Monday, March 11, 2013

What Shoes Kids Need

When our now 5 year old son started to walk, I proudly bought him his first pair of outside shoes. It was a fairly sturdy sneaker kind of shoe. A shoe pretty much like this one, just much smaller and not as pink:
You might recognize this shoe as a shoe most kids wear in day care or school - at least they do where I live.
Had I known what I know now, I would have looked for a shoe with a flexible sole, zero heel, zero toe spring (i.e.that upward slant on the sneaker in the pic) and enough space for the toes to spread - the kind of shoe my children wear now in and outside daycare. 

Why? Because a shoe on our feet is like big fat sturdy gloves on our hands. It immobilises. Overtime the many muscles that live in the foot atrophy (weaken) and that in turn has a negative impact on the overall health of the tissues in the foot. The nerves inside weak muscles are not good sensors of or responders to information - think tripping over objects or even over your own foot. Weak muscles are also poor stabilizers for the ankle and even impact the stability of knees and hips.

What makes the feet so special?

Out of the 206 bones we have in the body, 25% of those live in the feet - 26 bones and 33 joints in each foot. The same goes for muscles and nerves: 25% of our total live in the feet.
This amazing anatomy gives the foot the potential for 1001 little movements: Imagine walking barefoot through the forest and navigating the uneven terrain with big or small rocks, fallen tree branches and slippery slopes. Our feet are equipped with the ability to sense every little unevenness of this terrain and to deform to meet the changing shape of this environment. Nice!

Except that our feet spend their whole life inside shoes and hardly ever get the chance to put this amazing ability to use.

What shoes do to our feet

Shoes protect the feet from the environment but have the sorry side effect of putting somewhat of a cast around the foot. When it comes to shoes, we think the more stablity a shoe offers, the better for the foot. But we forget that we were given a ton of muscles and joints inside the foot and that its the job of skeletal muscle to move and stabilize joints. 

Let's go back to the imagery of the barefooted walk in the forest. Imagine you do it with your tight feet from a lifetime of shoe wearing. Your foot won't deform to meet the shape of a rock. You might trip over a branch or over your own foot. Without the many foot muscles working in sync, the ankle takes the brunt of the impact with every single step. Throw in some tightness of the calves (which we do have too from wearing shoes and sitting all the time) and the knee will hurt. Without restoring some foot mobility, the barefooted walk might do more harm than good.

I injured my foot last fall by missing the last step of our staircase. Turned out my foot had been slowly degenerating without me noticing it. Don't tell my mom but the shoes she bought us had lots of stability features but didn't foster the development of healthy feet. Obviously. So nice when you can blame your mom :)

Maintaining foot mobility in children - what to look for in a shoe

The sole of the shoe ...... should be flexible enough for the foot inside the shoe to deform to meet the shape of the environment while still offering enough protection from the environment. 

The heel of the shoe ... should be free of any kind of elevation as it brings the natural heel of the foot higher than the front of the foot. Even the smallest positive heel changes the geometry of the foot bones (how they relate to eachother) and therefore also impacts the alignment of bones in the legs, pelvis and spine. Alignment changes impact the muscles' ability to generate appropriate force. (You can read more about how heels impact your whole body alignment in my last blog post).

If you are after foot mobility for yourself or your child, the shoe should have zero heel. Sneakers do have a heel! Cute Mary Janes for girls also have a heel. A small heel for a child translates into a huge geometrical change!

The toe box ... is where the front of the foot is placed. It should be big enough for the toes to fit in easily without squishing. Toes should have enough room to spread and wiggle. The front of the foot should also not slant upwards as in the above picture of that sneaker, especially if the sole is stiff - the whole foot including the toes need to have contact with the ground.

The upper of the shoe ... is the material that makes the shoe. It shouldn't be too tight (the toes can't wiggle and move) or too loose. Flip flops or crocks worn without the strap at the heel offer a flimsy attachment to the foot and the toes have to grip hard to keep the shoe on - toe gripping does not lend itself at all to a natural gait pattern.

The best advice I can give parents with toddlers that are just beginning to walk is to allow those little feet to develop naturally and to keep them barefoot as much as possible or in socks with rubber dots on the sole or in Robeez or Soft Star shoes. Many water shoes also fulfill the above criteria and come in all sizes and offer a cheap alternative and are readily available in stores come Spring and Summer. Those shoes also make great choices for daycare or school.

And the same shoe criteria apply to adult feet of course. For a resource guide for minimal shoes, click here. 

I quickly took a photo of some of summer/indoor shoes we have lying around:

The second best advice I can give is to take yourself and the kids to walk on natural ground to let the feet go through a variety of little motions. I let the kids walk on people's lawns in the summer when we go to the playground. How about barefooted walks on forest trails, beaches or at the very least in your own back yard.

And the third best advice has to do with the very fact that we don't live in a natural environment. Our streets are hard asphalt and the times we do go walking, on uneven terrain or not/in minimal shoes or not, is limited. Older children and adults can restore foot mobility with little exercises: spread the toes as wide as you can, try to lift one toe at a time, use your foot to pick up objects (marbles, socks, ect) and put them where they belong. I, for example, try to build a habit of using my feet to pick up clothes that lie on the floor. If I do it, my kids will eventually do it. I hope :)

To get more ideas for what you and your children can do with your feet and to be inspired by somebody who does everything with her feet read this post  by a fellow Restorative Exericse Specialist.

And if you live in Ottawa and you have foot pain or you would like to transition to minimal shoes or you have a child whose foot development you are worried about, call me to book a session. In addition to being a brandnew Restorative Exercise Specialist, I also certified as a Healthy Foot Practitioner last year. And so did Jillian from LiveAligned - another Ottawa resource.  

More reading: 
Dr Rossi, podiatrist articles:
Why shoes make 'normal' gait impossible
Footwear: the primary cause of foot disorders
Children's footwear: launching site for adults ills

Book: Katy Bowman Every Womans Guide To Foot Pain Relief

A collection of abstracts and links to online material can be found here.

'And those healthy little feet of your children - keep them strong as they are now by giving your boys and girls the right kind of shoes and by teaching them to walk like and Indian - with toes straight ahead.' a short article about foot health written by a life insurance company!!! and published in 1932 in National Geographic Magazine.

'Shoes make 'normal' gait impossible. How flaws in footwear affect this complex human function'. This is the title of one of a series of articles Dr Rossi, a podiatrist, wrote in 1981.

1. Optimum foot development occurs in the barefoot environment.
2. The primary role of shoes is to protect the foot from injury and infection.
3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility.
4. The term "corrective shoes" is a misnomer.
5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications.
6. Shoe selection for children should be based on the barefoot model.
7. Physicians should avoid and discourage the commercialization and "media"-ization of footwear. Merchandising of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession.
Staheli, LT Pediatrics [1991, 88(2):371-375]


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