To Flip-Flop or Not

So, you’re in the department store shopping for your kid, because they seem to be growing every week! They are in dire need of new shoes and it’s summer, which means it’s flip flop weather, right?!

Not so fast! Although, I love the cute sandals they have for kids now a days – I think it’s important to look at how sandals may be effecting your child’s walking.

When you think about how a tennis shoe is secured to your child’s foot and then think about how a sandal is secured to your child’s foot – they are very different. When you’re wearing a tennis shoe you don’t have to think about keeping the shoe on your foot, which allows your walking pattern to be similar to how you would walk barefoot.

Now, when you’re wearing flip-flops, you have to secure the shoe on to your foot by gripping your toes into the sandal. This creates some confusion for your body. As you’re swinging your leg through, your hip is moving up/forward, but your toes are pushing down trying to keep the flip-flop onto your foot – do you see the confusion? Not only is your body confused, but by gripping your toes onto the sandal it places pressure and tension onto parts of your lower leg and foot that were not intended for that purpose.

But it’s hot out and my child and I need summer shoes! Consider a shoe that is secured to the foot – something that cups the heel. It can have straps and openings, but when the shoe isn’t secured to the foot such as flip-flops and slippers – it places abnormal pressure and tension on your child’s body.

Just some things to think about as you are buying your next pair of summer shoes!

Which Shoes Are Best?

As parents, you may wonder what is the best product or toy that will help your child meet their milestones or learn things quicker. I’m sure you’ve also wondered what type of shoe could be best for your new walker? There are so many shoes to choose from that will help make your child the most fashionable, but which one is going to be the best for the development of walking? There is not one right answer, but here are a few things to keep in mind when choosing a shoe that will be right for your child.

As children learn how to walk, their foot plays a huge role in their stability, shock absorption and momentum. The bottom of their foot allows them to feel where they are in space. Therefore, the type of shoe that is worn can determine their walking pattern and stability. Should your child go barefoot, wear a flexible shoe, or stiff shoe?

Some research shows (see below) that the best foot development occurs when a child is barefoot, so the best shoe would follow the barefoot model, meaning that the shoe should be flexible. Going barefoot allows the foot to feel the texture of the floor and gives them good sensory feedback to let them know where they are in space. A flexible shoe (soft material with a soft sole that allows for bending) can also allow for more sensory feedback, similar to going barefoot. However, a stiffer shoe can lead to greater stability compared to a very flexible shoe. It was seen that children keep their foot on the ground for a longer period of time when wearing stiffer shoes, possibly because they are not getting as much input and need that time to understand the environment that they are in. So if your child seems to be a little more unstable, a stiffer shoe may be best for them.

Depending on what type of shoe you decide to put your child in, they typically will adapt to it and change their walking pattern (amount of time they keep their foot on the floor, width of their feet, and speed of walking). Children are fast learners and are ‘flexible’ to any changes that come their way. As therapists, we are always trying to promote adaptability; so changing the type of shoes that they walk in can be a great way to teach them how to experience a new situation. As mentioned before, there is not one perfect shoe for all children and the need for flexibility vs. stability may need to discussed further depending on your child’s needs.

Keep in mind that the articles referred to focused on children who are developing motor skills typically, therefore, the amount of stability or flexibility may depend on the individual need of your child.

Buckland MA, Slevin CM, Hafer JF, Choate C, Kraszewski AP. The effect of torsional shoe flexibility on gait and stability in children learning to walk. Pediatr Phys ther. 2014; 26: 411-417.

Staheli L. Shoes for children: a review. Pediatrics. 1991;88:371

What type of Shoe may be best for your child?

As therapists, we believe that shoes can play an important role in your child’s gross motor development.  This article is meant to give you a brief idea of what type of shoe may be most appropriate for your child depending on their stage of development. You  may have read about this topic in one of our prior blogs.  If not, check it out!

When your baby is still spending most of their time down on the floor doing things like rolling, sitting, crawling no shoes are really necessary.  However, if you are looking for something to provide protection or warmth for outdoors, robeez, such as the pair to the left will do the trick.  During this time, a stiffer, more structured shoe may actually get in the way of your child’s abiliy to perform transitional movements or crawl.

