Barefoot is best

[Creative Commons Licensed Photo by Flickr user hlkljgk]

One of the most frequent questions parents ask me is, “What type of shoes do you recommend for my baby?” They are often surprised by my answer.

The truth is, the best shoes for emerging and new walkers are actually no shoes at all. That’s right – barefoot is best. When babies are crawling, pulling to stand, cruising around the coffee table, and even starting to take those first few steps; they need to be able to flex their forefeet and toes. They also need as much sensory input as they can get in order to feel the floor underneath their feet and know where there feet are in relation to their body. A hard-sole shoe just doesn’t allow for that (try putting on your stiffest shoes or boots and crawling around on the floor – you’ll see what I mean).

For toddlers and young children who are already walking, parents are often concerned about what appears to be “flat feet” and wonder if a special arch support or orthotic is needed. They are relieved when I tell them this is unnecessary. Flat feet are actually quite normal until age 6 or 7. Research shows that almost all typically-developing toddlers have flat feet (no visible arch in standing). At 3 years old, the majority of children continue to have flat feet. As children grow and develop strength in their feet and ankles, their arches develop. Although parents (and sometimes therapists) are tempted to place the child in a supportive shoe or order a custom or off-the-shelf arch support, there is no evidence this is helpful. In fact, it may even be harmful. Research shows that, in cultures where children under the age of 6 rarely wear shoes, there is a lower incidence of flat foot than in (Western) cultures where children typically wear shoes at young ages. So even for preschoolers, it seems that barefoot is best.

If a parent or caregiver has to put shoes on a young child who is an emerging or new walker (perhaps the childcare center requires it or the family is attending an occasion where going barefoot may not be appropriate), I tell them to simply think of shoes as foot covers. They really serve no other purpose, and they don’t need to. For crawlers and new walkers, I typically recommend a soft-soled shoe like this:

Image from robeez.com

This is a water-resistant leather or fabric shoe (foot cover) with elastic around the ankle. The sole of the shoe is also fabric, but slightly thicker and textured to prevent falls. This type of shoe allows for almost complete freedom of movement of the foot and toes, and allows quite a bit of sensation through the foot. Name brand styles of this shoe are widely available at Department stores, baby boutiques, and on the internet; but there are several off brands you can purchase for less than half the price at discount stores.

Once children are bona fide toddlers – walking exclusively and exploring by walking over many types of surfaces, including outdoors – I recommend something like one of these:

Image from robeez.com

Image from squeakers.com

The shoe at the top is similar to the infant shoe I recommend, but it does have a slightly thicker sole to protect the foot from things like puddles and sharp rocks. The shoe at the bottom is a more traditional shoe, but still has a soft sole. When I grasp this shoe, I can easily bend the sole in half. Again, these styles of shoes are available at multiple price points – and I have had success finding them at second-hand stores as well.

So the take-home message when it comes to infant and toddler shoes is this:

1. Barefoot is best. The best shoes for young children are no shoes at all, and hard-sole shoes should be avoided.
2. Flat feet is normal for toddlers and children up to age 6. Children need time – not expensive shoes or orthotics – to develop good arches.
3. Think of infant/toddler shoes simply as foot covers. Purchase the flimsiest, thinnest-soled shoe that will fit your needs.  There is no need to purchase an expensive “supportive” shoe, shoe insert, or orthotic for a child.

Of course, if you have concerns your child isn’t developing typically or if you notice her flat foot is so significant that her ankles are turning in, you should visit your doctor or physical therapist.  Otherwise, have fun [not] shoe shopping!

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12 responses to “Barefoot is best”

  1. Margaret@YTherapySource says :

    I agree 100% – barefoot is best.

  2. Tiara says :

    Hi, I’m a peds PT too but brand new to the field. More experiences therapists that were trained abroad stressed to me the importance of arch support, so it was unexpected to read your blog post promoting bare feet. My question is about toe-walking and how being barefoot does or doesn’t affect its incidence. At what age/point in development do we start treating toe-walking, or consider it to be a problem? I haven’t had any patients like this yet, but when I asked my mentor, he said to make them wear hard soles shoes. What do you think?

    • kendrapedpt says :

      Hi, Tiara. Thank you for your comments. Using hard-soled shoes & supports used to be common practice, but more recent research seems to indicate that – for typically developing children – bare feet is best. A flexible flat foot is normal until approximately age 6 and treatment with orthotics has not been shown to improve outcomes. Of course, children with developmental disabilities and/or pathological flat foot may require a different approach. This article is a few years old, but I think it does a nice job presenting some of the more recent evidence about flexible flat foot and orthotics in children: http://www.pediatricsdigest.mobi/content/118/2/634.full.

      Toe-walking can be normal in children until age 2 or 3. When toe-walking is not the result of spasticity or high tone, I have not found orthotics to be effective. If there is heel cord tightness, stretching can be effective. I prefer active stretching (i.e. squatting to lengthen the heel cord in a weight-bearing position. Often, the tightness is often a secondary impairment. So it is best to try to treat the primary issue. The toe-walking is sometimes actually coming from abdominal/hip weakness.

      • Tiara says :

        Thanks! Your response was very helpful. I suspect none of the PT’s I have talked to about this are up on their research. On a related topic, how do you usually address in-toeing in the 0-3 population? From what I have read and researched, intoeing is also normal due to the tibial curvature that straightens out as kids grow, but I have heard recommendations from other PTs to use a derotation brace and doctors commonly prescribe stretches. What’s your experience? Have you found any research on successful treatment?

      • kendrapedpt says :

        It really just depends. Some in-toeing is typical in toddlers, be we usually see it resolve by age 2-3. If it isn’t causing any functional problems, I may just monitor it. If it is causing problems with activities/participation – or I think it may lead to a secondary impairment – I will address it. I will usually do a torsional profile to figure out where the in-toeing is coming from, then try to address the source of the in-toeing (if possible).

  3. Nechama says :

    Hi! I was told that putting shoes on my baby will help with her intoeing. She is 15 months and we’ve never put shoes on her. What do you think?

    • kendrapedpt says :

      I can’t really comment on your daughter’s specific case since I have not examined her. But I can tell you that, generally, when I see a child with in-toeing I first try to determine the source. It is usually coming from either (1) the hips/thighs, (2) the lower legs or (3) the foot. If the in-toeing is coming from the hips/legs, shoes will likely have no effect. If it is because of an inward curve of the foot, shoes or orthotics may be considered. However, at 15 months, a child has barely begun walking and we often see in-toeing, toe-walking, flat foot, and/or bow legs during gait. As long as there isn’t another diagnosis involved, these issues almost always resolve on their own with normal development. If you haven’t already, I would suggest you take your daughter to a pediatric physical therapist or pediatric orthopedist for specialized examination and advice.

  4. HS says :

    Can you offer any thoughts on SMO orthotic for pronation in a toddler? Early intervention program PT thinks very slight hypotonia. I had always heard barefoot & flexible shoes, so this is hard for me to wrap me head around the whole orthotic thing.

  5. Trióna says :

    Hi. This is great advice. I am looking for shoes for my son. He is big for his age and grows fast. He has wide feet where you measure and also where his arch will be. He also has one foot 1/2 size bigger than the other. His little toe looks like it is turning in a little even though i get shoes every 2, 2 1/2 months. Can i buy shoes a little wider to limit them squashing hisfoot when he grows? He is 20 months but more like a 2 1/2 year old size. Thank you

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