Two questions always asked of me, and I am sure most podiatrists and pediatricians, is when should my baby start wearing shoes and what type of shoe should they be wearing?
For the sake of this discussion lets assume your baby is full term, healthy, with normal development and no neurological issues.
Most babies will start walking around twelve months of age although there are instances where some start walking as early as five months of age.
I have always been a believer as I think most experts are, that until a baby is actually walking, or even standing by balancing themselves with support, they should not be in shoes but simply either in socks for warmth, or barefoot. Even though your young child may look more "complete" in shoes particularly if you are outside, shoes at a very young age can be detrimental to the growth of the foot. Quite simply, the possible constriction of the shoe may hinder development of the foot even if the youngster is not yet walking. Initially, once your child starts to walk, the type of shoe to be worn has to be thought out.
Baby shoes come in various flexible soles ranging from very stiff to very flexible. When your young child first starts to walk it is not just a matter of one foot moving forward, followed by the other, but additionally it becomes a necessity for the young walker to get a "feeling" for the ground underneath them. This is known as proprioception and it helps in creating a normal gait as well as a better sense of balance.
As a side note, many diabetics lose their sense of proprioception as a result of their disease, and this creates problems with the breakdown of their feet and their balance.
So now that your child has begun to walk should they be in shoes all day or should they still be without shoes. I think the best advice is a combination of shoes at certain times and without shoes at other times. Obviously if your child is going outside, shoes should be mandatory but at home going without shoes is probably a better idea.
The reason for this is that being barefoot gives your child the best chance of developing proprioception. .
When it comes to choosing the best shoe for your child and I should point out that price alone does not determine the best shoe, you want to look for a shoe with a very flexible sole. Why a flexible sole? Simply stated, a flexible sole compared to a more rigid sole allows the foot to plantar load on the ground. In other words to adapt to the the terrain as the foot hits the ground. In general, walking around the house the floor surface is fairly even and flat, but if your child is outside say in the park or playground, the ground is uneven and as the foot hits the ground, the child needs to get a "feel" for the difference in terrain and then adapt to it. A flexible soled shoe results in more plantar loading (moving in response to the ground) then would a rigid soled shoe.
A study(1) was performed to test two hypotheses. The first was what are the structural differences across pediatric shoe design, and the second was to determine if these differences affect plantar loading during ambulation in the developing child.
Various shoes were tested ranging from very rigid soles to very flexible soles. Children differ from adults in that they have low body mass and low plantar pressure meaning their feet do not make much of an impact when hitting the ground. In order to maximize the plantar pressure, a more flexible soled shoe is required and this was ascertained in this study.
There is always the question of since almost all new walkers excessively pronate (feet flatten out), do we not want a more rigid shoe to control pronation? And yes, rigid shoes do control pronation better then flexible shoes, however, since rigid shoes reduce plantar load pressures and proprioception, they are not ideal in the development of the young foot. It is also worth mentioning that most children develop an arch as they mature and thus the end of flat feet.
In summary, as your child begins to walk, a combination of soft soled shoes as well as walking barefoot gives your child the best chance to develop balance and a normal gait. As mentioned, all children are flat footed as they begin to walk and this resolves in the majority of cases. If you are concerned at all about the development of your child's feet, a visit to a podiatrist might not be a bad idea.
(1)Effect of Shoe Flexibility on Plantar Loading in Children Learning to Walk Hillstrom HJ, Buckland MA, Slevin CM, Hafer JF, Root LM, Backus SL, Kraszewski AP, Whitney KA, Scher DM, Song J, Furmato J, Choate CS, Scherer PR (Hospital for Special Surgery, New York, NY: Temple University, Philadelphia, PA; Samuel Merritt University, Oakland, CA)
Journal American Podiatric Medical Association. 2013:103(4):297-305
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