Next your baby will most likely begin to pull to stand at furniture and learn to cruise. Again, shoes are not required for this in a protected environment.  In fact, it is often beneficial for your child’s foot musculature to be barefoot when beginning to engage in prewalking activities.  However, if your notice that your baby is hesitant to get up on their feet or appears unstable when standing at furniture, then you may try a slightly more structured pre-walker shoe such as the one to the left.  This type of shoe still has a very flexible sole so that it will bend and move with your chid’s foot but it gives just a bit more stability than the robeez.  If you opt for a shoe like this, it doesn’t mean you can’t also give your baby barefoot time as well.  The shoe may just help them initially to feel secure and then you can alternate netween shoes and bare feet.

Anywhere from 10-18 months, a typically developing child will most likely take off walking.  This is where shoes become even more important.  Now that they are really pounding the pavement, it is important to have a supportive shoe that promotes good alignment to avoid unnecessary stresses to the still developing joints of a toddler. During this stage it is important that function wins over fashion.  But don’t worry, most if not all children’s shoes are very cute regardless of the style! Generally, a sneaker type shoe offers the best arch support at this stage but there are many styles that will do the job.  For example, many brands make mary jane style sneakers or shoes for girls that offer good arch support as well.

If your child has an identified motor impairment or delay, it is important to discuss footwear with the appropriate service provider as they may require more than just the right shoe. Below, we have provided a list of our favorite shoe brands:

• Stride rite: great shoes for children of all ages; knowledgeable staff; most shoes accomodate for orthotics inserts nicely.
• Tsukihoshi: can be found in most bay area children’s shoe stores; very light weight; accomodate for orthotic inserts nicely.
• Ecco: light weight; accomodate for orthotic inserts nicely.
• Merell: great arch support; very durable for outdoor activity.

The brands mentioned above do tend to run a little on the expensive side.  However, if you find what you are looking for and the price is out of your range, take a picture of what you want to a less exepnsive store such as target or payless and you’ll be surprised that you can actually find a very comparable shoe.

 Good luck in your quest for the perfect shoe!

The Long Road to Walking

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I recently put together some footage for a video of some of the hard work that goes into walking for children with developmental disabilities. However, the same concepts can apply to any child who is learning to walk.

Balance is a huge factor for learning to walk. Give your child the chance at success first by controlling the environment they are learning in. It should be short distances, level ground, sturdy shoes, not a lot of distractions going on around them and lots of motivation/rewards.  This looks like toys that interest them, mom or dad cheering them on, etc.

As they start to get some success add in fun challenges such as ‘dancing’ or trying to pick up a toy from the ground, turning around to head in a different direction, different terrain (carpet, hardwood, grass), bare feet vs shoes, etc.

These are things that can make learning to walk fun for a child who has to work extra hard at it!

Things to look for when buying kids shoes

When buying shoes for your child there are a few things to consider.  In this post I’m talking about shoes they are going to wear the majority of the time.  Those special occasion shoes don’t fit into this category!

You want to have your child try on the shoe to make sure it fits.  If they use inserts or braces on their feet, make sure you have the braces/inserts with you so that you get the best fit.  Sometimes you have to take the insole out to give a better fit.

Beware of big toe boxes on shoes.  This can cause your child to turn their toes in more (if they tend towards this pattern already), and it can also increase tripping.  If you watch your child walk and they don’t seem to have any problems then this is not something you have to worry about.  Just be warned that walking on a flat surface usually found in the shoe store can look very different than walking over uneven terrain such as grass or sand and your child’s walking may change.  This is why its always a good idea to make sure the shoe store you buy from has a good return policy!

Make sure there isn’t a lot of space on the sides of the shoe where your child’s foot can wiggle.  This creates instability especially for those kids who are low tone or have some difficulties with walking.  You may need to ask your shoe store if there are shoes that come in narrow sizes so they have a snug fit all around.  It makes it that much more difficult to maintain balance and form if you have to carry a shoe around but your foot can’t stay stable in the shoe.

Look at the weight of the shoe.  Some shoes are heavier than others and this can be a good thing but you need to see how your child responds to it.  You can also find nice sturdy light weight shoes too if your child can’t handle the weight of a heavier shoe.  If you aren’t sure and you don’t feel like you can tell when you watch your child try it on, see if you can get both pairs and have your physical therapist look at how they are walking and give you input.   You may also want to ask their opinion before you go shopping because they may be able to steer you towards brands and styles that they have experience with and know will work well with your child.

Just a few things to consider when buying your child’s shoes!  Of course I didn’t even cover personal preferences such as color and light up and such!

Does your child need the perfect shoe?

