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Foot
Facts
What
does the podiatrist do?
Top tips for
children’s feet
Footwear
The
Ideal Shoe
Problems
associated with growth
Problems
associated with activities
Skin
and nail problems
How
can you help?
What
parents can do ?
What teachers can do ?
What the child can do ?
Interesting
facts about feet
Frequently
Asked Questions
How
often do I need to change my child’s shoes?
When should I buy my baby her first pair of shoes?
What style of shoe is best for a baby who has just started walking?
My baby has flat feet, is this normal?
Should I buy a baby-walker?
My child’s feet always seem to be cold, is this normal? Should I
put him in socks and slippers?
How tightly should I pull the socks on my child’s feet before I
put on their shoes?
How often should I cut my child’s toenails and how should I cut
them?
How can I check that my child’s shoes fit properly?
What shoes should I put my child in during the summer?
Should my child wear the same shoes everyday?
Are plimsolls advisable?
Shoe shops rarely seem to fit Wellington boots, canvas shoes and
slippers, how can I make sure that this type of footwear fits
properly?
Are width fittings really important?
Can a young child tell if her shoes hurt?
My child seems to have knock-knees, is there anything I need to do?
What socks are best?
Do I need to buy my children’s shoes from a specialist shoemaker?
My child always wears trainers. Is this unhealthy for their feet?
Do trainers need to be fitted?
My teenager insists on wearing high-heeled, pointed shoes, and I am
worried about the long-term damage this will do to her feet.
Are there any warning signs I should look for when I check my
child’s feet?
Do
I need to get my child’s feet measured every time I buy shoes?
Buying shoes - A straightforward guide
Foot Facts
Maintaining and caring for a child’s feet will benefit their
health, mobility and wellbeing throughout their entire lives. This
guide provides concise practical advice and information on feet,
their care and potential problems from birth until leaving school.
It addresses the main problems that may be encountered with the
young and developing foot and gives guidance on how you can keep
children’s feet in the best condition.
The human foot is a highly complex structure,
composed of 26 bones working together to allow the
foot to adapt to uneven walking surfaces, and acting as a shock
absorber with each step. These bones are usually fully hardened by
the age of 18. In the newborn, the foot is composed mainly of
relatively soft and flexible cartilage which gradually converts to
bone with age. In the young foot, the conversion to bone can be seen
as areas that are known as ‘primary and secondary centres of
ossification’. On an X-ray, this can make the young foot look as
though it has more bones than an adult. This is not the case, and
these centres gradually fuse to make individual bones. During this
period of development, the foot can be at risk from injury and
deformity due to ill-fitting footwear and great care should be taken
with shoe types and shoe fitting.
The foot also has a large number of ligaments
binding the bones together and helping to form joints that allow
free and painless movement. The foot contains approximately 19
muscles and numerous tendons running from the muscles in the lower
leg to allow the foot to work as part of the leg, and allow proper
walking. There is also a large network of blood vessels and nerves.
All of these structures have to adapt to the changes in foot posture
as the child grows.
As the old nursery rhyme goes, ‘the
foot bone’s connected
to the ankle bone, the ankle bone’s connected to the leg bone, the
leg bone’s connected to the hip bone’….so
it should be remembered that the foot cannot be considered in
isolation to the rest of the leg or body. Any postural foot
abnormality could have an effect further up the body, altering
posture and walking style. This is similar to the way that poor
foundations can cause general structural problems and instability to
a house.
What
does the podiatrist do?
When treating children, it is important to remember
that they are not small adults. They are physically and emotionally
different and, most importantly from the registered podiatrist’s
point of view, they grow.
Many of the problems found on the paediatric foot
are associated with growth, overuse, weight gain and postural
change. The podiatrist can help your child by providing an initial
diagnosis and then either managing the condition or referring to an
appropriate consultant. Treatment may take the form of footwear
prescription or advice, biomechanical assessment – which
determines the normal and abnormal functioning of the foot and lower
limbs and often involves the provision of orthoses (special insoles)
– active hands-on treatment and health education.
The role of the podiatrist is to prevent or correct
deformity and maintain normal mobility and function. Podiatrists
provide the basis for the ideal walking style and posture and
identify any medical or surgical condition that may require further
referral and management. They relieve pain, treat infections and
skin, nail, soft tissue and connective tissue problems. This is done
in conjunction with other members of the health care team.
Top tips for children’s
feet
• Always have your
child’s feet measured for length and width.
• Check
the size of their socks.
• Inspect
their shoes regularly for unusual wear and seek professional advice
if you are concerned. Unusual wear may be the first indication that
there is a problem with the foot posture or general posture and
should always be investigated by your registered podiatrist.
