Shoes for Children: A Review Lynn T. Staheli Pediatrics 1991;88;371-375 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1991 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 SPECIAL Shoes Lynn ARTICLE for Children: A Review MD T. Staheli, From the Department of Orthopedics, Children’s Hospital and Medical and Department of Orthopaedics, University of Washington, Seattle The nature of appropriate footwear for children remains a controversial issue. Some physicians believe that shoes are simply part of the child’s clothing, while others believe that shoes are important therapeutic tools capable of correcting deformity and preventing This review shoes, the the significant disability later in life. focuses on how the foot fares without normal effect development of footwear recommendations and footwear based on and for for data shoe children. rather child’s than foot were Sim-Fook impressions or The natural has been examined and that greater the wearing though noted of the foot, ie, the studied by several investigators. the feet of 186 natives of the Central Africa who had not he found some variability that all feet showed excellent worn bare foot, Hoffman1 Philippines shoes. Al- in the tribes, he mobility, thick- ening of the plantar skin, and wide variability in the height of the arch. He reported that eversion of the foot was rare and that these people’s feet were pain-free. Engle and Morton2 infections footprints found of natives no static studies deformi- 118 shoe- Chinese. barefoot fewer of the foot compared of the and and subjects showed than of those that the deformities consistently They showed un- shod human foot is characterized by: (1) excellent mobility, especially of the forefoot; (2) thickening of the plantar skin as great as 1 cm, which was FOOT state to parasitic non-shoe-wearing feet Seattle; apparently experiencing They found that major Hodgson4 107 mobility shoes. These BARE the He and and found are fmdings due studied Islands. wearing some tradition. THE problems trauma. James3 Solomon ties. modification, Our of live coals, whatsoever.” foot, modifications, effective normal objective of the shoe through a bed no discomfort Center, studied the feet of usually determined environment; (3) dorsum of midtarsal with the joints; metatarsals variability in static features in their the plantar and foot due to the flexibility of the (4) alignment of the phalanges causing the toes to spread; (5) arch height; and (6) an absence of deformity. NORMAL unshod natives in the Belgian Congo. They found an absence of “static foot deformities” and noticed that because of the extreme thickening of the plantar skin, the natives “would not hesitate to walk the by the surface creases on both Arch FOOT DEVELOPMENT development mented by changes footprint foot pattern This was in Morley.5 to one supported children was This study with advancing showing first docu- showed that the age from a flata longitudinal in a study by arch. Engel and Sta- heli.6 In Received for publication May 29, 1990; accepted Sep 5, 1990. Reprint requests to (L.T.S.) Director, Department of Orthopedics, Children’s Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105. PEDIATRICS (ISSN 0031 4005). Copyright © 1991 by the American Academy of Pediatrics. 1987, sample ment was made. nal that This arch the et a17 reported with a larger normal subjects). Arch developdocumented and standard deviations Staheli size (442 study develops range demonstrated during of normal the that first the longitudi- 6 to 8 years and is broad. PEDIATRICS Vol. 88 No. 2 August Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 1 991 371 recently. Pediatricians Most recently, Gould et al8 observed 125 subjects for 4 years during early childhood. Arch development proceeded independently of the type of foot- the and wear to a questionnaire worn. These that the during occurs studies are longitudinal infancy naturally The consistent in arch develops and and childhood. independently radiographic child’s foot 1988. They bearing changes in children. eters talar age. The included respondents veyed, 44% of 400 physicians preferred soft high-topped shoes, the associated with and talometatarsal range values of normal previously 1980, developing et al9 in weightsurvey of param- flatfeet, angle was to 500 development of footwear. a cross-sectional found radiographic They commonly inclination with in sent ered very considered that is, change and broad tennis diagnostic of shoes Staheli Only paedic diatric of and more the and ufactured in the EFFECTS OF consid- for past the shoes, 32% preferred tennis shoes. “ortho- pediatrician and the pemost opposed to rigid decade changing the shoe attitudes shoes less mn children. recommended by producing flexible Dyment respondents 279 24% preferred the were to question found that of the 269 and podiatrists sur- pediatricians footwear. During has responded to pediatricians Griffin’7 shoes.” Again, orthopaedist physicians first mn 1972, to be satisfactory and 7% the footwear. 