Shoes and children (Part 1)
Preserving what’s healthy without weakening it
Feet have often been the focus of attention of health professionals, whether it is to pay tribute to corrective technologies and their incidence on ambulation disorders or, actually doubt such incidence, or to question the intrinsic value of shoes. Health professionals, parents, young runners and large companies have all shared their experiences and contributed, to some extent, to expanding our knowledge. Let’s be frank, the items set out below will never silence the voices of dissent we can often hear on the subject, but they will at the very least allow us to catch up on contradictions and distortions. At a time when retail giants benefit from many platforms to express themselves and speak with a stronger voice than do actual experts, it is important to get back to scientific evidence and inform consumers on shoes and children.
The issue at stake...
There is a strong possibility that your baby’s first shoes will fall under the “corrective shoes” category, without your informed consent. This is even truer if your child is undertaking their first locomotor activities. Surprising, isn't it? Not so much when you consider that the majority of children’s shoes currently available on the market are made of rigid materials, manufactured with a raised heel and a plantar arch support. Shoe features allegedly intended to “correct,” or at least prevent, muscle and bone structure abnormalities or ambulation disorders. In other words, your child is healthy, their lower limbs are not yet fully grown and measures are already taken to protect them from problems that do not even exist. What’s more: these technologies limit feet stimulation, free development and muscle strengthening.
Interference with development
Before calling into question some of the most deeply held beliefs, which are not based on scientific evidence, let’s focus on one key point: a child’s growth is not completed before the end of their teenage years. Their body will continue to change; bones will lengthen and change shape, muscles will get stronger. Trying to prevent the occurrence of abnormalities or correct the presence of what seems a deficiency by looking at a specific standard or model is to interfere with your child’s normal course of growth. There is currently strong evidence (2016-Shultz, 2014-Hollander, 2011-Wegener) to the fact that having children wear shoes has the same impact on their biomechanics as it has on adults. Slower cadence, promotion of heel strike, increased vertical loading rate and higher oxygen consumption are the main consequences observed. In light of the scientific information currently available, none of these effects are desirable or even beneficial to a child’s development. Most children’s shoes available on the market are narrow, rigid, with an elevated heel and an over-pronounced arch. These features interfere with the feet’s normal growth, and even with general motor development.
All (or almost all) experts in that field seem to agree with the principle that children should be barefoot as often as possible or wear shoes that are as minimalist as possible. The American Academy of Pediatrics has been saying this for a very long time and so has the Canadian Paediatric Society concerning most recommendations along with the Canadian Podiatric Medical Association.
On the other hand, other bodies seem disconnected from science and it is hard to really know on what basis their recommendations are being made. It is about time that the Union française pour la santé du pied renew its recommendations for children and the same goes for the American Podiatric Medical Association whose commercial bias is blatant and exposed without any shame!
Why have I always been told the opposite?
If you ever run into skeptic people who still recommend children’s shoes with weird features such as those currently integrated into shoes, ask for references that justify their recommendations. They are the ones with the burden of proof and who need to demonstrate that their intervention (having a growing child wear bulky shoes) is not harmful or even beneficial! As you will probably see, there is not even a shred of evidence or even logic that justifies this practice, other than promoting a lucrative business.
For a long time, children’s shoes were perceived by consumers, and promoted as such by health professionals, as a tool meant to promote proper alignment in growing children. The materials used were rigid, feet were held in a firm structure and even if shoes were not worn for very long, and that they cost a fortune, people did not think much about the value of such an investment. Science and experts now speak a different tune. Four characteristics should guide your decision when purchasing children’s shoes. They should be: comfortable, flexible, light and thin (allowing to feel the ground). More on the subject in Blog 2 entitled “Detailed Practical Recommendations.”
2016-Shultz (Metabolic Differences Between Shod and Barefoot Walking in Children)
2014-Hollander (Effects of footwear on treadmill running biomechanics in preadolescent children)
2011-Wegener (Effect of children's shoes on gait: a systematic review and meta-analysis)