by Dr. Phil Maffetone
Twenty years ago, a review of shoes and gait in the journal Pediatrics outlined some key factors that affect children’s feet. Pediatric orthopedist Lynn Staheli, M.D., from the Children's Hospital and Medical Center, Seattle, Washington, listed these important points:
1.) Optimum foot development occurs in the barefoot environment.
2.) Stiff and compressive footwear may cause deformity, weakness, and loss of mobility.
3.) The term "corrective shoes" is a misnomer.
4.) Shoe selection for children should be based on the barefoot model.
5.) Physicians should avoid and discourage the commercialization and "media" obsession with faddish footwear.
6.) Merchandising of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession.
Perhaps the most offensive aspect of the footwear industry is the harm it deliberately inflicts upon unsuspecting children by encouraging them to wear bad shoes. Between the twin forces of television and parental encouragement, little Johnny or Jill are defenseless. In particular, there's the potential damage to the young developing body and brain. And, this could be a primary cause of physical imbalances, injury and disability and later as adults.
It was evident from Dr. Staheli’s article that shoe companies in 1991 were already heavily marketing unhealthy children’s shoes, playing on the parent’s emotions and those of older children. Today, shoe companies continue to use clever million-dollar advertising campaigns to encourage kids to ask for, and parents to buy, harmful shoes. And it’s obviously successful. The U.S. children’s footwear industry, which includes shoes for kids up to 16 years of age, generates over $5 billion annually, where products are made for cuteness and style rather than function.
What’s the best shoe for your child? None—barefoot is best and nothing comes close. Children should be barefoot, most, if not all the time. This provides the optimal stimulation of the foot by the ground, which helps train the brain for proper gait and other natural movements that children require from the start.
When a shoe becomes absolutely necessary, Dr. Staheli says it should be lightweight, flexible, shaped more or less quadrangularly, and should not have arch supports and stiff sides. She says that pediatric orthopedists strongly oppose "corrective" or "orthopedic" shoes for straightening foot and leg deformities like flat feet, pigeon toes, knock-knees, or bowlegs, claiming there’s no evidence that these so-called therapeutic shoes are effective. Instead most of the supposed deformities in children naturally correct themselves. How you might ask?
Being barefoot is the best way for that to happen. Most healthcare professionals who properly understand a child’s body mechanics know this. (Yet there are many “experts” who recommend the regular use of shoes for young children, but they are usually aligned with the shoe industry or companies making orthotics and other corrective devices.)
Any shoe has the potential to seriously disturb the gait of a young child. His or her sensitive feet sense footwear much more than the adult foot. Even relatively minor pressure on a child’s foot from a shoe can begin deforming it, leading to a permanent problem. During the first year following the acquisition of independent walking, most of the child’s gait activity, in particular, the neurological memories—the communication between brain and body—becomes well established.
During this time, if the feet are not allowed to develop well, gait and balance disorders begin to occur. In many children, these irregularities are often subtle (the “clumsy kid”) while others more serious such as increased vulnerability to physical injury and various neurological imbalances anywhere in the body, including those associated with eye movement.
The full development of a child’s balance and compensatory mechanisms, and overall gait mechanics, takes years to mature. While the first five years of life are most delicate, neuromuscular interference from footwear can occur at any and every stage along the way into early adulthood. This can lead to more serious and chronic physical imbalances later in life, such as a running injury or back pain, and even amplify the stress caused by imperfect shoes.
Earlier this year, Caleb Wegener, Ph.D., and colleagues from the University of Sydney, Australia, reviewed the problems associated with a variety of different shoes worn by children for walking and running. Their study, published in the Journal of Foot and Ankle Research, states that, “Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern.” In short, these are some of the specific items that are a recipe for physical and neurological disaster, and the start of a process of chronic injury and disability that could last a lifetime.
These researchers noted Dr. Staheli’s 20-year old suggestion that shoe design should be based on the barefoot model. But some of the shoes they tested were designed on these principles and still caused gait irregularities in children. The researchers also state that, “Further attention could also be paid to reducing the weight of shoes which may be responsible for some of the [abnormal] changes found in children’s walking and running gait.” (It’s interested that this type of “free” information is available to shoe manufacturers but may never be utilized—instead, they test their shoes on machines, not real people.)
Among the untold problems that wearing shoes can impose in the developing child is the impact on the brain. From a baby’s very first delicate steps, each walking and running gait pattern significantly influences brain development. These actions affect lifelong patterns in the nervous system, even beyond the gait and balance mechanisms—they include postural habits, the ability to compensate to physical stresses, and the growth of muscles, bones, ligaments, tendons and other tissues. Normally, with each muscle contraction and relaxation, and every joint movement, important neurological patterns are created by the brain, just like with any memory. Shoes distort this process, and instead, the brain learns and designs irregular patterns of movement throughout the body.
In addition, other areas of the brain can be impaired. Normally, during early development in children, all the important neurological input from body movements trigger increased blood flow throughout the brain. This brings in oxygen and many other necessary nutrients to promote growth and development in areas that include learning, speech, and memory. Without the natural muscle contraction in the feet, for example, especially in the very small immature muscles that move the toes, impairment from wearing thick, oversupported modern shoes can reduce the brain maturing process.
In children plagued with posture- and gait-related problems, avoiding wearing shoes is even more important. This can help stimulate the above-mentioned neurological functions, which can, in itself, be very therapeutic. Rather than attempting the use of “corrective” shoes and related devices, such as inserts or braces, finding and correcting the causes, including neuromuscular imbalance, is important. Many physical ailments in adults could begin at this young age. Think about all the physical problems you’ve had in your life—it’s possible that many began during development of the important brain-body mechanisms due to significant interference by shoes.
It seems silly to even be discussing the issue of children’s shoes. Most people don’t question the fact that eating junk food is bad for kids, or smoking cigarettes. The level of brain and body stress from wearing bad shoes can be just as damaging. The most logical, effective, and healthiest way for children to develop their whole body is by being barefoot.
This essay originally appeared on Dr. Phil Maffetone's website. For more information on the do's and don'ts of children's shoes, Dr. Mark Cucuzzella has a lot more on the kids page on his Two Rivers Tread website.