Normally, wear is across the back of the heel or between the back
and the outside. You should look out for severe wear on the inside
or outside of the heel which may carry forward to the sole of the
shoe. The heel area of the upper may also be broken and bulge inside
or outside.
• If possible, do
not put your child in the same shoes every day. Alternate shoes to
allow them to dry out, particularly if the foot is sweaty.
• Avoid the use of
plimsolls in school all day every day. If a change of footwear is
required in school, a fitted pair of lacing trainers is best.
• Be
aware that blisters and sores may develop with new shoes.
• Inspect
children’s feet regularly for inflamed nails, red pressure marks
on the top of the small joints of the toes, below the ankle bones
and at the back of the heel.
• Remember
that teenagers in particular can be secretive about foot problems
and a trivial, easily rectified problem can be more serious if
neglected.
• If
they complain of itchy or painful sites or you see any rashes or
hard, raised areas on the skin, seek professional advice
immediately.
• Wash
their feet daily with simple soap and water and dry well,
particularly between the toes. After drying, a small amount of
talcum powder should be used.
• Children
have naturally sweaty feet, but smelly feet may be an indication of
poor hygiene.
• The
toenails should be inspected regularly and trimmed as required. A
good investment is a pair of
nail clippers from your local chemist. Never cut down the side of
nails or cut them too short.
When cutting, follow the line of the nail at the tip
of the toe and always leave the corner of nail just clear of the
fleshy part of the toe.
Footwear
Many people regard footwear as purely shoes but it relates to any
covering for the foot and may include:
Babygrows and sleep suits
Care should be taken that the foot part is long
enough and does not cram the toes.
Pram shoes
These should only be worn for special occasions.
They are difficult to size and are best avoided. The best way to
insulate the foot is with bootees that do not constrict the ankles
or cram the toes.
Tights and socks
Tights and socks – particularly if regularly
tumble dried – may shrink and the fit at the heel and length at
the toes should be checked regularly, particularly if new shoes have
been required because of growth.
Knitted bootees
Knitted bootees are ideal to keep the feet insulated
but great care should be taken with their size and, if they are open
weave, care must be taken to avoid fibres wrapping around the toe
and cutting off the circulation.
Shoes for toddlers and early walkers
These should be fitted by a trained shoe fitter and
allow the foot to function normally. Remember that a young child’s
foot is a different shape from that of an adult or teenager whose
foot tends to have a rectangular shape when looking at the sole. The
shape of a young child’s foot is triangular with a narrow heel and
a broad front with the inner side of the foot angled inwards.
Reputable manufacturers are aware of this and design their shoes
accordingly. Ignoring this feature may lead to deformity of the big
toe.
GOOD
School
shoes
It is
always difficult to describe the ideal shoe, but a “school shoe”
is normally visualised as being an ideal shoe. This means that the
feet have been measured for width and length. The toe area is
foot-shaped and of sufficient depth to allow the toes to move
freely. The heel height is no greater than 4cm with a broad base of
shock-absorbing material. It also fits snugly around the heel area.
It is held on the foot with laces, Velcro or a strap and is made of
leather.
Trainers
Trainers
are generally foot friendly as long as the feet are measured. They
usually conform to the school shoe ‘model’ (see ‘School shoe’,
previous page). Beware of some trainers which, although leather, may
have extensive synthetic linings which can encourage excessive
sweating. Children are usually very keen to have a particular brand
name. Trainers could be worn in school in place of plimsolls.
BEWARE
Plimsolls
In order to
reduce noise levels and keep floor coverings clean, many schools
insist on children wearing plimsolls in school with their school
shoes only being worn to and from school. Often the plimsolls are
kept in a shoe bag at school overnight. As children’s feet are
very sweaty, it is unlikely that they will dry out overnight.
Plimsolls are excellent for the purpose they were designed for but
are an unsuitable environment for a growing foot. It is virtually
impossible to have the feet measured for plimsolls. They do not come
in half sizes and the rubber soling material encourages sweating and
while shoes are often changed regularly, plimsolls are overlooked,
so the child can end up with plimsolls that are too small. Children
who cannot tie their shoe laces are often encouraged to wear slip-on
plimsolls which may further encourage toe deformity.
Stilettos
Children
should not wear stiletto shoes. Apart from the obvious damage they
may do to a developing foot, they also alter the way a child walks
and their general posture, and may cause lasting damage. There is
evidence that children as young as eight years of age are wearing
high-heeled, pointed stilettos.
Platforms
The same
applies as for stiletto shoes – they alter walking style and
posture – but with the added risk of falls and ankle injuries.
Flat
shoes
Many
children are wearing very flat slip-on ‘dolly shoes’ that can
cause stress to the structures on the sole of the foot and back of
leg resulting in pain and inflammation. They also tend to have very
thin soles and give little protection from injury. Many slipon shoes
are deliberately worn approximately two sizes too small in order
that they do not fall off.