75% of the demonstrating spontaneously were reported by Vanderwilde provided normative data from radiographs normal This were value of supportive Bogan’#{176}found that that constrictive industry among are somewhat than those THE FOOT man- past. pes planus. THE HISTORY OF The The in history of footwear was 1972.’#{176}He noted that dating from about reviewed by the earliest 10 000 years wear, Stewart a status rope. Pointed of Anjou the symbol shoes to hide foreshoe his in Greece, were introduced own deformed length became has known footago, was re- covered from caves near Fort Rock, Oregon. were worn in ancient Egypt and Mesopotamia. tially worn to protect the foot from injury, became Rome, Shoes shoes and feet. Eu- heels to to signify Shoes a decree length grain were increase high were often the social sized elevated from the in that Measurements which were mm.The and barleycorn, is about started facilitated the one third at 3 inches shoe based standard and 7 inches for adults. Standard based on increments of one twelfth standardization distribution. de- individual century shoe of a of an inch. for children shoe widths of an inch. were This manufacturing and adult shoe by fashion. design During past shoe for children was 200 years, by quired rigid and shoes,11’5 372 the often design impression “support.” Many by corns, Supportive the child’s has the deterfoot which The of usually this CHILDREN’S was cover not imitate have aged were not McKee,24 74% were in shoe observed child’s foot tential studies rigid and opinion until shoe.” foot disability worn children, concept that that that shoes. found footwear deformities in the CORRECTIVE The these deformities not that that the configuration of did not conform to conventional suggest to produce tic” appears assumptions to had 2 to 4 years the lasts. These THE of 4000 of who wearing shoes that were 0.5 to 3.6 sizes Furthermore, Bleck,25 in a study of 1000 too small. children, normal a study noted effects by Emslie,23 toes. who the who been The These in children that Socrates, some seen shoes noted had of the but that ill-made and of footwear of painful, observers.”2”922 deformity on taste He noted by era based the feet with walking caused of disability shoes impossible.” feet 18th professor depraved and render effects other that or the foot the of footwear on children were studied noted that 80% of 281 children was a minority the harmful many footwear objected only absolutely on the In Dutch noted the toes not cases disease by re- compressive. physicians but that He had frequency of fashion “deformed has authors. acclaimed the footwear. “absurdities significant 2000 years, determined mined on of length For the past been primarily an observed dated to the pre-Christian world unfortunately did went barefoot. the to ridiculous 14th the many the introduced theorized of the Camper,’8 medicine, shoes by to status. from Edward was based on the of barley, ON wearing a time, proportional height century in some the heel’s original purpose was to stabilize the foot of the mounted warrior in the stirrup.’#{176}Again, the original functional role of the shoe was altered. mn grees that reported the day” Fulk For effect been caused mi- by Count individual’s social status. Heels were Europe in the 16th century. Stewart France, FOOTWEAR SHOES foot the poand adult. SHOE shoe design to be based on that the growing the has in children can be could the molded SHOES Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 be “therapeuwidely foot needs by accepted support a “corrective The assumption likely to traced to Andry26 that that develop minor the child’s normally in the postural foot 18th century. variations No significant is most if “supported” can be were a common cause of adult disability and taught that proper posture, therapeutic exercises, and supportive footwear in the child would prevent adult disability. ported A common arch could belief was that be permanently the child’s flattened difference Bordelon41 ometatarsal He theorized in childhood trast, unsupunless angle children with The effect assessed by subjects that et al43 treated even today.235 Evidence suggesting are unnecessary comes First, data indicate that stiff, supportive shoes primarily from two sources. that barefooted stronger and healthier feet than those who wear shoes. have shown that the arch regardless of footwear. The idea that the child’s subjects with fewer deformities Second, several studies develops in the child foot can as those associated or improved by the external modeling forces such casts. Other examples include is based on First, that with clubfeet application of as a series of molded the use of bracing in scoliosis and orthodontic appliances in dentistry. Second, that