Shoe Recommendations are among the most common requests I receive from parents as well as other therapists. A proper shoe can make a world of difference. This post is dedicated to three typical gait presentations. We also share recommendations for the best children’s shoes!
Note: I am a proponent of children participating in Physical Therapy sessions without shoes. This allows for helpful proprioceptive input. It also promotes intrinsic muscle strengthening, addresses alignment and balance reactions. A good supportive shoe is important when navigating in community and outdoor environments. This ensures children are provided with the stability and support they require, as they develop the control on their own.
Below is an image of one of my clients, with and without proper supportive shoes.
Before image: note the lack of medial arch, the calcaneal tilt and the line from the lateral to medial malleoli at a sharp angle. The child has an unstable and poorly aligned base of support.
After image: note the medial arch promotion, the malleoli at a parallel line and the heel aligned vertically. The child has an aligned and more stable base of support.
- Facilitate Weight Bearing
- Promote Lower Extremity Alignment
- Encourage Fluidity and Efficiency in Motor Patterns
Common Pediatric Presentations which require specific footwear recommendations include:
1) Flat Feet (aka Low or No Medial Arch)
Children who present with flat feet may have been late ambulators. They may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”. This denotes a lack of control as compared to more typical gait pattern (as weight shifts from heels to toes).
It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. Intervention may not be necessary if this presentation is not otherwise affecting function.
In my experience the proper footwear (along with appropriate Physical Therapy intervention in the form of exercises/activities to promote proper weight bearing, weight shifting, range of motion and strengthening) can prevent or eliminate the need for an orthotic.
2) Idiopathic Toe Walking
Children who walk on their toes, but do not have an underlying neurologic or orthopedic condition causing this presentation, may have been late ambulators, locking their forefoot to provide the stability they required as they began walking. These children may be sensory seekers, craving the extra input provided by the weight bearing force distributed over a smaller area. It is important to rule out an underlying condition which may cause toe walking.
Occasionally if a child has been toe walking for a long period of time, they may have muscular tightness and range of motion limitations that require a comprehensive PT intervention. Many times these children are recommended an orthotic, sometimes even an ankle foot orthosis (AFO) which locks the ankle in place and severely limits the child’s natural development of their plantar intrinsic muscles (key component of arch support) and limits the crucial proprioceptive input that children rely on to develop balance reactions and promote neutral alignment.
Children who present with in-toeing, turn feet inward when they walk or run. This may cause the child to stumble and lose balance more often.
In-toeing can be a result of:
- Metatarsus Adductus: foot curves inward from the middle of the foot towards toes.
- Tibial Torsion: lower leg bone or tibia rotates in.
- Femoral Anteversion: thigh bone or femur to rotate in.
Each of the underlying causes of in-toeing may be different, but the effects on gait are similar. Children who walk with their toes turned inward may experience frequent loss of balance. This is due to lack of foot clearance and difficulty maneuvering terrain changes.
Children who present with in-toeing may require help controlling lower extremity alignment and base of support. This will help address proper development of muscle strength, activation and inhibition of compensatory strategies. These compensations may cause future orthopedic concerns as well as potential muscle and joint pain.
The Best Children’s Shoes Offer:
- Stability: provides stable base of support, has a bit of weight to it, flexible but durable
- Support: offers control and support at key places – heel cup, medial arch and forefoot
- Comfort: allows the child to feel comfortable, made of a breathable material with enough shock absorption to cushion the ground reaction force
Some of the brand names/models which I have recommended to the families I work with include:
While this post reinforces the importance of proper footwear, the recommendations for Best Children’s Shoes made should be used in conjunction with Physical Therapy interventions to address the specific needs of each individual child.
For more read our post about Shoe Recommendations for Children.