December 2010

The right fit matters, shoe studies suggest

By L.W. Barnes

Children’s feet grow so irregularly and so fast.  As every parent can attest, their children seem to outgrow sneakers and maryjanes in lightspeed. But this headache isn’t the only problem. According to two recent European studies, children’s ill-fitting shoes can pose a health dilemma as well.

A Swiss study presented at the annual meeting of the American Academy of Orthopaedic Surgeons in 2009, found that about half of the 248 children surveyed were wearing outdoor shoes that were either too small (52.8 %) or too big (13.3 %). Although the study did not analyze the association between shoe fit and hallux valgus angle, it did find that 79.7% of 153 children had hallux valgus angles of 5º or more. An angle of more than 15º is typically considered clinically abnormal. This value was exceeded in 3.3% of children in the study.

The problem, researchers said, was largely caused by shoes that were advertised to be a certain size but turned out to measure smaller.

“It was a truly striking finding,” said lead author Norman Espinosa, MD, of the University of Zürich, who was quoted in the March 2009 issue of AAOS Now. “The shoe sizes given by the manufacturers almost never matched the true sizes measured by our group.” Dr. Espinosa went on to recommend that the focus should be on parental education to prevent the early onset of juvenile foot deformity.

Another study of 858 preschool children conducted by the Medical University of Vienna found that the majority of children wore shoes that were too short. More than half (57.8%) of 789 children had hallux valgus angles of 4° or more.

Pedorthists in the United States say they are no stranger to the problem of ill-fitting shoes, particularly when parents buy footwear on the Internet or without their children in tow and rely solely on the size stamped on the shoe box, not on actual fit.  

“We’ve had incidents where you can tell [the child’s] toes have been smashed completely inside the shoe,” said Donna Boland, CPed, who is with Brown’s Enterprises in Washington, MI. “The parents figure ‘It’s a cute shoe they won’t wear very long; it’s OK.’”

But as every certified pedorthist will attest, not all shoes are made equally.

“We always recommend that when a parent comes in and says ‘I’m looking for shoes for my child’ that it’s best to bring in the kids,” Boland said. “If not, bring us a tracing of the child’s feet so that we can get a better idea of what we’re looking for and measure the tracing. We also take the thickness of the foot into consideration when we do the fitting.”

Without enough space in the front of the shoe, Boland said, children won’t have [adequate] toe movement forward as they step. Make a shoe too big, she said, and the flex point of the shoe will not match up with the flex point of the foot. (Experts advise that the tip of a child’s big toe should be between 10-12 mm from the shoe’s inside tip while standing.)

Kristi Hayes, an ABC certified pedorthist and the current president of the Pedorthic Footwear Association, said that most children wear the wrong size shoes simply because few people are qualified to fit shoes. In addition, she cites parents who use hand-me-downs for small children, not realizing how detrimental an incorrect shoe size is on their soft bones.

“I have seen parents who buy shoes way too big to allow for growth, which is equally bad as the kids struggle to keep them on, or shear back and forth in the footwear,” Hayes said.

The answer, experts say, is to measure the foot often and adjust shoes accordingly. The right fit, they say, can potentially reverse any damage building on young feet.

Sponsored by an educational grant from Keeping Pace Children’s Orthopedic Footwear

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