I have had several requests on how to tell what kind of shoe to get for your child, usually in the infant to toddler age range, and I will do my best to impart my words of wisdom on the subject.  However, I will caution you that if you have serious concerns about your child’s feet or what kind of shoe they should be wearing, your best bet is to have a professional look at them because their help will be more accurate to your specific needs.  Ok, that being said, if you remember back to my first post ‘If the Shoe Fits…‘  I discuss why your child may or may not need shoes earlier than the recommended 17 months.  In this post I will discuss what to look for in your child’s feet and what to consider when buying a shoe.  If this is of interest than please feel free to read on!

To start, if your child is receiving services for developmental delay, and they have abnormal tone issues (low tone or high tone), than you may want to ask their service provider regarding what would be best for them in terms of foot wear, and possibly orthotics to support their foot position.  For children who don’t fit into this category, the thing I notice most that would cause me to recommend being choosy in their footwear, is a child who has excessive pronation at their ankle and foot.  Here is a picture of a child with pronation at both of her feet:

The easiest way you can tell is by looking at the back of the foot.  Does their heel look like it is slanting towards the middle, and does their achilles tendon not make a straight line?  It may look like your childs ankles are bending inward.  If this is the case your child most likely has foot pronation.  If your child has this, and is already walking, I would recommend a supportive shoe that will hold their heel in place, and covers their whole foot.  It should have a sneaker type sole and use laces or velcro.  I know sandals and Crocs and Robeez are really cute, although if your child needs support, these will not provide it!  Stride Rite makes several pairs that are great for supporting your child’s foot.  As for getting the correct fit, you can go into a store and get measured, although here are some guidelines to assist you in making the purchase.  In addition to finding a good shoe, if your child needs some additional arch support for their foot, Cascade is a company that provides children’s inserts.  They have several levels although the one I like the best is the Pollywog (pictured here):

This insert provides arch support while cupping the heel to help hold it in a neutral position.  The inside is made of a foam like material so it is comfortable for you child.  If you are going to get inserts, make sure you buy shoes after you get the insert to ensure they fit!

This may all seem a little overwhelming.  I mean, as adults there are a lot of us out there with pronated feet so why is it a bad thing for our kids?  I like to think of it as they are just starting out and their foot is their starting point.  If the alignment of their foot is off, it can change the alignment all the way up their bodies as well as potentially cause problems down the line.  And please remember, these are just guidelines and suggestions, if you have specific questions about your child’s feet, please have them looked at so you can get answers that are custom to your child.

If the Shoe Fits…

I am a pediatric physical therapist and I love what I do. I basically get to play with kids all day long. Along with the playing, comes the talking to and working in partnership with parents. For a parent with a young infant/child, walking is the most well known milestone.  Who doesn’t talk about when their baby started walking, or worry about when they will start walking.  In fact, I think my mom can still tell you the exact age each of her three children started walking (and that was many, many years ago)!  Its something that we all understand. What we don’t always understand is that shoe selection can really help. I recently read Best Foot Forward in mom & baby and it recommends and strongly encourages parents to not use shoes until at least 17 months of age (unless your child is a late walker).

According to Baby Center a child’s first steps can occur between 9-12 months and they are walking between 14-15 months although it shouldn’t be concerning if they walk as late as 16-17 months.  Well that is a huge range. How is a parent supposed to know if their child is a late walker? The trend in foot fashion for the very young has gone the route of the soft and flexible sole, such as Robeez. This is great if your child has a typical foot. However not every child does. Some kids have less muscle control in their feet and by not providing them with supportive shoes when they begin to stand, their ability to stand and walk independently is delayed. Believe me I understand the need to allow muscles to develop and strengthen in the foot, however not every child is served by this. By providing them with a supportive shoe such as the kind that can be found at Stride Rite (please note, I am not saying this is the only place to buy shoes, however they have a wide selection that is not only supportive, but stylish as well), it will give them the added stability they need to begin taking their first steps, or to begin trusting themselves to stand independently.

I know its not easy to know if your child needs shoes. There are a few solutions. One would be to contact your local pediatric physical therapist and ask some questions. Another would be to go to your local kids shoe store and talk to the people that work there. Even talking to your pediatrician might provide you with some answers. Kids feet can need help because they are too ‘floppy’ or because they are too ‘stiff’ and why not set your kids up for success early, as well as improving their alignment and letting them put their best foot forward!  What I hope will be your biggest take-away is that kids don’t come from an assembly line. Every child is different and has different needs. There may be nothing wrong with their feet, however if they are timid and hesitant to start walking, maybe a supportive shoe will give them that little extra boost in confidence they need to take that scary first step. Just think how you feel when you have just the right shoe on!