“I only buy the best shoes I can find.”

“I paid $150 for these!”

“All of the nurses and doctors wear this brand.”

“I change my shoes every three months.”

“I consulted with my local running shoe store before buying these.”

“I know I have the right shoe for my arch.”

I am sure many of you have heard these same comments and probably continually do on a daily basis. So what is the best shoe? Should this even be a question? In our society, we too often place our focus on finding a quick fix. In regards to foot injuries, that quick fix happens to be shoes. In reality, it might not actually be the solution.

Rather than beginning this discussion with what adults wear, let us take a look at what the literature advises on footwear for children. The American Academy of Pediatrics does not advise placing children into shoes until the environment necessitates it.1 When you review the pediatric orthopedic literature on shoe gear, it is also clear that children should be wearing shoes that are flexible and allow the foot to bend and move as though the child is barefoot.2-6 In his 1991 article in Pediatrics, Lynn Staheli, MD, makes the following comments.7

1. Optimum foot development occurs in the barefoot 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 modifications.

6. Base shoe selection for children on the barefoot model.

7. Physicians should avoid and discourage the commercialization and “media”-ization of footwear. Merchandising of the “corrective shoe” is harmful to the child, expensive for the family and a discredit to the medical profession.

Rao and Joseph demonstrated a higher prevalence of flat feet among children who wore shoes in comparison with those who did not.2 They found that closed toe shoes inhibited the development of the arch of the foot more than slippers or sandals. Rose advises not to address a flexible flatfoot in a child even with the use of custom orthotics, stating that treatment is not influential in the course of the flatfoot as the child ages.3

It becomes apparent even when looking at a child's foot that flatfoot deformities are more of a variant than a true pathology.

The question remains as to what truly happens to an adult’s foot if he or she continues to wear non-supportive shoes through childhood and into adolescence. Will the adult foot maintain the wider forefoot and more evenly spaced digits from childhood?

References

1. Hoekelman RA, Chianese, MJ. Presenting Signs and Symptoms. In: McInerny TK, Adam HM, Campbell DE (eds.) American Academy of Pediatrics Textbook of Pediatric Care, 5th edition, American Academy of Pediatrics, Elk Grove Village, IL, 2009, p. 1528.

2. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992; 74(4):525-7.

3. Rose REC. Flat feet in children: when should they be treated? Internet J Orthopedic Surg. 2007; 6(1). Available at http://www.ispub.com/journal/the-internet-journal-of-orthopedic-surgery… . Published 2007. Accessed June 18, 2012.

4. Walther M, Herold D, Sinderhauf A, Morrison R. Children sport shoes--a systematic review of current literature. Foot Ankle Surg. 2008; 14(4):180-9.

5. Wegener C, Hunt AE, Vanwanseele B, Burns J, Smith RM. Effect of children's shoes on gait: a systematic review and meta-analysis. J Foot Ankle Res. 2011 Jan; 4:3.

6. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008; 27(1):51-9.

7. Staheli LT. Shoes for children: a review. Pediatrics. 1991; 88(2):371-5.

Editor’s note: Dr. Campitelli has disclosed that he is an unpaid Medical Advisor to Vibram USA.