Saturday, January 22, 2022

The seasons change; there is a special occasion; your child’s feet are growing; he/she just started walking; there are many exciting and everyday reasons to purchase new shoes. However, the purpose of shoes is to cushion, support and protect feet.  When feet are not properly supported, they cannot withstand the load they bear.  This may cause gait abnormalities, foot deformities, pain, skin breakdown, and impaired function. Just think of the pain your feet endure when wearing high heels for a couple of hours on Shabbat or at a Simcha.

As a physical therapist, the task of selecting the proper shoes for my children is important to the development of their feet.  As a mother, I want to choose stylish shoes that my kids will like and will want to wear, but they also need to fit properly.  Shoes should not be selected solely based on their style, but rather how the shoes support to your child’s feet.

Since shoes play an integral role in the development of feet, it is important to know when to start wearing them.   For example, Alyssa is 10 months old and just began cruising (walking while holding on).  Her mom wants to get her a cute pair of sandals to go with her summer outfits.  Ben is 14 months old and just took his first steps.  Mom is so excited; she runs out and buys him a pair of sneakers.  Should Alyssa and Ben be wearing shoes at this point, and what would be the proper footwear? The answer is that the best time to get your toddler shoes is once he/she is actively walking.  Walking from the coffee table to the sofa is NOT actively walking.  He/she should be able to walk across a room or walk from room to room.  Once your toddler is able to walk without falling down frequently, it is time to take him/her to the store to be fitted with the best shoes for his/her feet.

When searching for footwear, it is important to know the anatomy of a shoe in order to find the best fit for your child’s feet.  All shoes are divided into two parts, upper and lower. The upper section consists of the toe box, vamp, and heel counter. The lower section includes the insole, shank, midsole, and outsole.  The toe box is the front area of the shoe where the toes rest.  It is important to make sure there is at least half an inch of space between the toes and the front of the toe box.  The vamp covers the top of the foot and should fit snuggly, holding the foot firmly but comfortably in place.  The heel counter is the back of the shoe that holds the heel in place.  A stiffer counter offers greater heel control and stability. If your child has flat feet, you should look for shoes with stiff counters.  The insole is the inside of the shoe where the sole of the foot rests.  The insole of the shoe can be easily removed and replaced with a more supportive insole if necessary.  The shank is located under the arch of the foot. The stiffer the shank, the more support it provides.  The midsole is the material that sits between the upper section of the shoe and the outer sole.  The softer the material, the more shock absorption the shoe has.  The outsole, or hard bottom of the shoe, is typically made of durable leather, blown rubber, or man-made materials.  Certain types of outsoles provide more traction than others.1

You can evaluate a prospective shoe using the following three tests:

Flex Test—When bending the shoe where the knuckles of the toes lie, it should be firm but not provide significant resistance.

Torsion Test—You can check the stability of the sole by twisting the shoe in opposite directions.  If the shoe twists over on itself it has inadequate support.

Counter Test—When grasping the heel of the shoe, apply pressure to the heel counter with your finger.  If the counter collapses with little/no resistance, the shoe is not supporting the heel.

Children’s’ feet grow very quickly.  Unlike shoes for adults, kids’ shoes need to support their growing feet.  Shoe-fit should be assessed every three months to make sure their feet did not outgrow their shoes.  If a child has some common foot abnormalities such as flat feet, pigeon toed, or high arches, shoes that support the arch or ankle, or an orthotic might be warranted.  In these cases, both a physical therapist and a podiatrist can perform a proper foot assessment and gait analysis in order to appropriately fit the child’s footwear.  The physical therapist will further assess the child’s gross motor function once the proper shoes have been selected to ensure there is adequate support.

Any further questions about finding the best shoes for your child can be emailed to info_thetherapygym.com.

Source: National Ambulatory Medical Care Survey (NAMCS, 2005-2009)

Elisheva Fuchs is the owner of Teaneck-based Therapy Gym. She can be reached at: ellie_thetherapygym.com or 201-357-0417 and her website is: www.thetherapygym.com

by Elisheva Fuchs, PT, DPT

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