How Should Children's Shoes Fit?

Something that is ingrained in us as Pediatricians is that “children are not merely little adults.” This holds true for virtually all childhood physiology (the way body parts function), from their hearts and brains all the way down to their toes, literally. Children’s feet are not simply “miniature” versions of adult feet. They are shaped differently from those of adults, and they change as they grow.

Adult Feet vs. Baby Feet

An adult foot is a complex structure made up of twenty-six bones. Designed to support the entire body through a lifetime of movement, the average foot spends its whole life absorbing different pressures and shocks, all while adapting to constant changes in functional stability. This is the essence of the Hueter-Volkmannn Law in Orthopedics, which states that bone growth, in the period of skeletal immaturity, is retarded by mechanical compression on the growth plate and accelerated by growth plate tension. What all of that means is that different stresses on bones determine whether they grow or not.

As baby first develops, their tiny foot contains far more cartilage (the flexible stuff your ear is made of) than bone. Over time (by age 18 or so), this cartilage will fuse and fully harden into the strong, adult bones we require. Cartilage is, by its nature, flexible, which is why a shoe that is too stiff or too tight can actually come to affect the overall shape and potential movement of your child’s foot permanently. Yes, permanently.

Foot binding is the custom of applying tight binding to the feet of young girls’ feet to modify their shape. It was practiced in China from the Song dynasty until the early 20th century, and bound feet were considered a status symbol, as well as a mark of beauty. Foot binding limited the mobility of women, and resulted in lifelong disabilities for most of its subjects. It’s an extreme example, but a vividly illustrative one, showing how malleable the human foot actually is. 

To make a long story short, because the feet of young children are soft and pliable, abnormal pressure can easily cause deformities. So, to move on to the crux of our article:

Why does proper fit really matter?

As early as in infancy, even the socks you choose for your child make a difference. Before a child starts walking, the feet do not need to be covered except for warmth or hygiene purposes (of course shoes are the perfect accessory). You should therefore cover your baby's feet loosely. Tight footwear restricts movement and can retard normal development. So if you want to extend the life of your onesies, please cut the toes off!

In the first five years of life, a child’s feet grow and develop rapidly. Your child’s feet can grow up to two sizes in six months, so you need to account for growth when buying shoes. That does not mean you should buy shoes that are too big! Oversized shoes are also a problem, causing the foot to slide forward, and putting excessive pressure on the toes. A good fit is about a finger's width (10mm or ½ inch) from the end of the shoe to the tip of the longest toe. Tight shoes, of course, can cause blisters, corns, and calluses on your child’s toes, blisters on the back of the heels, or worse, ingrown nails, which can become infected. There seems to be something to Goldilocks’ theory…

Feet should be measured prior to every new footwear purchase. See more on Measuring & Fitting Children's shoes here. Parents should be attentive to the need to discard and replace shoes that have become too small even though they may not appear to be worn out.

Average life of children's shoes is about four months

Speaking of wearing out, the average life of a pair of children’s shoes is about four months, depending on the quality of the shoes. Shoes lose their shock absorption over time, so replace any shoes with wear and tear around the edges of the sole. Worn-out shoes elevate the risk for heel pain, tendonitis and even ankle sprains and stress fractures later in life. Because of this, resist the urge to hand down or accept handed down shoes (although gently used “hand-me-downs” can be used as long as they are not badly worn or misshapen).

Many adult foot issues begin in childhood

Based on this information, it is not surprising that many adult foot issues begin in childhood. To help reduce the possibility of longer term foot issues, it is critical for parents to check their children's shoes at least every two months to ensure that they still fit. Remember that lack of complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.