Doctor´s statements

Children with the healthiest and most supple feet are those who habitually go barefoot. His studies of developing nations show that non-shoe-wearers have better flexibility and mobility, stronger feet, fewer deformities, and less complaints than those who wear shoes regularly. He says that, when a child must wear a shoe, it should be lightweight, flexible, shaped more or less quadrangularly, and above all, should not have the arch supports and stiff sides once deemed necessary to give the foot support. Many pediatric orthopedists strongly oppose “corrective” or “orthopedic” shoes for straightening foot and leg deformities like flat feet, pigeon toes, knock-knees, or bowlegs. Dr. Staheli and others contend that there is no evidence that corrective shoes correct anything, and that most of the supposed deformities correct themselves in almost all cases.

Dr. Staheli is a very prominent pediatric orthopedist …

Publication:  Staheli, Lynn T. Fundamentals of pediatric orthopedics. Raven, 1992. WS270 S781f 1992
Award:  Lynn Staheli, MD, received the Distinguished Service Lectureship Award, Orthopedic Section, American Academy of Pediatrics

Dr. Staheli  is on the Faculty of the University of Washington Department of Orthopædics in the Pediatric Orthopedics section. In 1992 … he was listed as Director of Orthopedics at the Children’s Orthopedic Hospital and Medical Center in Seattle

Most of a child’s developing foot is composed of cartilage, which is gradually replaced by bone. If the cartilage is deformed by badly shaped or rigid shoes, the bones will take on the deformed shape. More than 80% of foot problems, bunions and injuries are a result of misshaped and inflexible shoes.
Dr. Mark Cuccuzella
Most children’s shoes ought to come with a government health warning, they are like awful little bricks – too stiff, too rigid, with no flexibility at the sole and too much heel raise.
Tracy Byrne, Podiatrist specialising in podopaediatrics
What every kid seems to know instinctively — that going barefoot is good for you — has been confirmed by an orthopedist and rehabilitation specialist who has studied foot problems in various parts of the world.

“A high proportion of the world’s population walks barefoot most of the time, and the average person who walks barefoot has much healthier feet than the average person who wears shoes, says Dr. Paul W. Brand, chief of the rehabilitation branch of the U.S. Public Health Service Hospital, Carville, La. and professor of surgery a Louisiana State University Medical School.

Dr. Brand conducted an orthopedic clinic in India for 18 years and has also treated orthopedic problems in Ethiopia and the United Kingdom. On the basis of these experiences he suggests that maybe we in America should walk barefoot for at least part of each day.

Common foot problems in the United States include corns, bunions, hammer toes, athlete’s foot and ingrown toenail – but none of these is a problem in countries in which most people go barefoot.

“Every one is a product of footwear. They are caused either by poorly designed or poorly fitted shoes, or in such conditions as athlete’s foot, by the simple fact of wearing shoes that prevent free access of air between the toes,” he says.

Shoe-wearers also receive mechanical stress from walking on the same part of the foot with each step, while the rough, uneven thrust of the ground is transmitted to a different part of the barefoot walker’s foot with each step.

In shoes, Dr. Brand says, sensitivity, mobility, and intrinsic muscle strength of the feet are lost.
” The barefoot walker receives a continuous stream of information about the ground and about his own relationship to it, while a shod foot sleeps inside an unchanging environment. Sensations that are not used or listened to become decayed and atrophy. There is a sense of aliveness and joy which I experience walking barefoot that I never get in shoes,” he says.

Such direct contact with the ground has a great deal to do with preventing fractures of the ankle from “turning the foot over” by stepping on a rock or edge of the pavement. In India Dr. Brand saw no ankle fractures except in those who wore shoes.

The reason for this, he says, is that a barefoot person has instant information about the situation relayed by the touch-sensitive nerves in the skin of the sole and gets the information in time to avoid putting his weight on the unstable foot.

The person wearing shoes may not get this information in time to remove his weight from the leg to prevent a fracture.

Dr. Paul W. Brand, Quoted in the San Francisco Chronicle
Edited extracts from an interview with the president of the Australian Podiatry Association:

“Children’s bones are soft cartilage, easily compressible, and they don’t feel pain until the damage is done,” said the president. The comment was made on the need for parents to be aware of the damage that is being done by children wearing shoes.”

