Common Disorders
Shoe Fitting for the Infant
In thirty years of fitting children's shoes I have seen many changes in the shoe industry. This is especially true in the style of shoes that parents are purchasing for their babies. Hard leather soles and stiff uppers were the rule many years ago. Since that time we have progressed to rubber or PVC soles. Soft leather uppers that conform to the foot and offer greater freedom of movement are now recommended. Narrow, medium and wide widths have since replaced the traditional B,C,D,E,EE. With all the changes in the children's shoe industry one constant remains, no matter what style of shoes you choose for your baby, they need to fit properly.
Foot problems normally found in adults are now being found among children. I have observed this more in the last ten years. In most cases this can be attributed to ill fitting or improper footwear. Often parents don't know how a shoe should fit or what areas of the shoe need to be checked for proper fitting. Hopefully this article will help insure that parents are more aware of how to fit children's shoes.
Shoes are really not required until the child starts to pull up and cruise around objects. You will notice they stand on their toes and try to edge themselves around a table, sofa, or anything else they can hold onto. Toe gripping allows them to balance themselves and learn to take steps.
Babies feet are very soft and pliable with padding surrounding the foot. This is nature's way of protecting the underlying foot structure. This means the foot is thick, with the heel being narrower. Because of the narrower heel and the flexibility of the foot, high tops are generally better to keep the shoe on the foot. This will also allow for the shoe to be fit a little larger than a lower top shoe.
Fitting shoes is not a science, but an art. It takes practice and experience with different types of shoes and feet. Using the following guidelines, you will be better able to fit your child with the proper shoe size.
Measuring
Both feet should be measured in a standing position if possible. Feet are flexible and will expand in length and width with body weight. There are three measurements taken from the standard branock device. They are length, width and arch length. It is very important to understand that the size the foot measures is not necessarily the size shoe that the child will wear. Differences in construction, materials, last (the form the shoe is made on) and sizing systems will determine the actual shoe size. Note any differences in the sizes of the feet and be sure to fit the largest foot.
Length
How much length is necessary for growth? Generally there is one third of an inch between sizes, and one sixth of an inch between half sizes. Allowing one third inch growth translates to one shoe size. This allows two to three months wear for an infant. Keep in mind the growth rate will vary with individual children. Purchasing shoes that are too large is likely to cause tripping of an already unstable walker.
Width
Judging the proper width of a shoe is not as obvious as the length. Since the length and width of a shoe are proportional, the width will increase along with the length. Width increases about one-fourth inch per full size. Many manufacturers only make mediums. Try to find brands that are made in multiple widths. Remember that the foot is three-dimensional. Two of those dimensions are width and thickness. The thicker the foot or higher the instep, the wider the shoe has to be to accommodate the foot. As we discussed earlier, infant's feet are heavily padded and thick by nature's design requiring a wider shoe. Inserting the tip of the first finger between the shoe and foot at the instep is the first gauge of how well the foot is fitting the width of the shoe. If the finger will not fit then the shoe is not wide enough. Room in the throat of the shoe is critical to allow for the forward growth of the foot into the shoe. Since the growth of the foot is three-fourths heel to ball and one fourth toes most infants will outgrow the width of the shoe before they do the length. Parents will often check the length but not width of shoes. Using the thumb and first finger, at the ball of the foot, gently pull the leather in a lifting motion up from the foot. There should be enough room to lift the shoe material off of the foot slightly, but not in excess. Check the inside and outside of the foot for pressure points and cramped toes especially the little toe.
Heel
If you are fitting a high-top walking shoe on your baby, the heel fit is not a major concern. The heel is covered and the shoe will stay on well. On a lower shoe the heel should stay in the shoe with out popping out when the baby walks. Tightness in the heel will cause more problems than if the shoe is a little loose in the heel. A little looseness is permissible, but not a large gap between the heel and the shoe.
Walk Test
If the child is not walking on their own yet, let them pull up on a chair or fitting stool. All checks on the fit of the shoe should be done with the child standing. Feet are not static but dynamic. Standing will allow the foot to expand in the length and width to the normal size it will be when walking. If the child is walking, let them take a few steps and watching their balance. Take note of the break in the shoe. It should be straight across the ball of the foot. A deep break (excess wrinkle) or breaking at an angle would indicate that the shoe is too wide. Breaking forward of the ball of the foot would indicate that the shoe is too long. Check the shoe again after the child has taken a walk in them and the foot has relaxed and set in the shoe.
Other checks
On a low top, shoe material should either cover the outside anklebone or be far enough below the bone so as not to cause irritation. Always check the inside of the shoe before putting your child's shoes on. Nails, tacks, paper, plastic tags are some of the objects I have found in shoes over the years.
Fitting your child now with the proper size and style of shoe will help prevent possible foot problems in years to come. Longer life spans and more active lives mean more wear and tear on the feet. Don't let your child be like many adults that say, "I wish I had worn shoes that fit when I was a child." "My feet would not be in such bad shape now." If are you able find a local merchant that still knows how to fit shoes, then please make use of his knowledge and experience. If not, remember these tips the next time you buy shoes for your baby.
Written by Kirk Watson
Article provided by PodiatryNetwork.com.