Baby
walkers
Children
will walk independently in their own time and when nature intended.
Baby walkers encourage joints to take load earlier than intended and
the foot and lower limb to move in an unnatural walking pattern.
Research has shown the use of baby walkers is associated with a
delay in normal walking and activities such as standing and
crawling. Their use is best avoided. Baby walkers are banned in
Canada.
CAUTION
Fashion shoes
There
should be an element of common sense where fashion shoes are
concerned particularly with older children. They can be worn for
short periods for special occasions but are potentially damaging to
the foot and general posture as they are rarely accurately measured,
they tend to be pointed and have a narrow high heel. They are often
made of synthetic materials with a thin sole offering little
protection.
The Ideal
Shoe
The
ideal shoe is very difficult to find and is often a matter of
compromise, particularly
with older children who are under the influence of fashion and peer
group pressure. Footwear which is
too large, too small, or does not fit properly, can cause
life-long foot problems. These problems can easily be avoided by
taking care with the type of
shoe purchased and considering a few main points. These are:
Adequate
length and width
All
children’s footwear should be measured for length and width and
fitted by an appropriately trained shoe fitter. If fitting is not
available, or is refused, go elsewhere. Poorly-fitting footwear in
young children could result in deformity, whereas in older children
it may result in toenail and skin problems. The Children’s Foot
Health Register is a register of retailers who guarantee to be ‘centres
of excellence for children’s shoe fitting’ and ‘provide
comprehensive training for staff and offer children’s shoes in
whole and half sizes and in up to 4 width fittings’.
See the
website at: www.shoe-shop.org.uk
Heel
stiffener
This is the
part of the shoe at the back and sides of the heel. It stiffens the
back of the shoe and stops the heel slipping out of the shoe. Along
with a broad base of heel, it helps to prevent sprained ankles. It
also helps to prevent claw toes, as a shoe which slips at the back
will cause the toes to claw to keep the foot in the shoe.
Height
of heel
This can be
increased as the child gets older but should be no more than 1.5
inches (4 cm).
Broad
base of heel
This should
be as wide as the heel to give stability, and be made of a shock
absorbing material.
Retaining
medium
This is the
term used to describe how the shoe is kept on the foot. Ideally it
should be by laces, Velcro or ‘T’ bar, which acts like a
seatbelt in a car, holding the shoe onto the foot. This helps to
prevent toe deformities, as a poor retaining medium can allow the
foot to slide up and down in the shoe and damage the toes or cause
the toes to claw to help keep the shoe on. This is a particular
problem with the current fashion of not tying shoelaces.
Upper
Material
Ideally
this should be made of leather and have a Gore-Tex® liner if they
are going to be subjected to prolonged wet conditions. Synthetic
materials e.g. plastic, nylon and rubber can cause the foot to sweat
excessively and increase the likelihood of athlete’s foot,
verrucae and in-growing toenails.
Toe
area shape
This should
be foot shaped and not pointed. Pointed toe areas may result in the
formation of bunions.
Retaining
medium
This is the
term used to describe how the shoe is kept on the foot. Ideally it
should be by laces, Velcro or ‘T’ bar, which acts like a
seatbelt in a car, holding the shoe onto the foot. This helps to
prevent toe deformities, as a poor retaining medium can allow the
foot to slide up and down in the shoe and damage the toes or cause
the toes to claw to help keep the shoe on. This is a particular
problem with the current fashion of not tying shoelaces.
Upper
Material
Ideally
this should be made of leather and have a Gore-Tex® liner if they
are going to be subjected to prolonged wet conditions. Synthetic
materials e.g. plastic, nylon and rubber can cause the foot to sweat
excessively and increase the likelihood of athlete’s foot,
verrucae and in-growing toenails.
Adequate
depth of toe
area
This is
particularly important in individuals with a big toe that curls up
at the end and helps to avoid toenail problems.
Soling
Material
This should
be of a slip-resistant, shock-absorbing material.
Problems associated with growth
The main difference
and characteristic of a child’s
foot compared with that of an
adult is that it grows. This means that
the child can be at risk from certain
foot and lower limb problems at
different ages as the feet and lower limbs develop.
These
problems are classed as:
•
Causes within the foot
(intrinsic)
•
Causes outside the foot
(extrinsic)
Causes
within the foot relate to the posture of the foot as it develops and
this can make the foot appear flat-footed. These conditions require
expert examination and advice, and professional help should always
be sought from your podiatrist if there are any concerns. The first
indicator may be unusual wear on the shoe.