“The effects of childhood foot damage can show up in posture and gait in the early twenties,” the president said. “The inability for a person to stand for any length of time without stress can also be attributed to early foot problems. Shoes must take a lot of the blame for claw toes, under and over riding toes, bunions and ingrown toe nails, not to mention corns and callus’.”

“Between the ages of 7 and 12 years, growth is fairly rapid. Don’t hesitate to let them be barefoot. It won’t spread or flatten normal healthy feet as the foot only grows as long as the ligaments allow anyway. The majority of foot damage is preventable if parents take proper care of their children’s feet by allowing them to grow naturally – barefootedly.”

Care For Kids Then Care For Their Feet, From The Pilbara Times, Australia
Style and price are not nearly as important as fit when it comes to choosing a good children’s shoe. In fact, the best shoe for a child is often no shoe at all, “We are no different from any other animal. We don’t need shoes for proper foot development,” explains Frey. Walking is a collaborative effort requiring constant communication between the brain and feet. Nerve endings on the bottom of the feet sense the ground beneath and send signals to the brain that help it determine how and where weight should be distributed with each new step. Shoes alter that feedback to the brain. The thicker the sole, the more muffled the message. “Children are forced to walk with their feet further apart to keep their balance,” Frey says.

“Shoes are not necessary for support or development of the arch, they only protect the feet from the environment,” said Fry, who routinely treats foot deformities caused by ill-fitting shoes. Babies and crawlers need only wear socks or booties to keep their feet warm, she said. Toddlers, too, should be allowed to go without shoes whenever they are in a protected environment. Going barefoot helps children develop stronger and more coordinated foot muscles, Frey explained. Studies also show that barefoot children learn to walk more quickly and have fewer falls.

There’s a good reason Kenyans have won the last 10 consecutive Boston Marathons: They rarely wear shoes. This makes their feet extremely strong and far less susceptible to disorders such as fallen arches, says Dr. Frey.

Dr. Carol Frey, Associate clinical professor of orthopaedic surgery in Manhattan Beach, Calif
Abstract: We analyzed the static footprints of 2300 children between the ages of four and 13 years old to establish the influence of footwear on the prevalence of flat foot. Significant differences between the predominance in shod and unshod children were noted in all age groups, most marked in those with generalized ligament laxity. Flat foot was most common in children who wore closed-toe shoes, less common in those who wore sandals or slippers, and least in the unshod.

Our findings suggest that shoe-wearing in early childhood is detrimental to the development of a normal longitudinal arch.

In Europe and America flat foot is a common reason for attendance at a children’s orthopaedic clinic, but in India children are seldom brought for treatment for flat foot. The few children who do attend with this complaint are from affluent urban families and they all wear shoes. In our clinic we have never seen a child from the farming community or from the family of a manual labourer who complained of flat foot.

The high concentration of flat foot among six-year-old children who wore shoes as compared with those who did not, implies that the critical age for development of the arch is before six years.

Our cross-sectional study suggests that shoe-wearing in early childhood is detrimental to the development of a normal or a high medial longitudinal arch. The susceptibility for flat foot among children who wear shoes is most evident if there is associated ligament laxity. We suggest that children should be encouraged to play unshod and that slippers and sandals are less harmful than closed-toe shoes.

Udaya Bhaskara Rao and Benjamin Joseph, The Journal of Bone and Joint Surgery.
Recent research has shown that children are more likely to have good posture if they go without shoes as often as is possible and safe. “That way they get more ‘sensory information’ from their feet and will have better walking and postural skills.” Children should be allowed to go shoeless … in places where it’s safe to walk barefoot as a way to improve their posture, according to Perry.
Janet Perry, M.P.T., Physical therapist with Rehabilitation Network in Portland, Oregon.
An elevated heel of any height on a child’s shoe shortens the Achilles tendon and is the beginning of permanent tendon shortening. Soles that are over 6mm thick prevent 80 to 90 percent of children’s foot flexibility, thus denying the foot its normal step sequence.
Dr William A Rossi, (2002) Children's Footwear: Launching Site for Adult Foot Ills, Podiatry Management.
Slimmer and more flexible children’s shoes do not change foot motion as much as conventional shoes and therefore should generally be recommended for healthy children.
Sebastian Wolf, Foot motion in children shoes, A comparison of barefoot walking with shod walking in conventional and flexible shoes, Gait & Posture