Children’s Shoes

I have made it a personal and profession mission over the last 5 years to replace all the children’s flip flop sandals in the world with more sensible shoe gear. Summer is here again and I am on the lectern at my office preaching about the injuries associated with constant flip flop wearing. Is anyone listening? Not really. I have been on major network and cable television, in USA Today and over 50 smaller newspapers, more blogs and internet sites than I can count….yet…. Flip flop sandals have been increasingly and immensely popular in the last 7 – 10 years and have even been worn to the White House and the prom.

This constant flip flop sandal wearing has led to a significant increase in Sever’s disease (pediatric heel pain) and plantar fasciitis (arch fatigue) in children and in numerous adults. The only more offending shoe is the stiletto! (Of which I give up trying to get woman not to wear them, now I preach high heel survival tips!)  Since I cannot convince people to throw out their flip flop sandals, I propose a more ergonomic alternative….Crocs! A good alternative to the traditional flip flop and actually has scientific studies revealing it as a great ergonomic alternative that is actually good for the developing foot.

Let’s send our children out for summer fun and sports protected against overuse injuries that seem to plague our active youth. There is no better way of doing that than ensuring they have the right shoes.

Why are the right shoes important?

Shoes that fit are vital to a young child’s rapidly growing feet. By the time a child reaches the age of 12, his or her feet will have reached about 90 percent of their adult length. Therefore, development of a child’s feet is especially important in these first 12 years of life and it is the reason podiatrists consider the early years to be essential in the development of feet and foot problems. Hence why flip flop sandals should be banned! Children who continuously wear incorrect shoes can develop many problems in later life and exacerbate inherited foot problems. Common problems such as hammertoes, heel pain, Osgood Schlatter’s disease (pediatric knee pain), “growing pains”, corns, and ingrown toe nails can be prevented by selecting the right shoe. Remember, foot pain at any age is not normal! Some children have foot problems that cannot be corrected by shoes and need custom orthotics. If your child is wearing appropriate shoes (not flip flops!) and is still having foot and leg pain, a visit to the podiatrist can be quite helpful.

How do I choose the right shoe?

Here are some useful tips for parents buying shoes for their children:

  • Take your child with you to go shopping. Do not rely on the size from their previous shoes! Every brand fits differently.
  • Go shopping in the late afternoon. Our feet swell during the day and especially in the summer.
  • Try shoes on with socks that will be worn with the shoes.
  • Stand-up to tie laces and check width.
  • Check length from the longest toe – not always the big toe.
  • Never buy a shoe for a child to ‘grow into’.
  • Ensure the shoe is flexible at the ball of the foot.
  • Never wear hand-me-down shoes – they are worn in to someone else’s shape and can cause problems.
  • Try both shoes on – very few people have two feet with the same width and length. Buy shoes for the larger foot.
  • Never buy shoes that aren’t comfortable right away! You should not have to “break in” properly fitting shoes.
  • Perhaps the most important advice for parents is to visit a reputable shoe store where sales assistants are trained in correctly fitting shoes.

How long should the shoes last?

Children grow at different speeds and wear shoes down at different rates. But there are some important things to do once you have selected the right shoe.

First, ensure you check the fit regularly. Children’s feet grow quickly and, since shoes up to two sizes too small may not cause a lot of discomfort for the child, you may not even be aware a new pair is needed. Kids tend not to complain unless their foot feels like it is squished!

It is also important to regularly check the shoe for wear. Shoes that are worn down badly can cause as many problems to a child’s feet as improperly fitting shoes. Excessive abnormal wearing of the shoe may indicate a foot deformity that should be evaluated by your podiatrist.

Bottom line: fit your child for proper shoes before summer play. Barefoot and traditional flip flop sandals can actually increase their chance of foot and ankle over-use injuries. A good, fashionable, and ergonomic alternative to sandals are Crocs and most kids will wear them!

Does Running Cause Arthritis?

Is it a foregone conclusion, that if you run for years, you will have arthritis? Many of my patients are concerned that the aches and pains that are inevitable from distance running are actually harbingers for the future aches and pains of arthritis. This fear is even strong enough to get older runners to quit and start a lower impact exercise regimen like swimming and cycling. Is this a reasonable fear? Yes and No! Running by itself does not cause arthritis; improper biomechanics coupled with the rigors of running can cause arthritis.

Consider the stress of running on the joints for a minute. The foot hits the ground and the bones and joints experience force up to six times the runner’s body weight at impact. The joints are being asked to move and glide efficiently and smoothly while enduring this stress. In the event of a misstep or stumble, the joints need to continue to be stable to maintain their perfect alignment.

Osteoarthritis, a.k.a. “wear and tear arthritis”, is what runner’s dread. This is degeneration of the articular cartilage which absorbs shock, distributes stress and allows the joints to glide smoothly. The ability to run pain free depends on the health and integrity of this cartilage as we age. In osteoarthritis, the surface of the cartilage becomes roughened, fissured and even starts to shred into small fragments. These fragments “float” around the joint and cause more damage. The bone tries to protect itself by producing small bony prominences called osteophytes which actually in the end make the joint damage and pain worse.

Any kind of sports participation can increase the incidence of osteoarthritis due to increased twisting forces, high impact, muscle weakness or over-development and joint instability which causes abnormal peak pressures and greater stress in certain areas of cartilage which can lead to osteoarthritis. Nevertheless, for normal joints , there is no scientific evidence that simply the action of running, even over a long period of time, causes permanent joint damage or even a predisposition for osteoarthritis.

What is the risk of osteoarthritis in runners? Many studies of long-term runners show no increased incidence of osteoarthritis in these competitive runners. Some studies did show more evidence of osteophytes, but no correlation with joint pain or instability. Confusing the issue for many runners are the numerous incidents of misdiagnosis of repetitive stress injuries like patella-femoral syndrome as arthritis. This is reversible and caused by abnormal tracking of the kneecap, which is treated with physical therapy and orthotics.

Joints are in fact strengthened by activity and damaged by inactivity. Studies have shown that the articular cartilage actually thins and becomes more fragile with inactivity, therefore increasing the risk of arthritis. Joints adapt to the stress of exercise and become stronger and more able to endure the long term stress of running. Remember the doctor saying to increase slowly? This is why. Ligaments and muscles, which support the joints, are strengthened and reinforced by the stresses of the running activity, improving joint mechanics, if the joints are properly aligned.

Here is the truth about foot biomechanics. Proper biomechanics during the strengthening process is essential for joint health. Improper biomechanics can increase the stress on the joints in an abnormal fashion and actually increase the incidence of osteoarthritis and hasten joint damage.

Bottom line? Running does not increase the incidence of osteoarthritis unless the lower extremity biomechanics are faulty. In fact, almost 75% of Americans over the age of 65 experience some symptoms of osteoarthritis. This is not increased in runners. In fact, running may actually help with the symptoms of osteoarthritis.

The benefits associated with long distance running profoundly overshadow the risk of osteoarthritis. In runners, orthotic devices to correct their biomechanics early in their training may actually decrease the stress associated with increased osteoarthritis. If you have joint symptoms, see a sports medicine podiatrist today and have your gait realigned. Your joints will thank you. Remember, your feet are meant to carry you for a lifetime. Don’t let the fear of osteoarthritis rob you of the joy of a lifetime of distance running!