For many people, finding a shoe that fits properly can be a frustrating and time-consuming process. Because many people have subtle abnormalities of their feet, the process of finding a proper fitting shoe can be difficult. There are few simple guidelines that if followed can make the process a bit more tolerable. There are several good shoes on the market some of them may even be styles that you may like. With the availability of Internet shopping, the process of finding shoes for the hard-to-fit indiuidual may be made a bit easier.
When purchasing shoes, it is always a good idea to have the salesperson measure your feet. It is also a good idea to have both feet measured, because in many instances there may be a difference in the size of your feet. If you have two feet that are not the same size, it is recommended that you buy shoes to fit the bigger foot. Our feet change just like our eyes do as we get older. A person’s feet tend to become a bit longer and wider. Women, during pregnancy have a tendency for their shoe size to change. This is because during pregnancy a woman’s body produces a hormone called elastin. This hormone softens the ligaments about the pelvis to assist during delivery. Unfortunately, the hormone also affects other ligaments in the body. The ligaments in the foot are particularly affected. This coupled with an increase in weight and a change in the center of gravity causes many women to experience a change in their shoe size. Our feet also have a tendency to change size during the course of the day. Shoes that may feel comfortable in the morning may feel tight and uncomfortable later in the day. This occurs because of a variable amount of swelling in the feet that occurs as the day goes on. Therefore it is a good idea to buy your shoes later in the day.
The shape of the shoe is important, but surprisingly little attention is paid to this feature of the shoes we buy. The “Last” of the shoe determines the over all shape of the shoe. The shoe “last” may be straight or curved. To determine the “last” of the shoe, turn the shoe upside down and look at the sole. Imagine a line that goes through the center of the heel of the shoe and then out the center of the toe area of the shoe. You might be surprised what you find. In “curve lasted shoes” this imaginary line is in the shape of a curve, usually curving inward. Many shoemakers make curve lasted shoes. This is particularly true in sports shoes. A “straight lasted shoe” will have this imaginary line almost straight from the heel to the toes. Now, look at the shape of your foot. Have you ever wondered why your shoes seemed to wear out in the upper part about the toe box in such a funny way? The reason may very well be that you have a rather straight foot and you are wearing a curve shaped shoe. Curve lasted shoes can aggravate a number of foot problems. These shoes can cause an excessive amount of pressure on the outside of the foot. This has the potential of irritating existing problems like bones spurs in the fifth toe, soft corns between the fourth and fifth toe, and tailors bunions. Another area of the foot that can become irritated is along the outside of the foot called the “styloid process”. The styloid process is the base of the long bone (metatarsal) behind the fifth toe. In some people the styloid process is more prominent and subject to irritation by shoe pressure. There is also a powerful tendon that attaches into the foot in this area from a muscle on the outside of the lower leg. This tendon and some other small tendons on the top of the foot can be irritated by the curve lasted shoe.
Shoe manufactures make curved lasted shoes because they believe that by curving the foot inward it causes greater stability to the foot. In theory they are correct but shoes rarely are made of materials that are strong enough to influence foot function. Instead, as a person wears the shoe, the shoe over time becomes mis-shapen and can cause irritation to areas on the outside of the foot. The shoe manufactures have been a bit more successful at producing “motion control” shoe wear in sports shoes, but even there the shoe will rarely be able to hold up to the deforming forces of the foot over time. If a person has an abnormality of their foot that requires some degree of “motion control” they are better advised to seek the advice of a foot specialist who can determine their needs and prescribe a device that corrects abnormal function of the foot. These devices called orthotics fit into normal shoes and last for several years. In many cases the use of an orthotic will correct abnormal wear patterns seen in a persons shoes.