The main
cause outside the foot is ill-fitting footwear with the possibility
of causing deformity. Also, as the foot and lower limb grow, they
undergo various positional changes that may look like serious
problems to the untrained eye, but may be just a matter of
developmental change. These can include bow leg, knock knee, and
toes pointing inwards or outwards. Some problems associated with
growth are first indicated by pain in the foot, swelling, limping or
a change in behaviour. A podiatrist or health professional should
always see these. They can occur at any time during the growing
years but each condition tends to occur within certain age bands. It
should be remembered that no two children are alike, even in the
same family. If parents are concerned – for whatever reason –
they should always seek professional advice, as it is better for the
fears to be unfounded than to discover, often too late, that
treatment was required.
Problems
associated with activities
This
relates mainly to the very active child
and the early secondary school years.
Many very young children will
attend playgroups and nursery where
they will have a more formal
exercise routine and may also
take part in climbing. They
rarely approach podiatrists
with problems associated
with exercise, but may be referred
to a podiatrist due to
concern about the way a child
walks or unusual wear marks
on shoes, such as on the inside or
outside of the heel.
During the
primary school years they will become more active: dance, gymnastics
classes and occasionally martial arts classes are undertaken. Once
again, there may be problems associated with injury but overuse
begins to become a feature. Foot arch pain is not uncommon,
particularly in children who have very low arches or are double
jointed. They may awaken their parents during the night with
distressing pains in their legs and feet. Often no organic cause is
found for this problem but children with a postural foot problem
often improve when treated with foot orthoses (insoles). The
incidence and severity of pain is usually associated with the level
of activity. If no improvement takes place in the short term, it is
always advisable to investigate the problem further.
In late
primary school and secondary school, growth begins to accelerate and
the child reaches puberty. At the same time, sporting and athletic
activities tend to increase and become more formalised. The child
will also be more active during the school day and may travel
further to school. There may also be activities in the evening for a
particular interest or talent. This can result in foot and lower
limb problems associated with excessive unaccustomed exercise.
Growth, possible weight gain and increased exercise contrive to
cause a wide range of painful foot and lower limb problems that may
be sports related. These complaints should always be taken seriously
and a diagnosis made. Failure to recognise and treat these overuse
problems can lead to long-term problems for the child and an
inability to reach their true sporting potential. Most problems are
readily managed by your podiatrist, utilising a variety of methods.
But the treatment may also require periods of rest and a change to
everyday footwear and activity footwear. Often the problem is easily
solved with footwear advice alone. Always remember to wear the
correct footwear for the individual sport. You wouldn’t play
squash in stiletto heels or tennis in football boots. Equally,
different types of trainers are required for different sports.
Bare footed
activities, e.g. karate, judo, while good exercise for the foot can
result in injury but also cause problems due to the foot having a
relatively lower heel from what it is used to during the day as
shoes are not being worn. This puts added strain on the arch of the
foot and back of the lower leg. Careful training and preparation are
essential. If a child indulges in any form of activity, injuries
will occur and there will be aches and pains from time to time.
Children are no different from adults in this respect but they tend
to repair more quickly. Also, they will not rest due to an injury
and need to be managed and monitored carefully. Very young children
may regard the problem as the norm and not complain. All aches and
pains in children should be taken seriously and investigated
professionally, particularly during periods of active growth.
Skin and
nail problems
Children
rarely suffer from corns or hard
skin problems. However, they are
prone to chilblains and various skin
problems. This often leads to the popular
misconception that the main problems
associated with children’s feet
are athlete’s foot, verruca, sweaty
feet, smelly feet, in-growing toenails
and blisters. These conditions
do exist and parents will often
seek treatment and/or advice because
they are either troublesome or
anti-social. These conditions are often
given low priority from a health perspective,
but they can become particularly
troublesome and difficult to
manage if inappropriately treated and
should always be treated with respect.
It is very important that an accurate
diagnosis is made before treatment is started.
Ill-fitting
and inappropriate footwear is also a very common problem. This is
discussed on page 6. An overview of the more common skin problems
are explained below:
Athlete’s
foot
This can be
a problem at any age but is particularly prevalent during puberty. A
fungus that enjoys a dark, warm and moist environment causes it.
Normally the podiatrist would take a sample of dead skin to identify
the fungus and then treat it with an appropriate fungicide. These
come in cream, powder and spray forms. Athlete’s foot affecting
the skin can also affect the nails causing them to look discoloured,
thickened and crumbly. Therefore it should not be ignored. Good foot
hygiene and the treatment of sweaty feet is also essential.
Synthetic shoes and socks should be discarded.
Verrucae
Current
thinking suggests that verrucae are left alone to resolve in their
own time if they are not particularly
troublesome. Many are treated effectively by the simple measure of
keeping them covered with a piece of tape which limits their spread.
