Feet first

Feet need to be tough. We walk on them. We jump on them. We run on them. They have to carry all our weight. So how do we make sure that our kids don’t wear theirs out?

‘One of the best things parents can do to care for their children’s feet is to ensure that their shoes are fitted correctly,’ says Brett Waddell, podiatrist and occupational therapist.

Brett specialises in the paediatric area, and says many feet problems in both children and adults are caused by poorly fitting shoes. Besides being uncomfortable, poor fit can cause or exacerbate many painful conditions such as in-grown toenails, bunions, calluses and in more serious cases, actual deformities.

As they transition from toddlers to school age, children start to wear shoes for increasingly longer periods. By the time they go to school, children will be wearing shoes a minimum of five days a week during school hours. The correct shoes will protect and support little feet and ankles.

Experts recommend that children should have their feet professionally fitted, regardless if their feet seem ‘easy’ or ‘hard’ to fit.

‘To ensure appropriate fit it’s absolutely critical that children are fitted by a specialist who measures both feet,’ says Brett. Most people do not have identically sized feet. Because of this, the Australasian Podiatry Council recommends that shoes should be fitted to the largest sized foot.

These days some shoe fitters even use computer imaging technology to show exactly where the child’s foot sits in the shoe. This can be particularly useful for children with ‘hard to fit feet’.

There are simple steps that parents can take to check fit. They are both useful before you buy and if you suspect your child is outgrowing their shoes. In particular, there needs to be adequate space between the end of the longest toe and the edge of the shoe.

As a guide, an adult should be able to squeeze their thumb into the back of the shoe while the child is standing up, says Brett. Also, ask your child if their shoes are comfortable.

Shoes should not need to be ‘worn in’ and should never feel uncomfortable at the time of fitting. Feet often swell throughout the day so are at their largest in the afternoons. Therefore, consider shopping later in the day to ensure that the fit is absolutely correct.

Buying shoes can also be used as an opportunity to encourage young children to take responsibility for their own foot health, by teaching the correct way to put on and take off their shoes and practicing how to tie shoe laces.

The younger the child, the faster their feet seem to grow. With children’s shoes costing as much or sometimes more than adult equivalents it can quickly add up to a lot of money. It may be tempting for parents to accept hand me downs or buy sizes that children can ‘grow into’, but there are pitfalls.

Second hand shoes are generally not recommended as every individual will wear out their shoes in different ways. Sports shoes in particular will not provide adequate or correct support. If you have shoes from older kids that haven’t been worn much, take them along to a children’s shoe fitter to have them assessed.

Smell inducing bacteria thrive in dark, warm environments so consider shoes made of breathable fabrics as they discourage the moist conditions that can foster fungal infections such as tinea, a red, rash-like condition that can appear in the folds of the skin. Bacteria can remain in second hand shoes, so if you are handing shoes down to younger siblings they should be thoroughly washed prior to wear.

Some children will have smelly feet from a young age. It’s not necessarily caused by poor hygiene; rather the smell is generally caused by sweat rather than dirtiness. Buy socks made out breathable fabrics such as wool or cotton, change them frequently and wash stinky socks with tea tree oil or Dettol.

To reduce the risk of fungal and viral infections, such as tinea and warts, encourage children to wear thongs or other protective footwear in wet environments, such as pools.

Tinea can be treated with an anti-fungal cream. Plantar warts on the sole of the foot appear as hard pieces of skin and can sometimes be confused with corns and calluses. They can be troublesome and need to be treated by a podiatrist.

Podiatrists are trained to deal with medical conditions of the feet and lower limbs. Generally, patients can simply make an appointment to see a podiatrist without a doctor’s referral. Generally, conditions such as flat feet, in-toeing and out-toeing do not need medical intervention and normally correct themselves.

The Australian Podiatry Council recommends parents should check with a podiatrist if their child seems in pain or they are worried about uneven shoe wear, skin rashes, hard skin or lumps on their children’s feet.

Ingrown toenails, or when the edge of the nail literally starts growing into the toe, can be very painful, and may even require minor surgery to repair. To prevent them, trim nails straight across, rather than cutting a curve. It is also important to ensure that shoes are fitted correctly, as tight fitting shoes can encourage ingrown toenails. In children this often caused when they continue to wear shoes that they have outgrown.

Some children may be prescribed orthoses (orthotics) or foot inserts to prevent or treat problems. Orthoses are designed to support or cushion the foot. The ones that are custom made by a podiatrist can be prescribed to improve joint positioning and movement when walking.

The generic versions that can be purchased from chemists and shoe stores may help foot comfort and provide a basic amount of support or cushioning. ‘Over the counter orthoses may suit some individuals really well whereas for other feet they may not,’ says Brett.

For more information about foot health refer to the Australian Podiatry Council’s website.

By Emma Reeves

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, October 2007. Updated July 2009.