When selecting a good sports shoe there are a few simple guidelines to follow. First of all fit the shoe to the shape of your foot. In other words, if you have a fairly straight looking foot choose a shoe that has a straighter last to it. Secondly, consider sport shoes that are relatively rigid in the heel portion of the shoe. Heel stability is important in almost all cases. Additionally, look for a shoe that is fairly flexible in the forefoot area. If the shoes does not easily flex in the forefoot then as the heel comes off the ground during walking and running the big toe is unable to flex properly. Adequate movement of the big toe joint is important for normal foot function. There are two more things to check before you purchase the shoe. Place the shoe on a firm flat surface and observe what the back of the heel of the shoe looks like. The heel of the shoe should be relatively perpendicular to the surface the shoe is sitting on. If the back of the shoe is angled in one direction or another this could indicate a defect in the manufacture of the shoe. Lastly, put you hand inside the shoe and check for any defects in the seams of the shoe. Seams that are prominent have the potential to cause irritation to areas on the foot.
Diabetic patients need to be particularly aware of the type of shoes that they wear. This is especially true if they have poor circulation, numbness or a loss of sensations in their feet (neuropathy). Shoes should be purchased that have adequate room in the toe box area. The upper of the shoe should be of soft leather with few or no seams. Extra depth shoes are available that meet the needs of many diabetic patients. In many instances Medicare will reimburse for one pair of shoes per year if the patients doctor recommends extra depth or special shoes. There must be adequate documentation in the doctor’s medical record for the need for the shoes. Mnay foot doctors offer diabetic shoes as part of their practice.
As all runners know, running begins with a good foundation. And where do we find that foundation? At the ground level where the rubber meets the road.
In other words, your shoes, the pieces of leather and rubber that separate your feet from the hard concrete of the road.
Let’s look at the anatomy of a running shoe, and the four sections of the shoe that make it complete.
The uppers of the shoe may be made of leather or, for the lighter shoes, a synthetic which is lighter, washable and breathable (to reduce heat from the foot). Another component of the upper is the tongue of the shoe, which should be padded in order to cushion the top of the foot against lace pressure. At the back of the shoe, the ankle collar should also be padded to prevent rubbing and irritation of the Achilles tendon.
The outersole of the shoe is the treaded layer which is glued to the bottom of the midsole. It resists wear, provides traction, and absorbs shock. This is probably the most important layer for the “street fighter” or road runner. The outer sole usually consists of blown rubber, hard carbon rubber, or a combination. The blown rubber is the lightest, but is not durable as pure carbon. The stud or waffle outersoles are excellent for running on soft surfaces such as grass or dirt as they improve traction and stability. On the flip side, the ripple sole is better designed for running on asphalt or concrete surfaces.
The heel counter is the inflexible material surrounding the heel. It must be made of a material that is both rigid and durable to support and stabilize the heel. Just look at any old shoes, and you will see the wear and breakdown of the inner heel counter, which, over a period of time, tends to lose its stiffness. That’s why an external counter is typically placed between the midsole and the base of the heel counter. You will also see a wedge that adds height to the heel and enhances the shoe’s ability to absorb shock and reduce strain. The advantage to the added heel height is that it will shorten the Achilles and Gastrocnemius-soleus muscle, reducing the strain upon those important posterior running structures. The downside is that the higher heel height may feel less stable, causing reduced flexibility in the tendon structure.
The midsole is located between the outersole and the upper. Many regard it as the most important part of the running shoe. It provides cushioning and shock absorption while concomitantly controlling excessive foot motion (pronation/supination).
The primary materials used in midsoles are ethylene vinyl acetate (EVA) and polyurethane (PU). EVA is a foam that is light and has good to excellent cushioning. The problem is that this material breaks down quickly. In fact, it can break down just sitting in a box in your closet. Compression-molded EVA is one answer, making it harder and more durable. PU is also a foam, usually denser, heavier, and more durable than EVA. PU will stand up longer, but you will give up some of that precious cushioning in return.
Most shoes today are cushioned with gel, foam, or other manufacturer-specific materials that are designed within the midsole. This type of cushioning will extend the life of the midsole while simultaneously adding increased stability and shock absorption. This typically is where you will see the greatest quality difference between the various companies’ shoes and their models. And this is where the technology wars are being waged.
