Parents so often worry about their children’s teeth, eyes, and most other parts of the body, but do not worry so much over the developing foot. As numerous adult foot conditions can have their beginnings when people are young, awareness to shoes in kids can minimize the risk of these issues in adults.
Significance of the footwear to the child:
Badly fitting children’s shoes can cause a number of conditions in adults such as hammer toes, ingrown toe nails, foot corns, calluses and deformed joints. Considering the high level of discomfort and pain that these disorders can cause, it is obviously logical to attempt to prevent these disorders by ensuring that the child’s footwear is fitted properly. Foot conditions in kids are usually possible to avoid.
Fitting shoes for the child:
The most important factor in footwear for a child is that they fit. Preferably, this means that shoes are fitted by someone who has had some special training in the fitting of children’s shoes.
Advice for the fitting of children’s footwear:
* Children should have their feet measured around every 3 months (thus making sure the need for new footwear as required).
* Generally, for a shoe to be accurately fitted, there should be a thumb width between the end of the shoe and the end of the longest toe.
* When viewing the bottom (sole) of the shoe, it ought to be somewhat straight (not curved in too much) – feet are straight, so the shoe should be straight.
* The fastening mechanism (laces, velcro, buckles) must hold the heel securely in the back of the shoe (the foot really should not be able to slip forward in the shoe).
* the heel counter (back part of the shoe) should be robust and stable.
* the footwear should be flexible across the ball of the foot, since this is where the foot bends.
* Leather and canvas are a better material – these are more robust and can breathe. Artificial materials tend not to breathe as well, unless they are of the ‘open weave’ variety. Steer clear of plastics.
* Make certain the footwear have curved toe boxes to allow the toes more room to move.
* Shoes should not need to be “broken in”. If they do, they can be either poorly designed or inadequately fitted.
* An absorbing insole is useful, as the feet can sweat a lot – children are quite active!
* Numerous retailers specialise in footwear for the child – use them!
* Fitting footwear correctly in adults is also just as important
Three tips for examining the child’s footwear:
There has to be a thumb width between the end of the footwear and the end of the longest toe = length is proper.
You ought to be able to pinch the upper of the footwear between your thumb and forefinger (this may depend on the nature of the material) = width is correct.
Does the shoe fit snugly around the heel and arch? How stable is the footwear when trying to ‘pull off’ the shoe? = good fit.
Gowers sign is common in conditions that involve a proximal muscles weakness. The sign involves the child starting from a prone position and then using the hands to walk up the legs.
The most common condition that Gowers sign occurs in is Duchennes Muscular Dystrophy and it is an early sign. The sign is almost pathognomic for Duchennes, but can occur in any problem in which there is a weakness of the pelvic or proximal muscles.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine. Sometimes joint outside the spine are affected and some other structures can also be affected. It is part of the group of conditions known as the spondyloarthropathies. It is more common in males and usualyy starts in teh 20’s or 30’s. The most common initial symptoms are a mild ache in the low back. Occasionally the foot is affected.
In the foot anylosing spondylitis can cause heel pain and and arthritis like pain in the small joints of the foot. Of particular concern to those who are severely affected in the spine is the difficulty in being able to reach the feet to do self care.
The abductory twist is something that we see frequently in clinical practice when doing a gait analysis and is commonly associated with overpronation. This video on You Tube explains it really well (hat tiphere).
It is not a diagnosis, but just a sign noted during a gait analysis (interesting confusion regarding a patient thinking it was a ‘diagnosis’ here). There is also plenty advice for dealing with this (see here). It also is called a medial heel whip, a term this is more commonly used by physical therapists.
‘Overpronation’ is a term that has a mixed pedigree with some thinking it the holy grail of the cause of injuries in runners to it being a nonsensical term of no importance. There are so many myths and misundertandings about ‘overpronation’. The problem starts with the very definition of what it is. In lay terms pronation is a rolling inwards of the foot at the ankle joint and a lowering of the arch of the foot, so overpronation is when there is too much of that. The problem here is an agreement of what is too much and what is normal and there is hardly what could be called a consensus. For a long time, overpronation was considered a cause of overuse injuries in runners and hence its importance. Foot orthotics are widely used to treat this and all the outcome studies pretty much show that they work. Running shoes were and still are prescribed based on no, moderate or severe amounts of pronation. The problem arises that many of the risk factor studies in runners were showing the foot overpronation was not a problem. Some studies were showing it was a problem, so the research evidence was getting everyone confused. Even the health professionals and running shoe companies were giving mixed signals about this, so no wonder the running community were getting confused and the myths developing.
Fortunately we are now in the position were a powerful meta-analysis has combined all the data from all the risk factor and overpronation studies and they concluded that there is a small, but still statistically significant, risk of overuse injury from overpronation. Unfortunately the publication of this meta-analysis and systematic review has not put and end to the cherry picking of those who want to make their point one way or the other, though there are somewebsites that do give sound advice.