More radical treatment employs the use of caustics, cryosurgery and
electrosurgery.
Sweaty
feet and smelly feet
Sweaty feet
are common in children, but it can be excessive. Care should be
taken to change socks regularly. Avoid synthetic materials in shoes
and hosiery, and be diligent with foot hygiene. Special insoles are
available from the chemist particularly for smelly feet.
In-growing
toenails
These can
be very painful and distressing and require professional podiatry
treatment.
Blisters
These are
common with sweaty feet and back-to-school new shoes. If the skin is
broken, an appropriate antiseptic protective dressing should be
applied.
How can
you help?
What
parents can do
Always
ensure that your child has their feet measured by a trained shoe
fitter when you purchase their shoes. The Children’s Foot Health
Register provides a booklet with details on retail outlets that ‘guarantee
to provide comprehensive training for staff and offer children’s
shoes in whole and half sizes and in up to four width fittings’.
Use the advice card attached to this booklet when you purchase
shoes. If necessary, where there is conflict regarding style and
fashion, compromise. Some sensible features in a shoe are better
than none at all if children refuse to wear ‘old fashioned shoes’.
Speak with other parents regarding their footwear buying experiences
and compile your own list of reputable and responsible retailers.
Check their feet regularly and ask your podiatrist for advice if any
foot problems occur. Don’t rely on your child telling you if they
have a problem. Take an interest in your child’s foot health
especially if they are involved in activities that may damage the
feet.
What
teachers can do
Set an
example with your own footwear. Discuss foot health and foot issues
with the children. The sections on Foot Facts, Footwear, Top tips
for children’s feet and Buying shoes – A straightforward guide
can be utilised as an outline for child foot health lessons. Regard
foot health with the same gravity as other health issues. Utilise
your local registered podiatrists to provide input to the children.
Private practitioners can be found on The Society of Chiropodists
and Podiatrists website (www.feetforlife.org), or you can contact
your local NHS podiatry unit. Review school guidelines on shoes,
particularly plimsolls.
What
the child can do
Try to be
sensible with the shoes that you wear most often. If you have a
problem with your feet, get it seen to right away. Many foot
problems are very easily fixed but if they are neglected they can
cause life-long problems. Remember that if you have aspirations to a
job or activity that requires you to be on your feet all day, good
foot health will be very important. Children can learn about good
foot health with the help of Professor Pod, a character found on The
Society of Chiropodists and Podiatrist’s website (www.feetforlife.org).
Interesting
facts about feet
How
much do you know?
Circle the correct answer. The answers with descriptions are
here (only click here after you have circled your answers)
1. How many
bones are there in each foot?
(a) 10 (b)
20 (c) 26 (d) 31
2. Compared
with all of the bones in the body, what approximate percentage of
the total
do the
bones of the feet make up?
(a) 5% (b)
10% (c) 25% (d) 32%
3 How far
does the average person walk in a lifetime?
(a) 10,000
miles (b) 20,000 miles (c) 115,000 miles (d) 350,000 miles
4. How many
steps does the average adult take in a day?
(a)
500-1000 (b) 8,000-10,000 (c) 18,000-20,000 (d) 24,000-26,000
5. Do
children take more steps than adults do in a day?
(a) yes (b)
no
6.
Approximately how many sweat glands are there in a pair of feet?
(a) 10,000
(b) 150,000 (c) 250,000 (d) 1,000,000
7. How much
sweat does a pair of normal feet produce every 24 hours?
(a)
virtually none (b) a table-spoonful (c) around half a pint (d)
around a pint
8. How long
is a size in an English sized pair of shoes?
(a) 4mm (b)
8mm (c) 12mm (d) 16mm
9. When a
pair of children’s shoes are fitted new, how much bigger should
they be than
the length
of the longest toe?
(a) 4mm (b)
9mm (c) 12mm (d) 20mm
10. What is
the largest size of shoes currently being worn?
(a) 13 (b)
18 (c) 28.5 (d) 33
11. What is
the average size of a man's foot in the UK?
(a)7.5 (b)
9 (c) 10 (d) 10.5
12. What is
the main cause of foot problems?
(a) Poor
hygiene (b) badly fitting shoes (c) badly fitting socks
(d)
problems that you are born with
13. In
America, what percentage of the population experience foot problems
in a lifetime?
(a) 10% (b)
25% (c) 50% (d) 75%
14. What is
the combined length of the longest recorded toenails?
(a) 0.5m
(b) 1.2m (c) 2.2m (d) 3.1m
The
Answers
1. There
are 26 bones in each foot. The foot is separated into three areas.