Remember, shock absorption is related to how compressible the midsole material can be made. The more the material compresses, the more movement within the shoe is seen. The less the compression of the material, the better the shoe’s motion control, but there is a tradeoff in shock absorption. In this case, the shoe may feel harder, and not as soft as the first case scenario.
Know Your Foot Type
So how important is it to know what type of foot I have, and how I run?
Very important! You need to know the basics of running gait and foot types.
First, when you run, the heel strikes the ground first, usually on the outside (supination). Next, the foot rolls inward and flattens out along the longitudinal arch-pronation. The foot then resupinates by rolling through the ball and rotating outwards. At this point, the foot becomes a rigid lever as it again prepares to push off the ground.
To find a runner who supinates or pronates just the right amount is rare. Typically, most runners, particularly those who become injured with knee pain, Achilles tendonitis, shin splints, I.T.Band, or heel pain, suffer from either excessive pronation or supination.
So let’s look at those terms again, and how they relate on a runner’s gait. Everyone thinks pronation is an evil thing. Wrong! Your foot needs to pronate in order to adapt to uneven surfaces. We all have to pronate to a certain degree. However, excessive pronators whose feet roll inwards too much while running are the runners who develop over-use injuries. The overpronator generally has a flattened type of foot (low arches). You can check this yourself by wetting your feet, and walking on a piece of paper. If you see the whole foot print, including the arch, you can bet you’re an overpronator. If you check an old pair of shoes, you’ll see a wear pattern to the inside of your shoes, particularly around the big toe.
Overpronators generally have flexible feet, which creates a very unstable foot. This can lead to many of the overuse injuries previously mentioned. If you are an overpronator, look for a shoe with a lot of motion control, preferably with a board last. A straight-lasted shoe is also recommended for overpronators.
What about you supinators? The supinator’s feet typically roll outward, both in the heel and in the forefoot. You’re the ones with the high arches. If you want to see if this is your foot type, go ahead and wet your feet and walk on a piece of paper. If you only see a wet spot of your heel and the ball of the foot, you know you over supinate. When you look at an old pair of shoes, you’ll see that they wear excessively on the outside border of the heel, and on the outside of the forefoot near your little toe. You’re not in the majority here in this case. Supinators are definitely in the minority compared to pronators.
The high-arched, supinators’ feet are more rigid, and cannot absorb shock as well as an overpronator’s feet. Therefore, it stands to reason that with a rigid type of foot the supinator will be subject to morelateral ankle sprains, stress fractures, and pain on the outside of the shin and knee. Supinators should look for a shoe that has better than normal cushioning for added shock absorption, as well as flexibility. Many supinators feel more comfortable with a semi-curved or curved last, due to the shape of their foot.
So what are some tips for selecting a good running shoe? Both the American Running and Fitness Association and the American Academy of Podiatric Sports Medicine make the following recommendations:
It is always suggested that when looking for a good running shoe, first select a good specialty running shoe store with competent salespeople. They are the ones who know the latest in shoe design and performance. Typically, these “fitters” are runners like yourself. They’ve been hired because of their love of running and their interest in their fellow runners. So search them out, and develop a relationship with a store and a person who has been fitting shoes for a period of time. If you have had a history of injury due to a shoe or a biomechanical problem, seek out a podiatrist in your area. He or she will be able to detect what your problem may be, and the right shoe or shoes to look for.
To extend the life of the shoe, wear them only for running, and let them dry out slowly when wet.
As recently as thirty-five years ago, athletic shoes consisted of just a few shoes that were used for a wide variety of athletic events. There were a few tennis and basketball shoes. There were no shoes marketed specifically as walking shoes. Aerobics or fitness shoes were nonexistent. Running shoes only amounted to a few in number.
