Common Disorders

Did you know the foot has 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that 75 percent of all Americans will experience foot problems at one point or another in their lifetimes.

Fitting Preschool Children's Shoes

We discussed fitting infants' shoes in the last article, now your child is past the infant stage and into preschool. Children have usually developed their natural gait by this time, and are running and making lateral movements. At this stage children would rather be running than walking. Being more active requires a different type of shoe and different fitting of the shoes. The growth pattern will change, depending on the child, from a steady growth about every three months, to a spurt pattern. The foot may not grow for a period of time and suddenly grow a size or more in a short period of time. Due to the fact every child is different it is impossible to predict this change in growth pattern. The parent should check, or have a shoe fitter check the child's shoes every two or three months.

Most children of this age range are now attending a preschool, daycare, or mother's day out program. It is natural for the child to desire the popular shoes that the other children are wearing. Unfortunately because all feet are different the most popular shoe may not be the best for your child's feet. The style of children's shoes often follows the style of adult shoes, but fashion and function often do not go together. The requirements of a child's foot are quite different than that of an adult foot, so adult styles on a child's foot may be a poor choice. An example of this would be the clog style shoe that is popular now. A child who is running and climbing cannot keep this type of shoe on during normal daily activities. Another would be the slipon style of athletic shoe that is becoming popular with adults. A slipon shoe for a child must be fit shorter that usual in order to keep the shoe from slipping off of the foot. This means that the shoe must be replaced more often than a traditional lace athletic shoe.

No two feet are alike. Some are narrow, some wide, and they vary in the overall shape. Style and shapes of shoes should match the shape of the foot. Compatibility is very important in fitting the foot. The shoe may be the proper size but the shape of the last is wrong for the foot. For example, a narrow foot would not do as well in a heavy sole, broad toe style. Wider feet would be better suited for this type of shoe. Children wear their shoes differently. Some shoes will look new after three months wear while other will look totally worn out after three weeks. How your child wears his/her shoes should be a consideration when fitting the shoes. For the child that is hard on his/her shoes, a heavier weight shoe will make a difference in how long the shoe will last.

Due to the wide variety of shoe and foot shapes, and due to the fact that right and left feet are different sizes, the perfect fit does not exist. There are some things you should check when fitting the shoes: toe room, width, throat room, heel fit, anklebone clearance, and compatibility of shoe and foot. The following are guidelines you can use when fitting your child's shoes. Remember fitting is an art not a science, it takes practice and experience.

Toe Room: Generally there is one third inch between sizes. Leaving one-third to one-half inch in the toes will allow for a whole size or size and one half of growth room. Be sure that this room is allowed on the larger foot. If the shoe is too long, the break across the vamp (front of the shoe at the ball) will be at an angle instead of straight. The break or bend across the vamp may also be deeper on a shoe that is too long causing irritation across the top of the toes. As the shoe is worn, the toes will have a tendency to turn up.

Width: Shoe width is probably the most important part of fitting a shoe, but is ignored by most parents. Most parents want the shoe to fit with lots of toe room so that it can be worn for a longer period of time. However, if the shoe is not wide enough, then it will be outgrown in width long before the length becomes a factor. Foot growth is not in equal proportions; the toes are one fourth and heel to ball is three fourths of the total growth. If the shoe is too narrow then the foot cannot grow forward in the shoe, and length becomes less important.

You should be able to lift the leather off of the top of the foot by gently squeezing across the ball of the foot. One-sixth to one-quarter of an inch should give the child ample room for forward growth in the shoe. Be sure that the little toe is not cramped or turned under. Narrow feet are much more difficult to fit than wide feet because most manufacturers do not make narrow widths. Guidelines for fitting a narrow foot are the same, but you may have to try many more styles to find one the fits narrow enough for your child's foot. Frustrated parents will ask, “Will it hurt my child's foot to wear a shoe that is too wide?” The answer depends on the length of time the shoe is going to be worn and how wide it is. The foot will move constantly in a shoe that is too wide. The motion can cause irritations such as calluses and in some cases blisters. Sometimes insoles can be used to take up the extra space in the shoe, but it is difficult to find them in children's sizes.

Throat Room: The throat of the shoe is on the top where the foot meets the shoe. If there is not enough room between the foot and the shoe in the throat, then the foot will not be able to grow forward in the shoe. The tip of the first finger should be able to be inserted between the foot and the shoe in the throat. This will allow ample room for the forward growth of the shoe. Of course different styles of shoes will require different amounts of room. You cannot allow that much room in a slip-on shoe or loafer. If you do, the shoe will slip off as easily as it slips on. A buckle or Mary Jane style has a low cut vamp but you should still allow room on the top where the shoe and foot meet. The strap will allow for some adjustment of heel fit.

Heel Fit: Your mother always told you to make sure the heel doesn't slip when you are trying on new shoes. A little looseness in the heel is not a bad thing. If the heel is too tight however, you will be guaranteed a blister. Constant pressure on the heel will cause the body to build up a fluid to cushion the spot. Excess room will also cause problems, but just a little room will allow for more natural foot movement. Use caution on sling back shoes and clogs. These styles offer no lateral heel control. As the child runs, the heel will slip to the side, increasing the chances of twisting an ankle.

Anklebone: The anklebone on the outside of the foot is lower on some children and can be a problem area. Athletic shoes with padded collars usually take care of this problem. O n dress shoes that are harder and stiffer it can be a source of irritation. Check to see that the topline of the shoe comes above the anklebone or well below it. Sometime a felt heel lift will help until the topline softens.

Compatibility: There are many styles of shoes on the market today, and your child will want the one that is the most popular. However, is that the best shoe for his/her foot? A shoe can be the right size but be totally wrong for the foot. Be sure the shape, or last, of the shoe match the shape of the foot. Matching the shoe and foot shape will be more comfortable for the child and the shoe will look and wear better.

Several months ago a mother brought her daughter in with a pair of shoes that had been purchased at a specialty athletic store. Due to the fact that the child was in a school sponsored activity, the shoe was required for the uniform. The child had bunions and the beginning of hammertoes, and the shoes were very painful for her. The mother inquired about adjustment to the shoes that would allow the child to continue with her activity. After several adjustments on the shoes, they were less painful. However they still did not fit, nor were they compatible with the child's foot. Children will wear shoes that are popular or required for an activity whether they fit or not. It is the parent's job to assist the child in making correct choices. If proper fitting is started at an early age, then the foot will grow to its adult shape with few problems. Hopefully incidents like the one above will be avoided.

It is important for you to understand that the information provided is of a basic educational nature only, and does not constitute medical advice nor should it replace a medical consultation or the advice of your doctor.

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