The tarsus at the back of the foot has seven bones which act as
shock absorbers when the heel strikes the ground during walking and
then we move our weight forward onto five long bones called
metatarsals in the middle of the foot which join up with very small
bones called phalanges at the ball of the foot, allowing the toes to
bend upward during walking, pushing us forwards into the next step.
There are 14 phalanges with three in each of the small toes and two
in the big toe.
2. There
are 26 bones in each foot making a total of 52. There are 206 bones
in the body in total. Therefore the foot contains approximately 25
per cent of the total.
3. This will vary with your occupation and activity but in total is
approximately 115,000 miles. That is approximately five times around
the world (although some sources suggest a lower number of average
miles which works out to three times around the world).
4. This
also varies with occupation and activity, but is approximately 8,000
- 10,000 steps. With every step, the heel strikes the ground with a
force equal to twice your body weight. That means that if you weigh
10 stones your foot has to cope with 20 stones each step. If you
take 10,000 steps per day that is the equivalent of your feet
carrying 1,250 tons (1270 metric tonnes) per day. That is equivalent
to the weight of 12 blue whales.
5. Yes.
Children take shorter and faster steps than an adult and have to
cover relatively more ground to keep up.
6. There are approximately 250,000. The number of sweat glands and
how active they are vary from person to person; age, disease,
hormones and activity can affect them. If the sweat glands are very
active, this can lead to very sweaty feet and a condition called
hyperidrosis. Reduced activity, often associated with getting older,
is called anhidrosis, leading to very dry skin. Smelly feet are
termed bromidrosis. The soles of the feet do not contain sebaceous
glands (these are the glands that make our skin greasy and keep it
supple) and rely on the sweat glands to keep the skin in good
condition.
7. This
varies for the reasons stated in answer six but is approximately
half a pint per day between the two feet.
8. A size
in an English sized pair of shoes is approximately one third of an
inch, or 8mm. Be aware that different companies use different sizing
systems.
9.
Normally there should be approximately 12mm between the end of the
longest toe and the end of the shoe when the shoe is newly fitted.
This allows for growth and elongation of the foot during
exercise.
10. The
largest shoe size is cited in The
Guinness Book of Records as belonging to Matthew McGrory
in America at size 28.5. He can pay up to $22,745 for a pair of
shoes.
11. The
average size is 9.
12. This is
a contentious issue but is widely regarded as being due to badly
fitting shoes. It is also possible that we may inherit a particular
type of foot that is at risk if put into a certain type of shoe that
another individual will have no trouble with. This may be why many
foot problems tend to run in families.
13. In
America, 75 per cent of the population is said to experience foot
problems in a lifetime. In the UK, previous research has shown that
91 per cent of children have trouble with their footwear and that 89
per cent of older people require some form of foot care.
14.
The combined length of the longest recorded toenails according to The
Guinness Book of Records
is 2.2m. There is no
comment regarding footwear.
Frequently
Asked Questions
Children’s
Feet
How
often do I need to change my child’s shoes?
How often
you need to change your child’s shoes depends on the child and
their age. On average, children’s feet grow at two sizes per year
in the first four years of life and one size per year thereafter
until growth is complete.
However, a
child’s foot may not grow for a considerable period of time and
then grow several sizes in a relatively short period. To ensure that
shoes still fit properly for length and width, a trained shoe fitter
should check them every eight weeks. You may do this more frequently
if you are aware that they are actively growing in height. In
general, the main period of accelerated growth in girls is between
eight and 13 years with the peak rate at approximately 12 years of
age. In boys this is slightly later between 10.5 and 16 years with
the peak rate at approximately 14 years. This corresponds with
puberty.
When
should I buy my baby her first pair of shoes?
Ideally a
child should not require shoes until they are walking competently
out of doors. In order for the foot to develop normally and
naturally, the child should be barefoot for as long as possible and
within the realms of safety to avoid injury. The age at which a
child begins to first walk unaided is very variable. On average, for
a girl it is 12 months, and for a boy, 15 months, but it may be as
early as eight months and as late as 24 months.
What
style of shoe is best for a baby who has just started walking?
There are
varying opinions related to this. Some manufacturers provide very
flexible first shoes to allow the foot to be protected outdoors but
still function relatively normally (as if they were in their bare
feet). Some authorities prefer a rigid shoe to ‘support’ the
foot. This is really only required if the child has a diagnosed
problem with their foot function. Boots are not necessary for a ‘normal’
foot.
My
baby has flat feet, is this normal?
Nearly all
babies appear to have flat feet when they walk at first. This is
partly due to posture and partly associated with deposits of fat
which make the foot look flat. When a baby walks, it has to balance
a relatively large and unwieldy head on a short torso. In order to
do this, it walks with the knees bent, legs wide apart and the feet
turned outwards. Also, the nervous control of gait is still being
learned and all of these factors combine to give a flat-footed
appearance.