However, in today’s athletic shoe stores, the number of brands and styles of shoes for all types of sports is staggering. There are shoes made specifically for wrestling, rock climbing and windsurfing in addition to the more common sports such as running, basketball, tennis, racquetball, aerobic dance and walking. In the running shoe market alone, there are nine major shoe manufacturers with each manufacturer having about five to ten running shoe models within their line. Even though the increased selection of shoes increases the possibility of finding just the right shoe for each set of feet, the large selection of models creates a large degree of confusion among the consumer.
It is actually this diversity and complexity within athletic shoes that is their most interesting aspect. Shoes that have different shapes, are made of different materials, and which are put together by different construction methods all will function on the foot differently. The purpose of this article is to explain the major structural differences between the three broadest categories of athletic shoes (i.e. running shoes, court shoes and fitness shoes) so that their functional differences may be better appreciated.
Running, like walking, is considered a straight ahead sport since it involves no sudden stops, turns or other maneuvers. Most runners land on their heels and then propel off of their toes. This heel to toe cycle is repeated hundreds and thousands of times every running session. The major biomechanical differences between running and walking are that in running there is always one point during running when both feet are off the ground and also during running the impact forces which the foot absorbs are at least twice as great as that found in walking.
Most runners strike on the outside of the heel, rapidly pronate, stay pronated for a brief instant and then resupinate as the heel leaves the ground during the push-off phase of running. [Pronation of the foot is a rolling inward of the ankle in which the arch flattens. Supination of the foot is a rolling outward of the ankle in which the arch increases in height.] Due to the large degree of variation within the population, there are a large number of runners who pronate excessively during running causing a multitude of running injuries such as posterior tibial tendinitis, plantar fasciitis and pes anserinus bursitis, to name a few.
Because of the increased impact forces and increased excessive pronation seen in running, running shoes must be designed both to help reduce excessive shock to the body and also help reduce pronation in the foot (Fig. 1). Unfortunately, the same shoe design characteristics that are best at helping to control pronation also tend to lessen the ability of the shoe to cushion the foot. And conversely, any shoe designed to maximize the cushioning of the foot during running will tend to have decreased ability in helping to control pronation.
To better understand how the characteristics of running shoe design affect foot function it is important to detail the structural components of the running shoe. Every shoe is made of two basic parts, the sole and the upper. The sole protects the foot from the ground and provides a layer of cushion for the foot. The upper covers the top and sides of the foot to provide a comfortable fit between the foot and the shoe and to improve stability of the foot on the shoe sole.
In the running shoe, the sole is made up of two distinct layers, the outersole and the midsole. The outersole is the part of the sole that contacts the ground. It is made of a thin layer of relatively hard, abrasion resistant material which functions to resist wear, provide traction and allow flexibility in the forefoot for propulsion.
Many running shoes use a rubber compound with a high carbon content in the heel and forefoot area, which is similar in composition to an automobile tire, so that the outersole will resist the abrasion that comes from the heel striking the ground. Running shoe outersoles also are constructed with studs or ridges in the midfoot and forefoot area to aid traction on soft or slippery surfaces, such as wet grass or slick pavement. In addition, most running shoe outersoles also incorporate some form of transverse grooves placed in the area of the forefoot so that the shoe will be more flexible in the forefoot once the heel leaves the ground during the push-off phase.
The midsole, however, is the part of the running shoe that either makes it work well or makes it work poorly. The midsole is sandwiched between the upper and the outersole. The upper is glued or bonded to the top surface of the midsole. The midsole is the most important part of the running shoe because its design and construction largely determine whether the running shoe will be a shoe which is good at providing cushioning, good at controlling pronation, good for heavy runners or good for nothing.
Running shoe midsoles are designed so that there is thick cushioning under both the heel and forefoot to help provide cushioning to the heel and forefoot. The total height of the midsole and outersole under the heel is generally about 1 inch and the total height of the midsole and outersole under the forefoot is about 5/8″”. The 3/8″” difference of sole thickness between the heel and forefoot in many running shoes tends to be preferred by most runners and also reduces the strain on the Achilles tendon, therefore, reducing the likelihood of Achilles tendinitis.