the application of external forces can cause deformity. Examples include the severe cavus deformity induced by binding the feet of girls in China and the “giraffe neck” deformity produced by applying rings around the neck of growing children in Africa. and Hodgson4 Furthermore, in as noted 1958, it appears by Sim-Fook that causes of the such deformities correction and as bunions. These creation of deformity ternal forces basis are the “corrective shoe.” The assumption formity is responsible cations such and plate,37 Mattison39 supports keted. the forces a myriad in 1933 estimated 50 few objective the validity “corrective shoe.” immediate effect Penneau Two of arch et shoes data of de- were being have shoe flatfeet. wedges one on intoeing study. The has been commonly pre- as measured by ious shoe with corrections inserts been reported. a pes a period reduction Berzins44 the UCBL planus” Labo- of 2 years. improvement and Mereday “flexible in in improvement was maintained month follow-up period. and with on Biomechanics for experienced configuration, assessment with of California (UCBL) children have 10 children University ratory video This study, plus clinical expeshoe wedges are ineffective in problems. studies of children with var- All gait, arch discomfort. The throughout treated insert a 71 children or Helfet 6- for pes heelcup38 for more than improvement 1 year. Seventy-nine percent showed by clinical and radiographic measure- ments. Bordelon45 reported dren for treated ported a follow-up pes planus improvement in of 6 of 50 with the inserts. chil- He talometatarsal re- angles following customized orthotic use and in 5 of the 6 patients seen at follow-up the correction had been maintained. These three studies were conducted without control subjects and that with provement graphic studies reported by Vanderwilde radiographic were of open normal criteria to of im- question. subjects et al.9 They Radio- were recently found that the normal range included talometatarsal angles of up to 20 degrees in this early childhood age group. This range was defined as abnormal by Bordelon.45 Furthermore, the wide range of normal puts into question the criteria for improvement of just 3 degrees prospective arch the effectiveness of shoe the flexible flatfoot. mn a mar- 3-year compared modifications. only tal- in 50 published modification the by radiographic children with both of their hypermobile of shoe inserts by Bleck and Berzins.44 mn 1989, two controlled modifi- 100 different supports applied cause of shoe available from studthe concept of the studies al4#{176} studied taken planus feet by radiographs feet and with commonly of the heel,3#{176} Whitman mn Great Britain, that “doctor’s” examples by ex- concept external for as the Thomas Helfet heelcup.38 and There are ies assessing studies. that for footwear in the by custom-molded mirrored gait ramp. rience, suggests that managing rotational Several longitudinal Bleck planus be effectively changed by wearing a “corrective” shoe observations that fall into two categories: deformities such can be corrected have mn con- demonstrated. improvement scribed wedges were applied to the sole of the shoes of intoeing children by Knittle and Staheli.42 None of the wedges improved the intoeing of the 10 the foot was supported. An example of the common teaching of the time was by Griffith,27 who advised parents that their “infants should be taught to creep, and early walking discouraged.” The desirability of the stiff shoe for the child has been a classic recommendation of orthopaedists persists was reported pes bare that study evaluated in correcting of 129 children, no difference between treated a variety with those with normal flexible studied 125 children for planus” at the beginning. were prescribed. gardless controlled of the studies, Wenger children of Arch footwear. the studies with were et al46 found flexible “corrective flatfeet shoes” and footwear. Gould et a18 5 years. All had “pes Four types of footwear development In these application SPECIAL Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 occurred two re- prospective of ARTICLE “corrective 373 shoes” tudinal did not affect the arch of the child. Regardless of the development of the 8. Acceptable longi- very effectiveness of 9. Reasonably “corrective shoes,” an important consideration is the reason for attempting correction of the flexible flatfoot. Harris and Beath,47 in the classic Canadian Army foot study, showed that the flexible flatfoot in the adult is a benign condition. msraeli Army study48 showed Furthermore, fewer stress individuals The with suggests that child the low arches. treatment is probably of the both a recent injuries in available evidence flexible unnecessary flatfoot and in in ineffec- wear because appearance sensitive about priced. Medically not be expensive. need children are