Should
I buy a baby-walker?
No. A
baby-walker encourages loading of joints before nature intended, and
unusual and abnormal walking patterns. Nature will decide when a
child is ready to walk. Research has shown that they may cause a
child to walk later than he/she would normally.
My
child’s feet always seem to be cold, is this normal? Should I put
him in socks and slippers?
This should
not be an issue with older children but care should be taken to
insulate the feet in babies with socks or bootees as they have a
high surface area to volume ratio and lose heat very readily.
Children enjoy being in their bare feet but if the feet are
noticeably cold or they complain of this, some form of protection is
necessary. Socks alone may be dangerous due to slipping. Slippers
should only be worn as a short-term measure as they are not held
properly on the foot and the foot may slop around inside them,
leading to toe deformities in the future. Also, slippers do not come
in half sizes and fittings and are generally bought off the shelf. A
good pair of insulating socks and a trainer fitted by a shoe fitter
is best if not wearing outdoor shoes.
How
tightly should I pull the socks on my child’s feet before I put on
their shoes?
Just like
shoes, socks should be the correct size for the foot. They should be
just larger than the size of the foot and not cram the toes or
stretch over them. If you know the shoe size it should be possible
to buy socks the same size but beware as the shoe manufacturer and
sock manufacturer may use different sizing systems. Check the socks
against the feet regularly, particularly with children who are
dressing themselves, as tumble drying can result in shrinkage over
time.
How
often should I cut my child’s toenails and how should I cut them?
Many
children will bite or pick their toenails particularly if they are
too long. The rate of nail growth is variable from one child to
another but the length should be checked weekly. Nails that are too
long may be prone to splitting and hence in-growing. Cut toenails
using proper nail clippers, which can be purchased from your local
chemist. These are much safer and more accurate to use than
scissors. Follow the shape of the nail at the end of the toe,
cutting the nail so that the corners of the nail are free of the
fleshy nail groove. Children’s nails are very fine and it is
rarely necessary to file them after cutting. Leave approximately 1mm
of growing nail.
How
can I check that my child’s shoes fit properly?
This
is best done by the shop where the shoes were bought, ideally by a
trained shoe fitter who will also measure the feet. Some retailers
will keep a note of the foot
size and fitting or provide you with your own record card. An easy
way to check the length yourself is to cut a strip of paper that is
the same length as the inside of the shoe. Place this against the
skirting board and get the child to stand on it. Measure the
distance between the longest toe and the end of the piece of paper.
A newly fitted shoe will be approximately 12 – 16 mm longer than
the longest toe to allow for growth and the foot elongating when
walking. Shoes that are only 5mm longer should be regarded as too
short and replaced.
What
shoes should I put my child in during the summer?
Ideally
these are shoes that are well ventilated and of a natural material
(leather). For younger children, ‘T’ bar sandals. Most children
now wear trainers that are ideal if fitted properly by a trained
shoe fitter. However, many are bought off the shelf and not only fit
badly but are made from synthetic materials and cram the toes.
Should
my child wear the same shoes everyday?
Not
everyone is able to afford several pairs of everyday shoes for their
child. Ideally, different shoes should be worn on alternate days to
allow the shoe to dry out, as children’s feet can be particularly
sweaty. Wearing damp shoes all the time can make the child more
prone to athlete’s foot and verrucae.
Are
plimsolls advisable?
Plimsolls
are ideal for the purpose for which they were designed – as a
flexible gym shoe worn for short periods. However, they should not
be worn for long periods every day (as is the practice in many
primary schools) and left in shoe bags overnight where the sweat
from the previous day does not dry out. They do not come in half
sizes and width fittings and it is rare to hear of any that are
fitted by a trained shoe fitter. The soling material tends to
encourage the foot to sweat and makes it more prone to athlete’s
foot and verrucae infections. Very young children (primary 5) are
often encouraged to wear slip-on plimsolls, as they cannot tie their
laces. This may result in toe deformities.
Shoe
shops rarely seem to fit Wellington boots, canvas shoes and
slippers, how can I make sure that this type of footwear fits
properly?
Fit
in a shoe relates to length and width (see above, how can I check
that my child’s shoes fit properly?).
If the purchase is found to be too small it can be exchanged.
Feeling the broadest part of the foot (across the balls of the foot)
can check the width against the upper of the shoe. They should be
approximately the same width.
Are width fittings really important?
Shoes that
are too wide or too narrow can do as much damage to a growing foot
as shoes that are too short or too long.
Can
a young child tell if her shoes hurt?
This is
difficult to answer as children tend to adapt to what they regard as
normal and accept it. Peer group pressure and the dictates of
fashion may also stop a child complaining. This is why skilled shoe
fitting and regular checks are so important, particularly with very
young children.
