Not all practitioners embrace soft soles for novice walkers #13508539

Barefoot-like isn’t necessarily best

By Shalmali Pal

Barefoot is a biomechanics buzzword these days, but not all practitioners believe soft-soled shoes are best for very young children, even if such shoes do approx­imate the barefoot walking experience.

Fueling debate on this topic is a gait analysis study funded by children’s shoe company Stride-Rite, the results of which have been popping up at scientific conferences for the last year and a half. In early walkers, shoes with the most torsional flexiblity were associated with the highest plantar pressures, which the researchers suggested was an indication of enhanced proprioception, and were most similar to a barefoot condition (see “Impacts spell injury,” September 2010).

Mom and dad may be enamored of flexible footwear for their offspring, but not all the experts are convinced of their validity. There’s a time and place for soft sole shoes, they say, but young walkers need more than a barefoot experience.

It’s important to define “early” and “young” walkers, said Jeffrey Feld, DPM, who practices in Virginia Beach, VA, and is a clinical faculty member at Eastern Virginia Medical School in Norfolk. A child transitioning from crawling to ambulation is an early walker; one who walks with stability and balance is a young walker, Feld said.

For the early walker with an unstable gait, Feld said he is fine with pure leather, fully flexible shoes as long they are worn indoors.

“For such an early walker, I want that kind of flexibility. The child is learning tactile sense,” he said. “However, I do not like those super-soft shoes outside of the home as they make the child prone to trauma.”

Outside the home, and for a young walker, Feld called for protection against the environment.

“There are a lot of people pushing ‘Let’s get back to nature’ with these bare-minimum shoes. I ask those people, ‘Is the child walking on dirt, grass, and sand?’ We live in a concrete world and we have to put shoes on our feet to protect ourselves from constantly banging the pavement,” he said.

Feld’s preference is for a semi-rigid shoe that offers a thick or firm sole for protection, but flexibility in the toebox to maintain foot mobility. Given that early and young walkers have very malleable feet, shoes need to offer some support.

“The only places where the foot significantly bends are the toes and the ankle joint. Of course, there’s motion in the other joints, but nothing so severe that the whole shoe needs to bend in half as in some shoe products marketed today,” he said.

Randy Brown, CPed, of Brown’s Shoe Enterprises in Washington, MO, echoed that sentiment: Early on, a child’s round-heeled, fatty, archless, unstable feet need structure and strength.

Brown recommends a shoe with stability from the heel to the ball of the foot (suitable sole materials include rubber, suede, or urethane) and with some, but not too much, flexibility in the ball of the foot.

“A firmer sole shoe allows them to maintain their balance, and may actually encourage them to walk a little quicker,” he said.

Once a child has achieved balance and takes more confident steps, Brown is fine with migrating to a softer shoe with a nappy, sueded sole, generally at 10 to 12 months for girls and 12 to 14 months for boys. Durability of soft sole shoes is a non-issue, Brown said, because most kids will outgrow the shoes long before they wear them out.

The experts who spoke with LER were unanimous on one point: The buttery soft, flexible leather shoes that can be completely balled up like a piece of tissue? Their appeal is about fashion, not function.

Parental fascination with these extremely soft shoes may be little more than a backlash against the stiff, white, leather-soled shoes that they were made to wear as children, Feld suggested.

For walking indoors or in other safe environments, the child is better off being barefoot, said Yaron “Ron” Raducanu, DPM, president of the American College of Foot and Ankle Pediatrics.

“Most kids don’t develop an arch until they are two or three years old. A soft sole shoe isn’t really going to help that develop that,” Raducanu said.

Brown looks at these shoes as “crib shoes.”

“They really don’t have any other purpose. They are for fashion purposes and for pictures,” he said. “A young child doesn’t have the anatomy to gain benefit from barefoot walking.”

Shalmali Pal is a freelance writer based in Tucson, AZ.

This entry was posted in Pediatric Clinical News, 2011, July and tagged , . Bookmark the permalink.

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