The midsole may be constructed of various materials to provide cushioning and pronation control. The two most common materials used in the construction of running shoe midsoles is ethyl vinyl acetate (EVA) or polyurethane (PU). EVA is a copolymer of ethylene and vinyl acetate that has microscopic air bubbles within it that makes it lightweight and very cushiony. PU also has a microscopic air bubble structure like EVA but is generally firmer and more resistant to compression than EVA.
Running shoe manufacturers use combinations of different densities of EVA and/or PU within the midsole of the shoe, along with gel packets, air bags, plastic plates and other exotic materials to provide what they believe is the proper amount of cushioning and pronation control for the shoe. Many running shoe midsoles have a firmer midsole material or a hard plate under the medial heel and a softer midsole material under the lateral heel so that the medial heel resists compression more than the lateral heel when the heel strikes the ground in running [Medial is toward the big toe, lateral is toward the little toe]. This “”dynamic varus wedge”” effect does effectively help control foot pronation to some extent. The softest midsole material is generally placed under the forefoot since most runners find that good forefoot cushioning is a very desirable feature when running on hard surfaces.
The upper of the running shoe is usually made of a combination of lightweight nylon and thin synthetic or natural leather to reduce the total weight of the shoe. Since running involves at least a thousand footstrikes per mile, a lightweight running shoe is critical to insure that the runner can move at a faster pace with less fatigue. One drawback to the lightweight materials used in running shoe uppers is that they all tend to suffer in side to side stability since the thin material in the upper is ineffective at resisting medial and lateral shifting of the foot on top of the sole of the shoe.
The upper of a running shoe also incorporates a stiff heel counter that is commonly stiffer than in other athletic shoes to help control excessive pronation or supination during running. Most running shoes also incorporate a raised padded “”Achilles tendon protector”” within the design of their upper to supposedly help protect the Achilles tendon. Most runners find that the “”Achilles tendon protector”” serves only as a convenient handle by which to pull their running shoes on with and serves little importance in protecting the Achilles tendon from injury.
Within the interior of today’s running shoes are removable insoles known as sockliners. Sockliners serve to cushion the foot and provide some arch support. Many sockliners in more expensive running shoes serve to support the arch of the foot more effectively than those seen in cheaper shoes. Nearly all sockliners can be removed easily from the shoes so that custom foot orthoses may be added to the shoe to replace the sockliner if needed.
One more important fact about running shoe design is that running shoes make excellent walking shoes. Since running and walking are both straight-ahead activities, their basic shoe designs are quite similar. In fact, I recommend running shoes for my patients who walk for exercise in favor of many walking shoes since running shoes are lighter, more comfortable and biomechanically more efficient at helping control excessive foot pronation than the majority of walking shoes.
Court sports include tennis, racquetball, basketball, squash, badminton and volleyball. Because court sports require sudden starts, stops and side to side motions, the best shoe construction for court sports is much different than that required for running (Fig. 2). The sudden side-to-side movements seen in court sports tend to make the foot slide forcefully either in a medial or lateral direction on the shoe sole. For example, if a tennis player is moving quickly toward the right and then uses the right foot to come to a complete stop, the foot will tend to slide laterally on top of the shoe sole. The only thing preventing the foot from sliding directly laterally off of the shoe sole is the upper of that shoe. It is because of this necessity for side-to-side stability that court shoes must be constructed much differently than running shoes.
Like running shoes, court shoes come in all shapes and sizes depending not only on the sport which the shoe is designed for but also on the manufacturer. Unlike running shoes in which the upper of the shoe always ends just below the ankle bones (i.e. a low-cut shoe), the upper of court shoes may extend partially over the ankle bones to about the ankle joint level (i.e. a mid-cut shoe) or may extend above the ankle bones completely covering them (i.e. a high-cut or high-top shoe). Many basketball shoes tend to be made of a higher cut than other court shoes due to the relatively great frequency of ankle sprains seen with basketball. All other shoe design parameters being equal, the higher the cut of the upper of the shoe, the better that shoe will be at preventing ankle instability during the activity and the heavier that shoe will be.