that. satisfactory foot- “Tennis shoes” are commonly recommended for children. Unfortunately, “tennis shoes” encompass a large variety of shoe types. Some are ideal, meeting the criteria perfectly, while others have stiff soles with scribe parents occlusive uppers. the characteristics rather than simply Physicians should of a good shoe recommending de- to the “tennis shoes.” tive.49 NONCONTROVERSIAL CURRENT USE SHOE MODIFICATIONS IN THE FUTURE Shoes mize Some shoe modifications modifications are not may be of value. “corrective” but immediately demonstrable the short leg equalize limb effect: length gait. older (2) Shoe inserts in the These produce some (1) Shoe lifts for and may improve child or adolescent with rigid foot deformities may redistribute weight bearing more evenly about the sole for pain relief or skin protection of the insensate foot. (3) Shockabsorbing rubber dromes hood footwear inserts such and with cushioned soles or tion while routine NORMAL synchild- FEET is important.5#{176} Shoes that are the toes and create deformity.’6 length likely the child to fall.51 too If will become Probably the best model for footwear is the unshod state as shown by the studies of barefoot populations. It provides a basis for setting the criteria to achieve The 1. Quadrangular, configuration, toes.23’24’52 most to with effective conform abundant to footwear the should normal space should in the shoe FOR comfort an acceptable add to maxi- and protec- appearance. of maximum would CHILDREN be designed to provide retaining cushioning comfort and The fea- reduce the incidence of the overuse syndromes common during late childhood and adolescence. Physicians need to promote the concept that shoes are part of the child’s clothing, and selection should be based on practical rather than medical considerations. SUMMARY 1. Optimum the shoe is of excessive clumsy and is more footwear. and incorporation tures adolescence. SHOES FOR INFANTS AND CHILDREN WITH future function foot ideal be of the FOOTWEAR foam is helpful in managing overuse as heel or shin pain during later Proper fitting short compress OF foot for the to allow free foot movement.’2’13 without elevation of the heel.’1 4. Porous. Uppers should be made of leather or unsealed fabric to avoid skin maceration or fungal infections. 5. Moderately tractive. Sole friction should be equivalent to that of the bare foot. Soles that are slippery (leather) or that create excessive friction (some rubber soles) should be avoided.’ 6. Light weight to reduce energy expenditure. 7. Extended above the ankle in the toddler to prevent the shoe from slipping off during running.’7 foot development occurs in the bare- environment. 2. The primary role of shoes is to protect the foot from injury and infection. 3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility. 4. The term “corrective shoes” is a misnomer. 5. Shock absorption, load distribution, and elevation are valid indications for shoe 6. Shoe selection for children the barefoot model. 7. Physicians should avoid commercialization and modifications. should and “media”-ization be based on discourage the of footwear. Merchandizing of the “corrective shoe” is harmful to the child, expensive for the family, and a discredit to the medical profession. 2. Flexibls 3. Flat 374 CHILDREN’S REFERENCES 1. Hoffman 2. 3. 4. 5. P. Conclusions drawn from a comparative study of the feet of barefooted and shoe-wearing peoples. Am J Orthop Surg. 1905;3:105-136 Engle ET, Morton DJ. Notes on foot disorders among natives of the Belgian Congo. J Bone Joint Surg. 1931;13:311318 James CS. Footprints and feet of natives of the Solomon Islands. Lancet. 1939;2:1390-1393 Sim-Fook L, Hodgson A. A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg. 1958;40A:1058-1062 Morley AJM. Knock-knee in children. Br Med J. 1957;2:976-979 SHOES Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 6. Engel 7. 8. GJ, Staheli LT. The natural other factors influencing gait 1974;99:12-17 Staheli LT, Chew DE, Corbett survey of eight hundred and children Gould J Bone and adults. N, Moreland M, history in 30. Miller of torsion and Clin Orthop. childhood. 31. M. The longitudinal eighty-two feet Joint Surg. Alvarez R, arch: normal in a 32. 1987;69A:426-428 Trevino 5, Fenwick J. 33. Development of the child’s arch. Foot Ankle. 1989;9:241-245 9. Vanderwilde R, Staheli LT, Chew DE, Malagon V. Measurements on radiographs of the foot in normal infants and children. J Bone Joint Surg. 1988;70A:407-415 10. Stewart SF. Footgear: its history, use and abuses. Clin Orthop. 1972;88:119-130 11. Adams D. Proper shoeing ofthe child. JAMA. 1929;92:17531755 12. Crandon LRG. Flexible balancing shoes. Boston Med Surg J_ 1906;CLV:505-507 13. Sofield HA. Care of the feet of normal children. Illinois Med J. 1941;79:253-256 14. Staheli LT. Corrective shoes for children. J Cont Educ Pediatr. 34. 35. 36. 