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Why badly fitted footwear is bad for children

CHILDREN’S shoes are among the most important articles of clothing parents need to pay attention to as they grow in size and shape. Foot health is incredibly important to their overall health and well-being, especially in the years when feet are still growing.

In children, ill-fitting shoes are an important source of minor blisters and discomfort to worrying deformities and problems with gait and posture. Such footwear can irritate children’s feet and aggravate existing conditions caused by injury, heredity, deformity, or illness.

Investigations on children’s feet have shown that a high percentage of children wear ill-fitting shoes. This bad shoe types cuts across different countries of the world.

In Spain, researchers in a new study observed that the footwear of the schoolchildren was too short and too narrow in 72.5 and 66.7 per cent of the cases, respectively.

Only one third of the participants analysed had well-fitted footwear, also suggesting the importance of replacing, periodically, the footwear of children in primary education.

The 2019 study published in the journal, BMC Musculoskeletal Disorders, involved 505 children within the range of three and 12 years. Their maximum foot length, width and height were obtained from the longest foot. These measurements were compared with the inner length, width and height of the footwear.

The left foot was longer than the right foot in 72.6 per cent of the schoolchildren. Highest foot length average increase in girls occurred between seven and eight years. The boys had wider feet than the girls with significant differences from nine year-old.

Likewise, in the age range between four and nine years, the footwear was narrower than the foot, with significant differences.

Now, during a child’s development and until the age of eight years, the foot predominantly grows in length and after this age, the width/length proportion in older children is similar to observed in adults. Also, foot shapes differ between populations, genders and body weight.

Although parents will not bring their children to the clinic complain of foot pain due to ill-fitted shoes, Head, Department of Orthopedics and Trauma, Dr Michael Okunola, said this does not rule out the fact that children are more vulnerable to the effects of ill-fitting shoes.

Dr Okunola stated that ill-fitted shoes in children can lead to problems ranging from minor pressure marks and blisters to more worrying deformities and problems with gait and posture, especially in children with deformities.

According to him, “if appropriate shoes are not used, it can worsen existing conditions caused by injury, heredity, deformity, or illness. But if people use normal shoes that are in the market, they hardly cause deformities.”

Dr Okunola said shoe specification for children differs with age.

“And for babies, it is usually soft and well-padded shoes. But as the child grows, the common shoes in the market are usually well designed to fit. But it must be well fitted,” he added.

Dr Omolade Lasebikan, a consultant orthopedic surgeon, National Orthopedic Hospital, Enugu, stated that shoes for children that can cause foot malformations, in the long run, include high heeled shoes.

He stated that the pointed heels prone children to the danger of fall, ankle sprain and even fracture.

Dr Lasebikan declared “children have growing ends of the bone, so any injury that affects that growing end of their bones can cause a deformity in their foot.

“But the usual flat shoes with a light heel or canvass if properly fit is not likely to cause a problem if it allows some room for growth.”

The expert, however, urged mothers that notice deformity in the feet in their children such as club foot and fallen arches, also known as flat feet, to take them to the hospital.

Fallen arches is a genetic condition but can be aggravated by bad footwear. If left unchecked, flat feet can lead to osteoarthritis in the knees.

He also urged parents to be vigilant to ensure their children are wearing shoes that fit properly and provide the stability and support they need.

Common signs of badly fitted shoes can include blisters, corns and calluses to the child’s toes, blisters on the back of the heels or worse and ingrown nails, which can become infected. Signs of infection from ingrown nails include pain, redness or fluid draining from the area.

Howbeit, the researchers said there was a need for parents to adapt the sizes of footwear to the rapid increase in foot length and width of their children.

They, therefore, propose that parents change their children footwear twice per year for children between four and six years of age, and three times per year for those between six and 12 years of age.

Moreover, a cross-sectional study that involved 858 Austrian preschool children of 3 to 6.5 years also observed that the outdoor footwear was shorter than the feet in 69.4per cent of these children.

In fact, the researchers in this 2009 study published in the BMC Musculoskeletal Disorder, warned that children that wear too small shoes for them stand a higher risk of suffering from hallux valgus, a bony bump that forms on the joint at the base of the big toe.

Similar in a recent study conducted in South African children found that 67 per cent of the children and adolescents wore ill-fitting shoes shorter than the feet.

In women, shoe wear was also a statistically significant predictive factor for hind foot pain. Past shoe wear in women is associated with hind foot pain, regardless of age or weight.

Footwear has been used by humans for approximately 30,000 years. Although originally worn as a protective covering for the foot, modern footwear is designed to fulfill a range of purposes that are judged by three criteria: form, function and fit.

When shopping for shoes, it is important to fit new shoes to the largest foot.  There should be 12 to 16mm of space from the end of the longest toe to the end of the shoe. Of course, when the shoe is on the foot, it should be possible to freely wiggle it off the toes.

Indeed, footwear has been used to correct pathological skeletal alignment and foot posture among children. Therefore, correct shoe fitting in children is of paramount importance.

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