

    Just my 2 cents.
     
  7. User7

    User7 Active Member

    No shoes for children. Unless they walk on sharp lava, dirty streets, or are going to a wedding. In Kindergarten, first grade - certainly not. Shoes are for protection from sharp objects, fashion, comformity or orthotic necessity. Children need only heed the demands of the first. Anyone who says otherwise is certainly selling something. That's dogmatic, but I believe it sincerely.
     
  8. Podiatry777

    Podiatry777 Active Member

    Ok, I ignore shoes unless my own children need to go outside-protection.Yes, i put socks on the toddler until he fell in love with shoes about age 18 months because big brother has them and my toddler has a love for order-personality issue. I find most mothers struggle to put a shoe on in warm Australia, and we devise a plan and lots of adult and friends reinforcement if feet intoed for example, and need orthotic treatment.

    In short- socks are great for cold, shoes are for protection.
     
  9. Cameron

    Cameron Well-Known Member

    larare

    >Is there any medical research that I could learn from?

    No.

    The establishment's legal duty of care would support all necessary protection is undertaken with patrons whilst on private property. To reduce liability shoes may be a protective mechanism considered essential by the owners and hence this becomes a condition of entry. To not comply would debar you from the group. The same thing is seen in public access to privately owned spaces such as shopping malls where barefooted people are prevented from entering. There is no reason for this other than trying to prevent certain people (usually lower social economic types) from mixing with middle class clientele who use the premises. This bias against barefeet was evident in ancient Rome and sumpuary laws (legislation what certain people can or cannot wear) throughout history.

    Conventional wisdom would support the vast majority of the population can go unshod until the femur derotates (about 7 years of age), but convention determines (expensive) shoes are worn. As Felicity outlined, fit and suitability to activity are critically important for the growing foot.



    Cheers
    Cameron
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Todays Wilmington Star is reporting:
    Baby needs shoes
    Rest of story
     
  11. Boots n all

    Boots n all Well-Known Member

    We often get parents and grand parents coming to us for footwear, as junior has taken the first steps, we tell these people to go away and come back in 2-3 months or when the little one is walking with hands down near waist level, meaning they have true balance and gait, hands at chest level means they are still finding balance and have a side way action in their motion with the head tilted forward.
    We suggest good socks with the little rubber dots on for grip whilst inside, as for outside we always suggest in their own yard at least (where it is grassy, clean and tidy?)bare foot is great.
    As for third world children not using footwear and having better foot structure, are they walking on concrete all day at school? Most of our children do.
    Rules and insurance insure that most children need to wear footwear these days, the foot needs exercise, this can be achieved with a mixture of different footwear (last shape,heel height and style ect.) and bare foot activity, unless they have a foot/ lower limb pathology that suggest otherwise

    Thats my 2 bobs worth anyway
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Herald-Argus are reporting:
    If the shoe fits ...
    It's more than 'Baby needs a new pair of shoes' when you ask the shoe experts
    Full story
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This was missed earlier in the year. Its from April 2007, ConsumerReports.org
    Baby footwear: Lose the shoes
     
  14. From my PhD thesis: "Rao and Joseph (1992) compared arch height indices (AHI) in children who habitually wore shoes and children who had never worn footwear (1555 shod, 745 unshod). Static footprints were obtained using inked rubber mats. 154 children (6.7%) were diagnosed as flat-footed. A significantly higher prevelance of pes planus existed in children who wore shoes (8.6%) than among the unshod (2.8%) (p<0.001). This result supports the contentions of Didia ad Nyenwe (1988) who believed that shoewearing influenced the development of the medial longitudinal arch. Interestingly, Rao and Joseph (1992) also reported that 710 children displayed ligamentous laxity. The ratio of flat foot in children with ligamentous laxity was 14.4% compared with 3.35% in those who had no ligamentous laxity. The preponderance of flat foot also varied with the type of footwear worn. Rao and Joseph (1992) concluded that shoes which encased the toes were more detrimental to arch development than open-toe sandals or slippers and that the detrimental effects of closed-toe shoes were enhanced in the presence of ligamentous laxity."
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Press Release:
    Manufacturer-listed size for children's shoes seldom correct
     
  16. Sammo

    Sammo Active Member

    How much do people think sensory feedback, as well as structure of the shoe (and therefore the possible requirement for decreased use of the intrinsic muscles to stabilise the foot with a structured shoe), plays in the development of the foot? If the patient is in a shoe with a smooth insole, it could be suggested that they don't get the sensory feedback from the floor that they would in barefoot.

    Could that mean the foot adopts a more stable (pronated) position, to try to avoid inversion injuries/falling over etc.. Also, could the foot pronate more to try to increase the sensory input coming from the plantar aspect of the foot?

    Just asking peoples opinions..?
     
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