Take Off Your
Shoes and Walk
5 - Preventing Children's Foot Trouble

Care of Fallen Arches in Children

Preventing Foot Trouble of the Pre-walking Infant - No Pre-walking Shoes - Crawling for Exercise - Infants' Booties - Babies' Socks - First Shoes - Necessity for a Flexible Shoe - Shape of the Toe - Avoid Arch-support Features - Heels on Infants' Shoes - Choosing the Right Length - Choosing the Right Width - Going Barefoot Is a "Must" for Young Children - Then Compare . . . - Children's Shoes, Ages Five to Twelve - Are Loose Shoes Too Large? - How Long Should Shoes Last? - Dress Shoes for Children - Should Older Children Go Barefoot? - . . . . . .

In a paper published in the August 1959 issue of Journal of Military Medicine, Dr. Thomas Hale Jr. and I quote fifty of our leading authorities on foot disease, all of whom have different, and often opposing, ideas as to cause and prevention of foot trouble. Authorities acknowledge that causes are not established, and yet physicians, pediatricians, and foot specialists must refer to these authorities. If what to do about foot disease is confusing for a doctor, how much more confusing it must be for a nonprofessional Nevertheless, there is one thing which is certain about our commonplace foot trouble-it is one hundred per cent preventable. We will show you how to go about it with sensible, practical, and conservative techniques that will be supported by your doctor.

Preventing Foot Troubles of the Pre-walking Infant

You who are parents have probably noticed your child constantly spreading, bending, stretching his fingers and toes from the first weeks of life. You would not think of keeping your baby from moving his hands and wiggling his fingers. You would not swaddle his hands and fingers. Why, then, swaddle his feet and toes?

Tight blankets which keep feet and toes motionless serve only to weaken them. Place the blanket over the baby's feet loosely. Raised supports at the foot of the crib can be used so the blanket can be elevated over the feet, allowing plenty of room for movement. Toes which are not given opportunity for exercise in the very early years are likely never to develop properly - nor can any later treatment ever fully restore their proper functioning. Unfortunately, most American parents damage their infants' toes and feet in the first weeks of life by depriving the child of the chance to move his feet freely. By keeping anything tight or constricting off your baby's feet, you will have already started him on the way to foot health.

No Pre-walking Shoes

Do not buy pre-walking shoes for your baby. They may look pretty and soft, but they can seriously impede the natural movements of the infant's foot. Whenever you see a bronzed pair of baby shoes, know that it is a symbol of damage to some baby's foot. In warm weather, the baby should play barefooted in a play pen. When he starts to creep and crawl on the carpeted floors, he should be allowed to crawl barefooted.

Crawling for Exercise

Crawling is a necessary developmental exercise for your baby. Give him every chance to do so. (Infants are often forced to sit too long in devices which keep them from underfoot while mother does her work. Pressure upon the thighs caused by such apparatuses is likely to strain the muscles and cut off the blood supply.) The child should be allowed to crawl in the playpen whenever possible, rather than being kept inactive.

Do not try to hasten a baby's first steps. He will walk when his feet and legs are ready.

Infants' Booties

During the first year of life, wool booties are the best type of footwear. However, they should be bought large enough so they cannot in any way constrict the feet or toes. When the baby begins to toddle about on the cool floor, these booties or soft slippers, which yield to the pressure of the baby's toe movements, are the most suitable.

Infants' feet do not have to be protected from the cold nearly as much as some adults think. Babies need no more protection for their feet when crawling on a cold floor than they do for their hands. The reason most adults are concerned about exposing their babies' feet is because they are used to having their own feet always covered and protected, and are not accustomed to a little bit of exposure. Babies actually thrive on it.

Babies' Socks

When your child begins to wear socks, you must take the same care in fitting them as with shoes. A sock is not made in the shape of the foot. It is made more like a tube that tapers to a point at the end of the foot. For this reason stretch socks can be particularly harmful they cause constant pressure on the toes. If a sock is pulled tight over the child's toes, his toes will tend to take the shape of the pointed sock.

Buy socks at least one inch longer than the toes. Pull them out so the extra length is free of the toes - the extra length of sock will fit into the unused portion of the toe of the shoe.

First Shoes

When your child has started to walk by himself at home, he will shortly be walking on pavement and you need protection for the bottom of his feet. You would now be ready to get the first pair of shoes for your infant. Shoes that are flexible, roomy, and simply made are best. Remember, children's toes and feet must be allowed to grow naturally without restrictions and pressures.

Necessity for a Flexible Shoe

Some shoes look better, and have better leather and more durable construction, but too often they are so firmly made that they rob the infant of the free use of his foot.

