Categorized | Dr. Mark's Desk, Kids

Get Your Kids Into Minimalist Shoes to Ensure Natural Foot Development

Posted on 28 September 2011

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.

Donate

19 Responses to “Get Your Kids Into Minimalist Shoes to Ensure Natural Foot Development”

  1. Doug says:

    Thanks for this post Mark. My daughter just started Kindergarten this year and my son will start next year. What is the best plan of action when the note comes home saying “children must wear athletic shoes for PE time”?

    I grew up shod 24/7 (almost), so I am very jealous of my kids’ strong, flexible, and agile feet. I’m getting there, but I have lots of rehab.

    Doug

  2. Jeff Gallup says:

    Great article! I am relatively new to running, and quickly made the transition to minimalist shoe/barefoot running, simply because it is so much more comfortable and natural. Since then I’ve encouraged my boys (7) to run/play barefoot whenever possible… of course we are headed into winter so that will be more difficult. Thanks for the great info..

  3. Chris Wilson says:

    I totally agree. But you don’t need expensive shoes to keep it minimal for kids. My 6 year old wears Vans when he wears shoes. My 8 yr old wears low-top Converse All-Stars. Both cost less than $30/pair and they meet all of the criteria you listed – except the toe box could probably be a bit wider. In any case, my test is when they run, can I tell if I just look above the knee if they’re wearing shoes. I always can with the thick ones.

    Good stuff!

  4. Hey, don’t forget that Invisible Shoes come in kids sizes (plus they make a great project to do with your kids).

  5. Ran says:

    What do you think about shooshoos ?

    http://www.shooshoosusa.com/

    Are they good for kids/infants ?

    My baby boy (1yr 3mon) is making it first walking steps.
    I want him to get proper shoes from start.

    Thanks !!
    Ran

  6. Phil says:

    As a current podiatric medical student, I’m ashamed of the official stances of the American Podiatric Medical Association and the American Academy of Podiatric Sports Medicine. Though nearly all podiatrists I’ve personally spoke with subscribe to the benefits of minimal footwear for nonsymptomatic runners, the official statements of podiatric associations haven’t yet caught up. I’ve wondered why this could be,and I’ve wondered why barefoot and minimalist runners demonize podiatrists. Sure, news stories always features two sides: the injury-free barefoot runner and the anti-barefoot podiatrist, but these are extremes. The best explanation so far for this dichotomy is that minimalist runners and podiatrists are thinking of fundamentally different people when they’re making shoe recommendations. In the past 6 months of seeing patients, I haven’t seen any healthy, strong,asymptomatic feet. Why would I? The patients have severe deformities, pain, biomechanical abnormalities,chronic illnesses with systemic manifestation, all in a different realm from the mostly healthy but chronically injured runners that barefoot advocates are talking about. Most podiatrists don’t have a chance to recommend barefoot shoes because their patients are too old, too pained, and too unwilling to make necessary health-conscious decisions. Getting some poeple out of a pair of heels is much harder than surgery. Meanwhile, minimalist advocates may not have realized that for most podiatrist’s patients, walking a few blocks is daunting, and barefoot activity is painful. I think the APMA and AAPSM reflexively recommend stability shoes because their leaders have too much clinical experience with a narrow range of patients who benefit from stability shoes. So they recommend stability shoes for children, when their basing that recommendation on the 76 year old with severe hallux valgus, multiple arthridities, plantar fat pad atrophy, and a lifetime history of ill-fitting, high-heeled shoes. Unfortunately for the AAPSM and APMA, the vast majority of people are not patients, and won’t become patients, if they utilize minimal shoegear and learn proper running technique.

    That’s my rant. Don’t see a doctor for a running-related problem who doesn’t run him or herself.

    • mathilde says:

      I agree with what you say. I must tell you that I had a hallus valgus operated 18 years ago (I am a women , 52), very successfull operation, and that I have started barefootrunning with great pleasure (2 kms the first time, beeing used to run 5/8 kms twice a week).
      I am sure that body posture while running is the most important cause for getting or not injuries… my first discoveries, which are the opposite of what is said on “courircommepiedsnus.com” – a French site on barefoot running: i suggest you start with your usual shoes, run some kms, and then put your new barefoot shoes (muscles are “warmed up” for a new strain) – and DO NOT stretch carves (tendon d’Achille) if you are hyperflexible… Have a good run

  7. Asle says:

    I have a sister who is grownup but has size 33 EU. This means it is almost impossible to get hold of decent “grownup” shoes but has to use kids shoes. Does anyone know where I can get hold of shoes in this size from VivoBarefoot, Vibram Fivefingers, Merrell trail gloves or similar shoes? I know Vivo and Vibram makes them but I don’t know where I can order them. I live in Europe so I would have to get them online.

  8. Hayley says:

    Are converse a good option for kids? I like the merrells but I am not sure if I want to spend $60 for a shoe that my child will grow out of in a few months.

  9. Steph says:

    This article brought tears to my eyes. I am so overwhelmed with what to do for my child. At 9 yrs old he was diagnosed with plantar facitis, hammer toes in both feet, and pronation in both feet. I had taken him for 2-3 phycian opinions every 2 years from the age of 18 months, and was always given opposing opinions. One wanted to brace him, one do nothing, and one wanted to cut tendons under his toes to flatten them out. Although I would try new doctors these varying opnions would result time after time. Then a few years ago a family member went to work for a podicatrist. He was opposed to surgery due to his growth plate and suggested orthotics. So we have done this, only to have him wear them during football practice which resulted in 2 months of physical therapy. His PT suggests flexible orthotics, while Podiatrist says his are too severe and needs hard orthotics. He is now 11 and playing tennis and basketball. After a few practices of tennis his feet and toes hurt so bad that he has to miss and WILL NOT put on a pair of shoes. (I have to say he did not wear his orthotics to tennis because they were causing his heel to pop out in the shoes he o wear.) I am at my wits end…. he starts basketball next month and I’m not sure what to do. I take him to the running store for shoe fitting and pay $60+ for high end Saucony running shoes, but he complains of his toes being squished (from looking at the bottom of his feet it looks as though he only has four toes because his second toe is elevated above his third toe on both feet). He already has to work so much harder than all the other kids, and I feel so bad for him as his gait is much different than others ~ any recommendations you could provide I would so appreciate. I cannot afford to continue buying shoes that just do not help and am unsure where to go from here.

  10. Shachar says:

    Struggling to find winter boots for my 2 year old son. Any suggestions? Are pedipeds a good option?

  11. Carol says:

    I am wondering about how people with flat feet will do with these shoes … is their enough arch support for those who would normally wear orthotics?

    • MarkC says:

      Carol,

      a healthy foot even if “flat” does not need arch support. thanks for note. See Dr Kerrigan’s and Dr McClanahans articles on the site.

      Mark

  12. RANDY FULGHAM says:

    these are great for kids

  13. good article and this shoes are good for kidz


Leave a Reply

*