37. 39. 1978;20:22-25 18. Staheli LT, Griffin L. Corrective of current practice. Pediatrics. Camper P. Dissertation on Orthop. 1975;110:2-5 19. Blyth Brooke COS. 20. 147 Didia contact 21. 22. 23. BC, Omu index Foot ET, shoes for children: health. Obuoforibo II for classification best form Med Officer. AA. The Emslie M. Prevention offoot use deformities 44. of footprint in a Nigerian Med to Surg school 45. J. 46. 27. delphia, 28. Cowell the in children. 47. Lancet. HR. Shoes and BUSH Likewise, Bush won’t the in the curative are ‘arch support’ LD, Winter foot shoes RB. Pes planus: orthoses and shoes. of California Biomechanics flatfoot Am anyway? radiographic Foot Ankle. in children of shoe modifica1976;7:1019-1025 Evaluation of the Laboratory shoe shoes as treatment for flexible flatfoot in- in infants Joint Surg. 1989;71A:800-810 Harris RI, Beath T. Army Foot Survey: An Investigation Foot Ailments in Canadian Soldiers. Ottawa, Canada: tawa National Research Council of Canada; 1947 Giladi 295 49. J Bone M, Milgrom factor Stein J, et al. The low arch as fracture: a prospective study of recruits. Orthop Rev. 1985;14:709-712 Philosophy of care. Pediatr Clin North Am. military Staheli C, of Ot- LT. in stress 50. Coughlin MF. Fitting children’s shoes: what to tell the J Musculoskeletal Med. 1985;2(9):39-46 51. Gould N. Shoes versus sneakers in toddler ambulation. Foot Ankle. 1985;6:105-107 52. Barnett CH. Footwear for healthy and disordered feet. Phys- corrective value parents. of foot- iotherapy. WON’T White CHANGE House STRATEGY acknowledged would have a big payoff for U.S. after concluding it was “not likely change support sert in ‘flexible’ pes planus. Clin Orthop. 1972;82:45-58 Bleck EE, Berzins UJ. Conservative management of pes valgus with planter flexed talus, flexible. Clin Orthop. 1977;122:85-94 Bordelon RL. Hypermobile flatfoot in children: comprehension, evaluation and treatment. Clin Orthop. 1983;181:7-14 Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. protective of Infants and Children. Phila1920:423-424 corrections. Pediatr Clin North shoe of positive 1986;33:1269-1275 Am. 1977;24:791-797 29. Hansen AH. The prophylactic and gear. Med Record. 1922;101:416-418 children” the idea 48. French The Diseases PA: WB Saunders; K, Lutter and children. 24. Mckee JJ. Bady needs new shoes! Hygeia. 1942;20:142-143 25. Bleck EE. The shoeing of children: sham or science? Dev Med Child Neurol. 1971;13:188-195 26. Andry N. Orthopaedia on the Art ofPreventing and Correcting Deformities in Children. London, England: A. Millar; from New Corrective chil- 1939;2:1260-1263 1743. Translated Griffith CJP. AJ. 1956;1:262-264 Mattison ND. What Med. 1933;39:582-585 University 1948;80:146- of flat feet population. Foot Ankle. 1987;7:285-289 Soutter R. Shoes and feet. Boston 1906;CLIV:40-42 Wilkins EH. Feet: with particular reference then. Med Officer.1941;71:5-30 Clin shoe. of children’s Am J Orthop Surg. 1913;11:215 way of treating flatfeet in children. Lancet. 41. Bordelon RL. Correction of hypermobile by molded inserts. Foot Ankle. 1980;1:143-150 42. Knittle G, Staheli LT. The effectiveness tion for intoeing. Orthop Clin North Am. 43. Mereday C, Dolan CME, Lusskin R. a survey of on the examination R. Importance of weak feet. changes with 1982;2:299-303 1980;65:13-17 the Whitman treatment 40. Penneau Staheli LT. Evaluation of planovalgus foot deformities with special reference to the natural history. J Am Podiatr Med Assoc. 1987;77:2-6 16. Dyment PG, Bogan PM. Pediatrician’s attitudes concerning infants’ shoes. Pediatrics. 1972;50:655-657 Observations Parks CC. Scientific treatment of foot disorders. Med Record. 1935;141:138-140 Polokoff MM. An approach to children’s foot orthopedics. J Am Podiatr Assoc. 1976;66:419-423 Roehm HR. Weak, pronated and flat feet in childhood. Arch Pediatr. 1933;50:380-394 Tax HR. Enough is enough: Tax answers Staheli. J Curr Podiatr Med. 1987;36:6-12 Wickstrom J, Williams RA. Shoe corrections and orthopaedic foot supports. Clin Orthop. 1970;70:30-42 Cole HP. Shoes for cure of flat-foot. Med World. 1908;26:207-209 38. Helfet 15. 17. WR. J Pediatr. 1957;51:527-536 feet. strategy on poverty. San Jose that 1967;53:137-140 ON POVERTY a major new society in the long run, to show an immediate Mercury News. July “investment in but it shelved reward.” 6, 1990. SPECIAL Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007 ARTICLE 375 Shoes for Children: A Review Lynn T. Staheli Pediatrics 1991;88;371-375 Updated Information & Services including high-resolution figures, can be found at: http://www.pediatrics.org Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.pediatrics.org/misc/Permissions.shtml Reprints Information about ordering reprints can be found online: http://www.pediatrics.org/misc/reprints.shtml Downloaded from www.pediatrics.org by Michael Martin on September 13, 2007
© Copyright 2024