Shoes and foot development: why proper footwear matters!

By Catherine Andrasko PT, DPT, PCS, SCS & Tara Liddle PT, MA, DPT, PCS

The foot is one of the most complicated parts of the body and also one of the most important. It connects the body to the ground, facilitates movement, and due to its bony connections, can also impact the knees, hips, and low back. 

Anatomically, the foot has 26 bones along with many ligaments, blood vessels and nerves.  That means, 25% of our bones are in our feet. Most of this bone development happens before 7 years old and the bones in our feet don't even start to harden until age two!

Children's feet grow rapidly, often three sizes and half the length of their adult size by their first birthday, making proper shoe fit crucial. The feet are highly sensitive, with over 7000 nerve endings and enduring three times more stress than adult feet. This sensitivity underscores the importance of comfortable, high-quality shoes that allow for natural movement.

Lastly, kids’ feet sweat two times more than adult feet. Therefore it is necessary to consider the material and fit of shoes for children.  Ill fitting shoes or shoes that don’t allow moisture to escape well may cause blisters, difficulty balancing, increased tripping, and falls. Due to their feet sensitivity, don’t overlook complaints of pain or issues with shoes in children.

Developing motor skills from tummy time to standing is crucial for proper foot development in infants. Movement is essential for the development of muscles and bones in babies. It involves compressing and pulling soft tissues around the bones, which is necessary for maintaining proper alignment required for balance, walking, and advanced gross motor skills. Since the foot connects our body to the ground, its proper development is vital for the overall development of the musculoskeletal system.

So what should you do?

Barefoot is best. Barefoot walking is beneficial for children, aiding in brain development, strengthening small stabilizing muscles, improving balance and coordination, enhancing posture, and providing sensory feedback crucial for sensory-motor development.

When choosing shoes, prioritize flexibility and fit with room to grow. New walkers and toddlers benefit from flexible soles that allow for natural foot mobility and balance. Wide enough to not squish the toes together and long enough so the big toe is not hitting the front of the shoe. Shoes with lace or Velcro closures provide adjustable support, while pre-laced elastic bands can lead to instability and toe issues.  There are many great brands of shoes at all price points. Focus your attention on the quality and fit. Important areas to focus your attention: fit with room to grow, flexibility, a stable heel, non-slip soles

Shoes should be considered when your child is walking throughout a majority of their day for safety in outdoor play environments: sidewalks, parks, etc. (grass & sand are great for barefoot walking!). If your child is toe walking: shoes can help bring their feet down in certain instances.

We would be remiss if we didn’t bring up container devices. It's important to note that babies are often placed in jumpers and walkers before their feet and legs are adequately developed to support them. Consequently, they end up compensating and using muscles and postures that they shouldn't, leading to incorrect movement patterns and overuse of muscles not typically engaged in early walking. In these devices, babies may often be found on their toes, hindering the development of proper walking mechanics.

Furthermore, the design of these devices limits the baby's ability to see their legs and feet, which disrupts the crucial eye-foot connection necessary for coordination and balance. Additionally, babies cannot effectively practice balance and protective responses while confined in devices like exersaucers or infant walkers.

For a safer and more developmentally beneficial alternative, consider using a playpen or creating a screened area tailored to your home and your baby's needs. If you already own such devices, it's advisable to limit the baby's time in them to under 30 minutes a day. When using these devices, ensure that the baby's feet are flat on the ground and discourage bouncing on their toes.