To test flexibility, grasp the heel of the shoe in one hand, the toe in the other, then bend the heel and toe toward each other. If the shoe bends at the ball (the part of the sole directly behind the toes), and not through the center of the shoe, it means that the shoe has steel stiffening through the arch. A toddler wearing such shoes must walk stiff-footed because the shoe will prevent him from bending his feet. Such a shoe must not be purchased for any child.

Shoe stores which sell an arch-support line of children's shoes often do not carry a flexible infant's shoe. A clerk in such a shop may use the most persuasive arguments to convince you that his supportive shoes are best. Be firm, and find a store where the shoe in your child's size is flexible through the arch. Having found a flexible arch, make certain that the sole itself is not so thick that the shoe becomes hard to bend. An infant will outgrow a pair of shoes before he outwears it, so an unnecessarily thick sole has no value and should be avoided.

Do not resole younger children's shoes, for resoling them makes them smaller.

Shape of the Toe

The next thing to look for is the shape of the toe of the shoe. Shapes of children's shoes have undergone much improvement in the past decade. Occasionally one finds the old-style cowboy-boot-type shoes with their pointed toes. Do not under any circumstances purchase these.

Learn to identify pointed-type infant shoes by noting the differences between the generally tapered toes of adult shoes and the common broad-toed infants' shoes. The few minutes it will take to learn the difference will be worth while. Knowing the difference, and continuing with broader-toed shoes as the child gets older and the choice of shoe styles increases, will provide for added years of more normal growth until the inevitable adults' pointed-toed shoes must be worn.

Avoid Arch-support Features

Look inside the shoe. If the salesman says it is an "arch" shoe, or if it is so labelled, that does not necessarily mean it is supportive. Some manufacturers falsely use the words "arch support" in their shoes to sell more of them. Run your fingers over the inner sole of the shoe. If there are added elevations on the inner sole, beware. Shoes that have raises inside them are also likely to have other arch support features, all of them deforming. More about this later, but for the present, any shoes with arch support features are to be avoided.

Heels on Infants' Shoes

For infants, shoes without raised heels are the most desirable, though often unobtainable. Very likely, you will have to settle for a so-called "spring heel" in which there is a leather elevation under the sole at the heel.

Choosing the Right Length

When you have selected the best type of shoe for your child, you are ready to choose the correct length. Shoe clerks generally use a measuring device to measure the approximate size, then bring out a few pairs of shoes to be tried on. Check the clerk's assurance as to proper length. Have the child stand up with his weight resting evenly on both feet. Use your fingers to feel exactly where the child's toes lie in the shoe. Do not be afraid of spoiling the shoe by pressing your finger into the stiff leather toe in order to find where the big toe ends. Remember, a "good fit" is not what you are after in your child's shoe. If a pair of children's shoes fits "just right," when it is bought, it will certainly be too small in no time. There should be at least one adult thumb width or three-fourths of one inch of space between the end of the child's toes and the end of the shoe.

Choosing the Right Width

When buying your child's shoes, get the widest size possible. To test the width, feel alongside both sides of the foot at the ball, making sure there is free space between the sides of the foot and the sides of the shoe.

Be sure to feel both sides at the same time, so as to avoid pushing the foot to one side of the shoe when feeling for the proper width. A guide to getting the widest possible shoe for your baby is to leave enough space between the rows of eyelets to be able to tighten the laces. Mothers must be prepared to have uninformed shoe clerks protest vigorously at their insisting on wider shoes. Most people are not aware that the usual infant's shoe fit will deform the toes.

Severest deformities from shoe pressures occur before four years of age when bones are softest.

Going Barefoot Is a "Must" for Young Children

It is not enough that children's feet be free from deforming shoes-foot health also depends upon going barefoot in order to develop agility and strength in the feet. . . . For toddlers, shoes should be worn outdoors only during inclement weather and indoors only for infrequent dress-up occasions.

Fortunately, children can go barefoot most frequently in life during the first five years, while they do not yet attend school. These years are the most important in foot development. Children under five who go barefoot, if watched closely by their parents, are unlikely to walk where they will cut their feet or do themselves harm. Moreover, if they go barefoot frequently, they will soon develop tough, protective skin on the bottom of their feet. Skin thus developed is soft and has no callus but will give much protection. You have read accounts in the newspapers of international track stars winning races over cinder tracks barefooted - a normal capability of the human foot, though a constantly shoe-wearing "tenderfoot" is unable to understand it..

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Then Compare . . .

