Children’s Shoes: A Position Paper

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Children's Shoes: A Position Paper
By Dennis Shavelson, DPM
Biomechanics Editor, PRESENT Podiatry
As a Board Certified Foot and Ankle Surgeon and a Podiatrist that has maintained a biomechanical core and
focus on my practice, teaching and mentoring, I have studied and published on the subject of the
biomechanics of weightbearing feet and postures from babies to adult, for close to forty years.
Players in the children's shoe marketplace as well as the parents, educators and health care professionals
agree that the reason to debate how to care for developing feet is that foot and postural pain, suffering and
deformity has increased to a rate that is alarming. Calls for re-examining how we house our kid's feet to
prepare them for a healthier, more productive life are coming from more diverse locations and they are
getting louder.
Historically, children's feet have been left alone to make their own way in the world,
until they either develop pain, deformity or performance issues as juveniles or young
adults, or they pass on to being adult feet too often harvesting the bunions, or knee
and low back pain or performance issues they were destined to develop..
Kids' shoes, until recently, were developed, marketed and promoted by the shoe
manufacturing industry to parents, educators and health care professionals,
preparing our kids to accept the tight, heeled, unhealthy but stylish shoes they are
marketing for adults to wear.
In the last few years, the pendulum has swung towards the
opposite direction, with refreshing entrees into the pediatric footwear marketplace like
VivoBarefoot Kids, Merrell Kid's and Pediped Shoes that offer generous, zero heeled,
flexible shoes claiming to prepare their users for a "barefoot", healthier, stronger and
more injury free foot and postural future.
The current marketplace for kids shoes is wide open but polarized into two biased self
funded groups, served by partial blogs and social media, calling for society to choose
between them without a middle ground.
It is my opinion that the key caveat that is
overlooked in the Children's Shoe debate
is that like it or not, all feet, even one's left and right feet are
different, mechanically. The functional foot type® that we inherit
has huge influence over our lifestyles from birth until death, but
the pundits view all feet as if they behave alike mechanically
when it comes to developing shoes. Summarily, the starting
platform for examining kids feet is unrealistic, because what is
good for one foot type of feet is often bad for others and it is
fostering predictable future foot and postural pathology that
could be avoided if manufacturers, health care professionals and shoe fitters began with a functional foot
typing of the shoe purchasing public.
I opine that we need to interject some biomechanical sense into the mix in order to temper and centralize the
debate to consider the variations that exist among us all for the benefit of our kids.
Let's start with some information, thoughts and theories that deserve consideration when visiting shoe gear
for developing feet with a developing foot being defined as: the human foot until the day that bone growth
ceases, biomechanically.

Horses race for the Triple Crown at 3 years of age.
Humans can barely complete a short slow jog at three years of age.
Antelope run away from an attacking cat days after just being born.
Humans stay relatively still and weak for almost a year before taking an erect step.
Parents are not educated or prepared as to how to house their children's feet for future
health and fitness.
Stride-Rite, the number one children’s shoe manufacturer is owned by a the corporation that
also owns wolverine, payless and Saucony.
We are a society that must protect and prepare our young until they can become productive and when it
comes to their feet, the shoe industry has not put enough emphasis on function and fitness and instead, too
often, place children into adult shoes manufactured in children's sizes and start introducing tight fitted and
stylish shoes too early and aggressively.
Until one year of age, infants have a bony pedal arch structure not
unlike an Architectural Arch. Two equal
pillars and a central keystone.
In fact, from the age of seven on, the
distal bones (the forefoot) grow faster
and longer than our proximal bones (the
rearfoot) allowing our muscles and
ligaments to develop lever arms that
once trained, form a flexible tie beam
that can support our bony truss and allow
it to perform tasks such as lifting,
moving, walking and running well posed. Problems occur at this time if the tie
beam doesn't strengthen as fast as it needs to in order to maintain pedal
biomechanical health that can be determined by diagnosing the existence of
“juvenile tie beam expansion”, functional foot type-specific..
