First, let's talk about the human foot. The foot is the foundation of the human body, absorbing shock, accepting weight in an upright posture and propelling the body forward with each step. When someone (especially an adult) has hip or knee pain, I immediately look at their foot and ankle alignment. One foot has 26 bones, 33 joints and more than 100 tendons, muscles and ligaments. That's a lot of moving parts. When these moving parts are working optimally, an arch is present. When an arch is present, your body is able to efficiently absorb it's own weight and move with both power and precision.
BUT, this really doesn't happen until after age five or six. Research shows that almost all typically-developing toddlers have flat feet (no visible arch in standing) and their arch doesn't develop until they've spent thousands of hours in a standing position. That's why it's so hard to fit a squishy toddler foot into a shoe! In fact, flat feet are actually quite normal until age five or six. Again, as children grow and develop strength in their feet and ankles, their arches develop. They gain strength thru active play -- running, jumping and climbing.
The truth is, the best shoes for toddlers and young children are actually no shoes at all. That's right -- barefoot is best. Babies especially need to be able to flex their squishy forefeet and wiggle their toes. They need as much sensory input as possible to be able to feel the floor. If you must put your toddler in a shoe, purchase the thinnest, flimsiest shoe you can find. Make sure you can fold it in half. And don't spend lots of money.
Even for older children, barefoot is best. There is a large body of research to support this claim. A 1992 cross sectional study from The Journal of Bone and Joint Surgery found that shoe wearing in early childhood was actually detrimental to the development of an arch. The incidence of flat foot among children who used footwear was 8.6% compared with 2.8% in those who did not. Common foot problems in the United States such as corns, bunions, hammer toes, athlete's foot and ingrown toenails simply do not exist in countries where most people go barefoot. The best thing you can do for arch development in children is to provide barefoot opportunities for jumping, running and climbing to strengthen the muscles of the foot and ankle.
As your child gets older, pay attention to their gross motor skills. I'm talking about a general understanding of motor skills, nothing too specific. And use your parenting instincts and intuition. If you think your child's foot is unusually flat or oddly shaped, it probably is. If your three year old isn't jumping or they seem slower than their peers, consider a referral to a pediatric physical therapist. I will always recommend orthotics for children who have pain or are delayed in gross motor development because sometimes an off-the-shelf product will make a world of difference. Here is the take home message:
- Barefoot is best. The best shoes for toddlers and young children are no shoes at all!
- Flat feet are normal for toddlers and children, sometimes up to age six. Relax and take a deep breath. Children need time and active gross motor play, not expensive shoes or orthotics.
- Encourage active gross motor play -- running, jumping, climbing -- for good arch development.
- If your child seems behind with regard to gross motor skills, visit a pediatric PT.
Thanks. See you in 2016.