Since the goal in a well designed court shoe is to make the upper hold the foot on top of the sole, the uppers of court shoes are thicker and made of heavier weight materials than running shoes or fitness shoes. The uppers of court shoes are constructed of thicker leathers or synthetic leathers than either running or fitness shoes. Lightweight and thin materials such as nylon are used less frequently in court shoe uppers. In addition, many tennis shoes may have an extra layer of synthetic or natural leather toe box reinforcement to prevent the upper from wearing through in the toe box area from the scuffing which occurs during tennis serves.
Many court shoes also are constructed with an extended outersole or midsole which rises up on the sides to the bottom edge of the upper to give added strength to the sole/upper interface. As a result of the use of thicker upper materials and the side reinforcement of the sole up onto the upper, court shoes are nearly always heavier than the same size of running shoe.
The outersole of court shoes are usually made of a non-marking rubber compound for traction on outdoor or indoor courts. Court shoes have a much lower profile of tread patterns on their outersoles than running shoes since court sports are nearly always played on a dry, flat and smooth surface. In addition, court shoes often have a circular designs constructed into the outersole under the forefoot area of the sole to act as a “”pivot point”” for the shoe during rotational motions of the foot on the playing surface.
Like running shoes, court shoe midsoles are predominantly made of either EVA or PU. However, the midsoles of court shoes are firmer and thinner than running shoes to reduce the instability of the court shoe during side-to-side movements. Shoes with firmer soles have better side-to-side stability since the force of body weight through the foot will not deform a firm sole as much compared to a cushiony sole. The more that a shoe sole deforms under the forces which the foot exert on it during aggressive maneuvers, the more likely the shoe sole will tilt to one side or the other which may lead to either pronation or supination instability at the ankle joint complex.
Thicker soles increase the height of the foot and ankle from the ground that, in turn, increases the distance of the ankle joint complex from the ground. The higher that the ankle joint complex is from the ground, the longer is the lever arm for the reaction force from the ground to cause a either a pronation or supination force on the foot and ankle. Therefore, the thinner soles of court shoes decrease the likelihood of ankle sprains since the ground has a much shorter lever arm to produce pronation or supination forces on the ankle joint complex.
About fifteen to twenty years ago there was a dramatic increase in the popularity of aerobic dance. At that time, the shoes worn for aerobic dance were either running or court shoes. Unfortunately, since running and court shoes were not specifically designed for the demands of aerobic dance, many injuries occurred. Those aerobic dancers wearing running shoes had good cushion to the forefoot, but suffered from ankle sprains due to the lack of lateral stability in running shoes. Those dancers wearing court shoes had good side-to-side stability, but suffered from painful symptoms in the forefoot due to the lack of cushioning in the forefoot in court shoes.
Shoe manufacturers responded with the aerobics shoe that blended technologies from both the running shoe and court shoe. The result was a shoe with a midsole thickness and degree of cushioning midway between that of court shoes and running shoes. In addition, the aerobics shoe had an upper that was midway between the court and running shoe in material weight and thickness.
Today, shoes made for aerobic dance are very similar in design to those shoes made for the various activities available in a health or fitness club. Therefore, shoes made for aerobic dance and cross-training are now known as “fitness shoes”. Understanding the construction of fitness shoes is important since they not only are a very popular style of shoe, but their relatively recent birth into the shoe marketplace demonstrates the ability of shoe manufacturers to design a totally new and unique style of shoe to meet the biomechanical demands of a new sport (Fig. 3).
The fitness shoe has been designed using technological features from both running shoes and court shoes to create a shoe that is actually a better all-purpose shoe than either the court shoe or the running shoe. It is lighter in weight and more well cushioned than the court shoe and much more able to resist side to side movements of the foot than a running shoe.