My
child seems to have knock-knees, is there anything I need to do?
Knock-knee
is a normal developmental variant between the ages of approximately
three and seven years. Little can be done to influence this and
unless it is excessive or the degree of knockknee is different on
both legs, nature should be allowed to take its course. Often the
feet will accommodate the unusual posture of the foot by rolling
inwards and it is best to provide a firm, well fitting shoe during
this period to reduce the likelihood of this becoming excessive.
What
socks are best?
Firstly the
sock should fit and be the same size as the shoe. One hundred per
cent cotton is best, particularly if the child has skin problems.
Most cotton socks contain a small percentage of nylon. A 50 per cent
wool/50 per cent mix is also very good. Avoid 100 per cent nylon
socks as they will make the foot sweat and do not absorb moisture.
Some modern walking socks have a wicking effect and when used with
footwear with a Gore-Tex® lining, keep the foot dry. They are
usually made from modern synthetic fibres but can be expensive.
Do
I need to buy my children’s shoes from a specialist shoemaker?
Not
necessarily, but ensure that they have trained staff. The Children’s
Foot Health Register is a register of retailers who guarantee to be
‘centres of excellence for children’s shoe fitting’ and ‘provide
comprehensive training for staff and offer children’s shoes in
whole and half sizes and in up to four width fittings.’ (Children’s
Foot Health Register, PO Box123, Banbury, Oxon OX156WB. Tel. 01295
738726.
Website: www.shoe-shop.org.uk). There are many excellent independent
retailers. Some high street chains offer the use of DIY measuring
boards or they may have a trained person on the premises.
My
child always wears trainers. Is this unhealthy for their feet?
No, as long
as good foot health is practised, the feet are measured for the
shoes and they have sensible features. i.e. adequate room, depth and
width in the toe area, foot shaped in the toe area, laces or Velcro
fastening, well fitting and firm at the heel, leather uppers, shock
absorbing heel and sole.24
Do
trainers need to be fitted?
Fitted
trainers are best but not always possible. Remember that many
trainers are designed for particular sporting activities and may not
be suitable for regular every day wear. Children often pick trainers
due to peer group pressure and fashion trends to wear the right
label or style.
My
teenager insists on wearing highheeled, pointed shoes, and I am
worried about the long-term damage this will do to her feet.
Children as
young as eight years of age have been noted wearing this type of
footwear. You are right to be concerned regarding the long-term
effects this will have and the practice should be discouraged and
reserved for occasional use. The long-term effects are not only to
the feet but also to the posture in general with the possibility of
future knee, hip and back problems. In the short term, the feet will
also be damaged with restricted movement at the ankle joint, hard
skin on the soles of the feet and tops of the toes and increased
risk of in-growing toe nails.
Are
there any warning signs I should look for when I check my child’s
feet?
Yes. These
can be broken down into four main areas. These are skin, nails,
deformities and posture.
Skin – look for areas
of redness and rashes particularly between the toes, in the arches
and below the ankle bones indicating athlete’s foot, particularly
if they are itchy. Look for red marks and/or blisters at the back of
the heel and on the tops of the small joints of the toes indicating
illfitting shoes. Raised and painful hard masses on the soles of the
feet may indicate a verruca.
Nails –
any inflammation around the nails should be taken seriously as it
may indicate infection. Any discolouration of the toenails should be
checked by your podiatrist.
Deformities –
Toes should always be straight in line with the foot and not drawn
back or curled. The fifth toe may tuck under the fourth slightly and
the fourth under the third toe but the big toe should also be
straight.
Posture –
If the feet appear to be excessively turned in or out or the arch
looks very flat, particularly if the child complains of pain, the
advice of your registered podiatrist should be sought.
Do
I need to get my child’s feet measured every time I buy shoes?
Yes. It is
impossible to know the size of your child’s foot otherwise, as
growth can be erratic.
Maintaining
and caring for a child’s feet will benefit their health, mobility
and well-being throughout their entire lives.
Buying shoes
- A straightforward guide
•
Always have both feet measured for
length and
width.
• Ask if the assistant is a
trained shoe fitter.
• A newly fitted shoe should be
approximately 12-16mm
longer than the longest toe
• Avoid slip-on shoes. Shoes
should be held on
the foot with laces, straps or Velcro fastenings.
• Heel height should be no more
than 4cm. Lower
for younger children.
• The heel should have a broad
base and be made
from a shock-absorbing material.
• Natural material uppers are
best i.e. leather
• The toe area of the shoe should
be footshaped and
also deep enough to allow the toes
to move freely and not be squashed.
• The shoes should fit exactly
around the heel.
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