BACK TO SCHOOL: Is your child in the right shoes?

21 January 2019

It’s that time again! Back to school checklists at the ready, many parents are heading to local shoe shops for their children’s new school shoes.

Back to school time can be a stressful and expensive time for parents, with ever-changing uniform, technology and footwear requirements at many schools.

But what about school shoes? Should you opt for the expensive shoes measured by professional fitters or will Big W shoes do the job just as well? Will allowing your child to wear the Vans/ Converse/ Nike SBs they so vehemently insist ‘everyone else wears’ cause problems for their growing feet?

At Potter Podiatry, footwear is front and centre of many children’s foot and lower limb problems that I see. The change in footwear trends, insistence on ‘all black joggers’ and family budget can all complicate matters further.

From birth until approximately age 18 when growth plates of bones are fused, children’s feet are especially vulnerable to abnormal forces and pressures. A shoe that is too shallow, tight, short or wide can cause significant changes to the way children use their muscles in their feet and lower limb, and can result in pain, reduced sports performance or easy fatigue. It is unusual for me to see a child presenting with heel pain, recurrent ankle sprains or an in-toed gait to be in a well fitted, appropriate shoe.

Thinking back to my own back to school experiences in England, I recall the hour-long drizzly drive to the nearest town with my dear mum, the palpable dread in the car for what we both knew lay ahead. The Clarks shoe fitters surely remembered us from last year, suddenly disappearing out the back as the bucktoothed children (at least my sisters’ teeth were worse than mine) and their long suffering mother approached the unsuspecting new member of staff. Every year was groundhog day as the Clarks shoe fitter gravely reported that once again my strangely long, A width, flat feet could only fit into an incredibly daggy formal lace up - the Clarks Daytona. Alas, most years my temper tantrums, tears and A grade attempts at emotional blackmail fell on deaf ears as an uneasy truce was made that typically involved bribery with a Hypercolour t-shirt, slinky or Jason Donovan tape.

So here’s the problem, everywhere wants to sell you school shoes these days and 95% of shops that sell them to do not measure your child’s feet either at all or properly. So how do you know where to go and what to look for?

A good shoe fitter will measure the width and length of both feet, ask about shoe history or problems with the child’s feet and be familiar with the footwear requirements of local schools. Your first red flag should be a sales assistant who simply asks: “what size do you need?” Of course, if your budget is tight and you’re heading to Big W, KMart or Discount outlets, often it is just you and a large selection of low-cost options.

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There are 3 main components to good shoe fit:

  1. Length. Remove the liner from the shoe, place beneath the child’s foot with their ankle at 90 degrees & not standing on it, there should be your thumb width’s length at the end. This is the ‘maximum growing room’ recommended for new shoes.
  2. Width. With the shoes on & laces/ fastening done up, there should be approximately 10mm of loose material across the toe box that you can grasp.
  3. Depth. With the laces pulled tight but not done up, can you get 2 fingers to the bottom of the laces. If not, the shoe isn’t deep enough. If it’s very roomy, the shoe may be too deep.

Why does this matter? Gross motor skill development (the ability to run, catch, jump etc) relies on input from Proprioceptive, Visual (eyesight) and Vestibular (inner ear) systems. A loose or tight shoe that slips or compresses the feet as the child moves can alter the proprioceptive input, changing how the child activates the muscles in their legs. Combine this with chronic ear infections or eyesight problems and we have the recipe for a gait disorder.

A common point I hear is that the child wears their shoes out so quickly that cheaper shoes are more cost effective. It is important to understand that children who tear through their shoes in 3-4 months, particularly with an uneven pattern of wear or a shoe left looking twisted or asymmetrical may have a problem with how their feet and lower limb are functioning. Whilst there is of course exceptions to this (scooter riding being number 1!), I would encourage parents who encounter this issue or whose child’s feet regularly blisters or have difficulty finding a well-fitting shoe to seek an early assessment by a Podiatrist experienced with assessing children’s gait and lower limb function.

Which brings us to the features of the shoe. Typically, I like to see the following features:

  • A heel slightly higher than the forefoot
  • A ‘shank’ through the midfoot (if the shoe bends through the arch it doesn’t have one)
  • A stable heel cup (compress the heel of the shoe, it shouldn’t collapse)
  • Sufficient heel cup depth to enclose the heel bone in the shoe
  • Forefoot stability (press under the ball of the foot, it shouldn’t bend back on itself)
  • Good fixation (laces are best, slip ons unhelpful, buckles okay but should be wide)

Can cheaper shoes have these features? Sometimes yes, but typically, no. The ‘shank’ of the shoe provides stability but requires manufacturers to add an extra stage to their manufacturing process (and therefore cost). Cheap joggers in particular (and some expensive ones, I’m looking at you Nike Free!) rarely have this. My go-to brand for many formal shoes is Ascent, available from Athletes Foot stores across the cost, fitted by qualified shoe fitters and with some models offering a 6-month sole guarantee. Proving that mother’s are seemingly always right (especially my own), Clarks also continue to offer great formal shoes for children.

At Potter Podiatry, we believe early screening of children with possible foot, lower limb or gait problems can improve your child’s enjoyment and competence in physical activity as well as treat pain if present. Queensland has a major problem with childhood obesity, the research tells us that children with foot or lower limb pain are less active & have a lower quality of life. Foot pain can set off a snowball effect on a child’s level of physical activity, emotional wellbeing and general health.

So what are the signs that good quality, well fitting footwear may not be enough for your child’s foot & lower limb health?

Signs your child should see a Podiatrist:

  • Foot or lower limb pain particularly when occurs after activity or at night
  • Poor balance/ clumsiness/ co-ordination
  • Gait disorders (in-toeing/ out-toeing/ tip-toeing)
  • Family history of lower limb pain/ alignment problems or gait disorders
  • Family history of Joint Hypermobility (‘Double-Jointedness’)
  • Delayed walking
  • Unusual crawling, walking pr running style
  • Flat feet
  • Gait disorders (in-toeing/ out-toeing/ tip-toeing)
  • Difficulty keeping up with peers in running, climbing, catching, kicking
  • Alignment disorders (Clubfoot, Junvenile Bunions)
  • Child trips more than peers, asks to be carried regularly/ wants legs massaged
  • Unusual wear patterns on footwear
  • Difficulty finding well fitting footwear
  • Blisters from footwear

Who should you see?

Podiatrists’ experience with assessing and treating children can vary significantly. We are lucky to have many Podiatrists that are highly experienced with treating children on the Sunshine Coast. If you’re taking your child to a Podiatrist, ask about their experience with treating children. A typical Paediatric Podiatry assessment should involve a detailed history, evaluation of alignment, hip, knee, ankle and foot joint range of motion, lower limb strength, neurological function, gross motor skills, walking and running gait.This will typically take about 45 minutes. Brief check ups can miss the occasionally more serious underlying causes of some gait disorders and should therefore be avoided.

 

 

 

Written by

Chloe Potter / Podiatrist

Chloe Potter BSc(Hons) Podiatry MAPODA MAAPSM is the Sunshine Coast’s go to Podiatrist for children’s foot & lower limb problems. Chloe has treated 1000s of children including national level junior athletes, children with disabilities and children with connective tissue disorders. She is a member of the Australian Podiatry Association as well as the Australasian Academy of Podiatric Sports Medicine.

Chloe has recently opened Potter Podiatry, consulting in Birtinya and Noosaville. You can find out more about children’s podiatry at https://potterpodiatry.com.au
Facebook https://www.facebook.com/potterpodiatrynoosa/
Email info@potterpodiatry.com.au
Phone 07 5628 3020

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