The upper of fitness shoes can range from a low-cut to a high-cut with the most popular height being a mid-cut. The mid-cut upper is a very popular style in fitness shoes since it does provide extra lateral stability without adding a great deal of extra weight to the shoe. The fitness shoe upper is made from a combination of thinner natural or synthetic leather and nylon that decreases the weight of the shoe compared to a court shoe. However, since the fitness shoe upper is more substantial than the upper found in running shoes, the lateral stability of the fitness shoe is greater than in the running shoe.
Like court shoes, many fitness shoes use an extended outersole or midsole on the medial and lateral sides of the upper to provide extra bonding strength to the sole/upper junction. The extended midsole is now very popular in fitness shoes and does provide an extra degree of lateral stability to the shoe.
The outersole of fitness shoes are very similar to court shoes being made from non-marking rubber compounds in a low profile. However, the midsole in a fitness shoe is thicker than that seen in the court shoe to provide extra cushioning to the forefoot and rearfoot during aerobic dance, running and other impact activities. Even though the midsole in a fitness shoe is not as thick as that in running shoes, the fitness shoe can safely have a thicker midsole in its design since the side to side activities seen in fitness shoes are not as aggressive as that seen in court sports.
Certainly in the case of all the shoes described, it is clear that the structure of the shoe determines how the shoe will affect the function of the foot within that shoe. Whether it is the composition of the outersole, midsole or upper, or it is how the sole is attached to the upper, or it is any other shoe design parameter, the construction of athletic shoes must match the biomechanical requirements of the specific athletic activity in order for the shoe to be useful and desirable for the athlete.
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.
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.
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.
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.
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.
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.
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
We discussed fitting infants’ shoes in the last article, now your child is past the infant stage and into preschool. Children have usually developed their natural gait by this time, and are running and making lateral movements. At this stage children would rather be running than walking. Being more active requires a different type of shoe and different fitting of the shoes. The growth pattern will change, depending on the child, from a steady growth about every three months, to a spurt pattern. The foot may not grow for a period of time and suddenly grow a size or more in a short period of time. Due to the fact every child is different it is impossible to predict this change in growth pattern. The parent should check, or have a shoe fitter check the child’s shoes every two or three months.
Most children of this age range are now attending a preschool, daycare, or mother’s day out program. It is natural for the child to desire the popular shoes that the other children are wearing. Unfortunately because all feet are different the most popular shoe may not be the best for your child’s feet. The style of children’s shoes often follows the style of adult shoes, but fashion and function often do not go together. The requirements of a child’s foot are quite different than that of an adult foot, so adult styles on a child’s foot may be a poor choice. An example of this would be the clog style shoe that is popular now. A child who is running and climbing cannot keep this type of shoe on during normal daily activities. Another would be the slipon style of athletic shoe that is becoming popular with adults. A slipon shoe for a child must be fit shorter that usual in order to keep the shoe from slipping off of the foot. This means that the shoe must be replaced more often than a traditional lace athletic shoe.
No two feet are alike. Some are narrow, some wide, and they vary in the overall shape. Style and shapes of shoes should match the shape of the foot. Compatibility is very important in fitting the foot. The shoe may be the proper size but the shape of the last is wrong for the foot. For example, a narrow foot would not do as well in a heavy sole, broad toe style. Wider feet would be better suited for this type of shoe. Children wear their shoes differently. Some shoes will look new after three months wear while other will look totally worn out after three weeks. How your child wears his/her shoes should be a consideration when fitting the shoes. For the child that is hard on his/her shoes, a heavier weight shoe will make a difference in how long the shoe will last.
Due to the wide variety of shoe and foot shapes, and due to the fact that right and left feet are different sizes, the perfect fit does not exist. There are some things you should check when fitting the shoes: toe room, width, throat room, heel fit, anklebone clearance, and compatibility of shoe and foot. The following are guidelines you can use when fitting your child’s shoes. Remember fitting is an art not a science, it takes practice and experience.