In addition, biomechanically, some feet are weak in the back, some in the
front, some in both and some in neither. Furthermore, our weaknesses show up at different ages with varied
consequences for each of us. The current gold standard for profiling
feet is called the wet test. This examines wet feet for the footprint they
leave on the ground grouping them into high, normal and flat arches.
This method falls short because it doesn't define where the arches are
failing and it offers no direction for treatment. What we need is a new
profiling system targeting the locations of the foot that are collapsing for
each of us so that we can be correctively supported and strengthened
starting with shoes that are developed foot type and age specific. That
system is Functional Foot Typing®.
The Old Testament states that a boy becomes a man at thirteen (the Bar Mitzvoh in Judaism), the army
drafts soldiers at eighteen (when bone growth ceases). These ages define periods in our development
where the differences that exist within us all help direct us to our "life calling" when it comes to work, play
and lifestyle.
One, Seven, Thirteen and Eighteen are ages where decisions should be made that take a homogenious
population and diversify it into a heterogeneous civilization.
In light of these facts, it seems reasonable to state that at least until seven, children's feet, as a rule,
should be in spacious, flexible, light, foot shaped shoes, or barefoot.
My focus has been to profile all human feet and classify them into smaller groups using morphology so that
they can be studied more purposefully. This has led me to the conclusion that depending on ones
biomechanical makeup, children's feet should live in shoes that magnify the strengths and overcome the
weaknesses that exist in them. This goal can be best met by developing shoes, temporary props and
training programs starting with a foot type-specific platform. All of this must be preceded by a paradigm shift
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in the way we manufacture, market and deliver kids shoes as well as a change in the current orthotic model
which advocates their permanent and almost universal use instead of using them as temporary supports.
If we go back to the architectural parallel, some feet collapse in the back half,
some in the front one, some in both and some in neither. When feet are
profiled, they can be classified into types, creating a starting platform for each
type that can be applied for developing shoes, footbeds, exercise and training
programs within minimalistic shoes and this should be used as part of the
decision making process when choosing lifestyles.
Juvenile Tie Beam Expansion (JTBE)
To better explain my point, there are some children that
develop pathological flat feet and bunions at a very
young age. Their feet are growing like those of other
children but in addition, they are getting longer, wider
and flatter due to mechanical collapse coming from
weakness in the flexible tie beam. They foot type
flexible in the rearfoot and flexible in the forefoot. This
pathological scenario is known as Juvenile Tie Beam Expansion (JTBE) and unless treated early, it leads to
a lifetime of foot and postural pain, suffering and deformity whether they wear soft, hard, flexible or stiff
footwear growing up. Props, training and exercise or in severe cases, reconstructive foot surgery is in order
for these kids.
My final position therefore, is that children, and depending on their inherited foot type, should be
prompted to wear minimalistic shoes as much as possible with added custom, foot type-specific
props and/or muscle engine training if they have JTBE until age 13 and then at that age, taking into
consideration parental, societal, physiological and individual factors, start to introduce tighter, more stylish
toeboxes and higher heels realizing that at that moment, they are sacrificing their health and foot and
postural functional future depending on lifestyle selection.
At age eighteen, or when bone growth ceases, feet should be supported and trained where necessary, foot
type-specific to prevent Adult Tie Beam Expansion (ATBE), a lengthening, widening and flattening of the foot
after bone growth ends, with a goal to develop an exercise, activity, shoe and prop wardrobe that will
maintain performance, quality of life and lifestyle until death.
It is my goal to influence the decision making of all sides of the children's shoe debate that a professional,
state of the art biomechanics paradigm should be developed as a starting platform in order to
develop a new generation of kids shoes designed for health, protection and prevention that will produce
a generation of wearers that are stronger, more productive and more injury free throughout their
adult lives.
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