If you will have your child follow the directions just outlined, until he is five, you will find that he has perfectly functioning, almost entirely unimpaired feet. (The ends of the first, fourth and fifth toes may be curled in a little, no matter how great care is taken, because there are presently no shoes on the market which are entirely non-deforming). Compare your child's feet with those of his playmates the same age - with whom this care was not taken. Your child will have straighter, stronger toes and denser muscles on the bottom of his feet. You will be amazed to discover that other children's toes will be skinny and weak, even gnarled. When you see the ease with which your child moves about on his feet you will feel rewarded for the care you have taken of his feet.

Children's Shoes, Ages Five to Twelve

Shoes available for older children are not designed to be grown into - they taper more at the end of the toes and are worse in this respect than baby shoes. Your child will often outgrow his shoes a month after they have been bought. Therefore, you must make it your responsibility to examine his feet at least once a week. If there is one-half inch or less of free space beyond the big toe, the shoe has become too short. Discard that pair, no matter how much wear is left in them.

To understand why such a shoe must be discarded, look at the toe of your child's shoe. Notice how narrow it becomes in the last inch. The area in the toe of the shoe one-half inch from the end is sometimes reduced by half. Moreover, children's toes are deformed without their feeling the slightest pain. Consequently, parents can be unaware that their children's feet are being deformed daily. You must never depend on your child to complain that his shoes hurt him to insure that his shoes are not crippling his feet.

Are Loose Shoes Too Large?

Fitting the shoe large, as it should be, will provoke comments and advice from older people about a loose shoe being bad for the foot. Do not believe them. They think feet need shoe support because their own feet are so weak-a tight fitting shoe must serve as a brace for them to walk at all. Children whose feet are healthy do not need a shoe for support; they need a shoe only for protection.

How Long Should Shoes Last?

How often should you replace your child's shoes? Anywhere from one to nine months, generally, though he can outgrow shoes in about twelve weeks. It is always a race of the growing foot and the wear left in the shoe against the time when the narrowing end of the shoe will begin to pinch the toes together.

Dress Shoes for Children

The habit of buying dress shoes as well as everyday shoes for growing children is unfortunate. Most parents have the idea that when the everyday pair becomes shabby, the dress shoes can then be used for everyday wear. The temptation to get full wear out of both pairs is great, even though they may be too short. Buying single pairs more frequently would solve this problem for boys.

For girls, however, it is not as easy, since most little girls want a special dress shoe, such as a patent leather pump. If such shoes are worn, the parents can only reconcile themselves to the expensive but inescapable fact that a pair of dress shoes can only be worn for the twelve Sundays it takes to outgrow it.

Another popular style among younger girls is ballerina-type slippers. To stay on the foot, they must be fitted snugly at the toe. This is not as dangerous as it might seem, since the end of this shoe is flexible and the toes can mold the shoe to some extent. However, ballerina slippers which have stiff toes are quite deforming.

Should Older Children Go Barefoot?

Not so long ago, children in rural areas most always went barefoot in warm weather, as did many adults. It is only since shoes have been inexpensively made that we have taken to wearing them constantly.

Fortunately, customs are changing again. In California and Florida it has become popular for children in larger cities to go barefoot. It has always been popular in Hawaii. Children in the suburbs of Eastern cities are going barefoot in the summer.

Are you afraid your child will injure his feet playing if he goes barefoot? In Hawaii children and grownups play football in their bare feet. There are a great many such football teams, called the "Barefoot Leagues."

Are you afraid he will catch cold if he goes outdoors with his feet uncovered? In a children's institution in Eggenberg, Austria, some years ago, the director, unable to afford shoes, had the boys and girls go barefoot throughout the winter - sometimes in deep snows. They were none the worse for the experience, and they developed a much greater immunity to colds than children in the same village who wore shoes.

Are you concerned with what neighbors will think about your child going barefoot? One summer I examined the children's feet in an orphanage in Baltimore. The shoes which had been provided were so illfitting that I suggested to the woman in charge it would be better to let the children go barefoot. "I agree," she replied, "but visitors seeing orphan children barefooted will protest, 'The poor children are not even being given shoesl' " Surely your child need not be bound by such artificial notions of well-being.

Do you live in the city, where children do not ordinarily have the opportunity to go barefoot? Then you should make it a habit to have your child take his shoes off when coming in from the street. Let him put on slipper socks, thong sandals, or go barefoot.

If you had the occasion to examine as many feet as I have, you would instantly be able to detect those who have had the opportunity to go barefoot as children. The suppleness and strength in their feet makes their appearance distinctive. "You went barefooted often as a child!" I frequently tell people I have never seen before. They look at me surprised, but invariably they say, "Yes." I add, "You never tire easily, do you?" The answer is almost always, "No, never."

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The Shoe Industry and Foot Health


Care of Fallen Arches in Children