Toe Room: Generally there is one third inch between sizes. Leaving one-third to one-half inch in the toes will allow for a whole size or size and one half of growth room. Be sure that this room is allowed on the larger foot. If the shoe is too long, the break across the vamp (front of the shoe at the ball) will be at an angle instead of straight. The break or bend across the vamp may also be deeper on a shoe that is too long causing irritation across the top of the toes. As the shoe is worn, the toes will have a tendency to turn up.
Width: Shoe width is probably the most important part of fitting a shoe, but is ignored by most parents. Most parents want the shoe to fit with lots of toe room so that it can be worn for a longer period of time. However, if the shoe is not wide enough, then it will be outgrown in width long before the length becomes a factor. Foot growth is not in equal proportions; the toes are one fourth and heel to ball is three fourths of the total growth. If the shoe is too narrow then the foot cannot grow forward in the shoe, and length becomes less important.
You should be able to lift the leather off of the top of the foot by gently squeezing across the ball of the foot. One-sixth to one-quarter of an inch should give the child ample room for forward growth in the shoe. Be sure that the little toe is not cramped or turned under. Narrow feet are much more difficult to fit than wide feet because most manufacturers do not make narrow widths. Guidelines for fitting a narrow foot are the same, but you may have to try many more styles to find one the fits narrow enough for your child’s foot. Frustrated parents will ask, “Will it hurt my child’s foot to wear a shoe that is too wide?” The answer depends on the length of time the shoe is going to be worn and how wide it is. The foot will move constantly in a shoe that is too wide. The motion can cause irritations such as calluses and in some cases blisters. Sometimes insoles can be used to take up the extra space in the shoe, but it is difficult to find them in children’s sizes.
Throat Room: The throat of the shoe is on the top where the foot meets the shoe. If there is not enough room between the foot and the shoe in the throat, then the foot will not be able to grow forward in the shoe. The tip of the first finger should be able to be inserted between the foot and the shoe in the throat. This will allow ample room for the forward growth of the shoe. Of course different styles of shoes will require different amounts of room. You cannot allow that much room in a slip-on shoe or loafer. If you do, the shoe will slip off as easily as it slips on. A buckle or Mary Jane style has a low cut vamp but you should still allow room on the top where the shoe and foot meet. The strap will allow for some adjustment of heel fit.
Heel Fit: Your mother always told you to make sure the heel doesn’t slip when you are trying on new shoes. A little looseness in the heel is not a bad thing. If the heel is too tight however, you will be guaranteed a blister. Constant pressure on the heel will cause the body to build up a fluid to cushion the spot. Excess room will also cause problems, but just a little room will allow for more natural foot movement. Use caution on sling back shoes and clogs. These styles offer no lateral heel control. As the child runs, the heel will slip to the side, increasing the chances of twisting an ankle.
Anklebone: The anklebone on the outside of the foot is lower on some children and can be a problem area. Athletic shoes with padded collars usually take care of this problem. With dress shoes that are harder and stiffer it can be a source of irritation. Check to see that the topline of the shoe comes above the anklebone or well below it. Sometime a felt heel lift will help until the topline softens.
Compatibility: There are many styles of shoes on the market today, and your child will want the one that is the most popular. However, is that the best shoe for his/her foot? A shoe can be the right size but be totally wrong for the foot. Be sure the shape, or last, of the shoe match the shape of the foot. Matching the shoe and foot shape will be more comfortable for the child and the shoe will look and wear better.
Several months ago a mother brought her daughter in with a pair of shoes that had been purchased at a specialty athletic store. Due to the fact that the child was in a school sponsored activity, the shoe was required for the uniform. The child had bunions and the beginning of hammertoes, and the shoes were very painful for her. The mother inquired about adjustment to the shoes that would allow the child to continue with her activity. After several adjustments on the shoes, they were less painful. However they still did not fit, nor were they compatible with the child’s foot. Children will wear shoes that are popular or required for an activity whether they fit or not. It is the parent’s job to assist the child in making correct choices. If proper fitting is started at an early age, then the foot will grow to its adult shape with few problems. Hopefully incidents like the one above will be avoided.
article written by: Kirk Watson