As a family physician, I firmly believe that children should play in their bare feet or in activity shoes that complement natural foot development and proper biomechanics of movement. Runners, walkers, coaches, and the medical community are all awakening to the benefits of allowing proper natural foot motion to occur in all of our daily activities.  Leaders in the running mechanics, sports medicine, dancing, and yoga/tai chi communities all understand that the smartest design that will ever be developed for human movement and injury free activity is the human foot itself. Running shoe companies are adapting their product lines to create footwear that allows your foot to behave like a foot, but most have only applied this new thinking to adult models.

Kids’ shoes until recently have been marketed by the shoe companies to parents, educators, and health care professionals to  prepare  our kids for  shoes they are marketing for adults to wear. The modern shoe industry and its marketing machine effectively convince parents that when running, a child should wear miniature versions of traditional adult running shoes; almost all of which have elevated heels, extreme cushioning, and some form of motion control technology.  Many dress and casual shoes for children are also stiff and overly supportive.

Here’s an important point to keep in mind – a child’s foot is not a miniature version of an adult’s foot. In early development, a child’s foot is widest across the toes. If our population wore shoes that were designed with this functional shape from birth, most adults would also have feet with the widest part across the toes, and the toes would be perfectly aligned with the metatarsals (long bones in midfoot). Most of a child’s developing foot is composed of cartilage, which is gradually replaced by bone. If the cartilage is deformed by badly shaped or rigid shoes, the bones will take on the deformed shape. More than 80 percent of foot problems, bunions and injuries are a result of misshaped and inflexible shoes. It’s vital that kids’ shoes allow enough room for natural growth, until the foot bones mature. This doesn’t happen until ages 18-19 for girls and 20-21 for boys. Simply put; inflexible, poorly shaped shoes are potentially harmful – they restrict the natural movement and development of the foot.

Currently, almost every running shoe company has products supporting natural running. Most of these new shoes are being made solely for adults. Outside of a few select brands (VivoBarefoot Kids, Merrell Kid’s,  Vibram,  Softstar, and Pediped as examples) a void exists in the development of proper youth footwear, where natural foot function and development are perhaps most critical.  Without any supporting evidence, the President of the American Academy of Podiatric Sports Medicine (AAPSM ) David  Davidson made this comment when asked about children’s footwear by Running Times MagazineKids should not be running in minimalist footwear at all, and as in other shoes, should be wearing brand name running shoes with good motion control, cushioning, etc…

I believe the opposite. I feel children should run barefoot as much as possible, and when they need a shoe, they should wear one that allows the young foot to develop its natural strength, support, and function.  Parents should think twice before heeding the message that their children need “sturdy” or “supportive” shoes. As Dr. Lieberman demonstrated so well in his landmark paper in Nature (Jan 26, 2010), footwear can have a large influence on natural gait.

I also find it highly unusual and there are no supporting documents to the APMA (American Podiatric Medical Association) parent flyer which states that parents should “Select a shoe that’s rigid in the middle. Does your shoe twist? Your shoe should never twist in the middle.” Curiously, right below that piece, and written in fine print, there is this accurate statement: “Step three does not apply to toddlers shoes. For toddlers, shoes should be as flexible as possible.” I’m left wondering “So at what time does a toddler become a child and we bind their feet up?”

As a parent and physician I believe that the APMA statements could cause harm in a developing child’s foot. A foot builds its own intrinsic support via communication with the ground, building strength and stability through proprioception, and allowing normal force loads to be applied to the areas that nature intended. If you change anything from what is natural in a developing child, then you proceed at your own risk

A recent review in The Journal of Family Practice (Vanstory 2009) concluded that flexible flatfoot does not affect function and that there was no evidence to treat it. Twenty years ago, a review of children’s shoes and gait in the journal Pediatrics (Staheli 1991) outlined key factors that affect children’s feet:

– Optimum foot development occurs in the barefoot environment.
– Stiff and compressive footwear may cause deformity, weakness, and loss of mobility.
– The term “corrective shoes” is a misnomer.
– Shoe selection for children should be based on the barefoot model.

One example of deformation we see now in many high school runners is hallux valgus — “big toes pointed in.” Hallux valgus is generally caused by ill-fitting shoes with a pointed toebox. Furthermore, most runners, both young and old, cannot stabilize and balance on one foot. To run properly, you must be able to do this.

The next time you are in a park, watch a child run barefoot.  Notice the relaxed movement and foot placement. They lean slightly forward and their legs fall out behind them.  They do not strike hard on their heels. Then watch the child with the highly cushioned or supportive shoe.  The difference is easy to see.

So what are the important features to look for in a child’s shoe?

  • Ultra-thin soles to allow proper proprioception, neuromuscular activation in the entire kinetic chain, and to complement the body’s natural ability to absorb ground forces.
  • Low, flat to the ground profile – shoes should allow all play activity that involves climbing, running, and jumping. Shoes should enhance lateral movement since the foot will not be up on a platform or have a slope from heel to forefoot.
  • The materials should be soft and supple, thereby allowing natural foot function. The shoe should bend easily at the toe joints – this is where a foot is designed to bend to recreate the arch on takeoff.
  • The toebox should be wide enough to allow natural toe spread. Foot support is created by the natural arch of the foot with the great toe stabilizing the arch.  When the heel is elevated and great toe deviated toward the second toe (a common design flaw in many shoes which come to a point), this stability is compromised. The foot produces the most leverage when the toes are straight and aligned with the metatarsals. A child’s foot is widest at the ends of the toes (as should an adult’s be if they have been in proper shoes or barefoot).
  • A single piece midsole/outsole allowing protection on unnatural surfaces (concrete, asphalt) and natural rough surfaces (rock,trail) while allowing proprioception and natural dissipation of ground reaction forces.
  • Upper material should be soft, breathable, and washable.
  • Get over the notion that shoes need “traction.” In a moving child the more stickiness and grip, the more heat produced in the foot and braking moments on running activity.
  • Discourage the use of thick, heavy socks as these interfere with foot proprioception.

Why do I care so passionately about this?  The most important reason is that I am a parent and want to do what is best for my children and not be influenced by marketing claims or trends.  I have been a competitive distance runner my entire life and am personally involved in multiple projects and grants involving both youth and adult physical fitness.  If we can teach proper approaches to pain free activity throughout life then the daily walk or run will be sustainable.

I had both of my feet operated over 10 years ago for severe arthritis of my large toe joints caused by a combination of improper gait mechanics, lots of hard miles as a collegiate and post collegiate runner, and the negative influence of new trends in footwear such as elevated heels and crash pads. The foot instability this created and greater impact in the great toe joint caused this joint to deteriorate. I had surgical corrections in both feet and instead of taking the standard doctor’s advice of not running anymore, I chose to relearn how to run. I also got heavily involved in footwear design and function for runners and children.

I have watched my own children  dramatically change their movement patterns after discarding all cushioned and inflexible shoes and getting them into minimalist shoes.They are six and eight years old.  They will not put anything else on their feet now when they need to have shoes. At my store, Two Rivers Treads, we gave away 150 pairs of Vivo Barefoot kids shoes a couple weeks ago thanks to a generous contribution from  VivoBarefoot and supplemented from our own inventory stock.  Dozens of moms and kids have thanked us for the discovery they have made. Footwear designers are a critical part of the future of preventive sports medicine. I’m glad they are starting to think more about our children.