The Current Research Behind Shoes for Infants and Toddlers

Summary: Barefoot is good! Shoes may be necessary.

From the American Academy of Pediatrics website for parenting tips, healthychildren.org, babies' feet will develop best without shoes; however, shoes are necessary for protection once they are walking outdoors.¹ Gimunová, et al published a study in 2022 which showed a higher plantar arch and smaller foot progression angle for infants walking barefoot after 7 months of independent walking.² The foot progression angle is how far the toes point out when walking. In a systematic review on the effects of shoe flexibility published in 2019, there was limited evidence on effects of shoe features such as sole hardness on gait and no evidence of changes in muscle activation patterns.³ Another recent article looking at the spatiotemporal measures of walking on running (the timing and placement of footfalls) comparing 3 types of common footwear to barefoot conditions found that even soft-soled footwear impacted gait compared to bare feet; however, the authors acknowledge that there is unknown clinical significance.⁴ More long established research published in 1989 by Gould, et al in Foot Ankle, foot arches developed regardless of footwear worn but development of the arches developed faster during the first 2 years (1-3 years of age) with arch support footwear.⁵ Lastly, a review published in Pediatrics by Staheli in 1991 listed the following: “1. Optimum foot development occurs in the barefoot environment. 2. The primary role of shoes is to protect the foot from injury and infection. 3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility. 4. The term “corrective shoes” is a misnomer. 5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications. 6. Shoe selection for children should be based on the barefoot model. 7. Physicians should avoid and discourage the commercialization and “media”-ization of footwear.”⁶

In my experience, shoes are important for safety when walking outdoors (hot surfaces, potential sharp objects, etc) and can be useful when treating infants with excessively flat feet or infants who frequently stand or walk on their toes. It is worth noting that flat feet are normal for infants, but in some cases can be beyond expected, which is best determined by a physical therapist or physician. It is also worth noting that intermittent toe walking is not concerning, but if it happens often and persists beyond 2 years old it should be corrected with physical therapy. Outside of these conditions, bare foot walking is great to strengthen the small muscles in the feet, strengthen and train the ankle muscles to stabilize on uneven surfaces, and exposes the feet to a variety of textures for sensory development. My usual recommendation for clients is to go barefoot in the home and in contexts you know are free from hazards, but to use shoes when playing outdoors.

References

1. "Shoes for Active Toddlers." healthychildren.org, 6/10/2015, https://www.healthychildren.org/English/ages-stages/toddler/Pages/Shoes-for-Active-Toddlers.aspx?_gl=1*pip9r7*_ga*NTc0MTgxOTM4LjE2OTg2OTYwMzk.*_ga_FD9D3XZVQQ*MTc0MDc2MjEzMi42OS4xLjE3NDA3NjM3ODAuMC4wLjA&gad_source=1&gad_campaignid=69654055&gbraid=0AAAAADyMpZEeuD2wxc2k9lEZ-r_roF5Ja&gclid=CjwKCAjw-svEBhB6EiwAEzSdrrC5koBDkL4fsbprHSifE7r0cFS0yDsL6odm9deL07R_PSOgKFBMEBoC-KIQAvD_BwE

2. Gimunová M, Kolárová K, Vodička T, Bozdech M, Zvonar M. How Barefoot and conventional shoes affect the foot and gait characteristics in toddlers. PLoS One. 2022 Aug 23;17(8):e0273388. doi: 10.1371/journal.pone.0273388. PMID: 35998149, PMCID: PMC9398026.

3. Cranage S, Perraton L, Bowles KA, Williams C. The impact of shoe flexibility on gait, pressure and muscle activity of young children. A systematic review. J Foot Ankle Res. 2019 Nov 29;12:55. doi:10.1186/s13047-019-0365-7. Erratum in: J Foot Ankle Res. 2020 Jan 20;13:4. doi: 10.1186/s13047-019-0368-4. PMID: 31798689; PMCID: PMC6884820.

4. Cranage S, Perraton L, Bowles KA, Williams C. A comparison of young children’s spatiotemporal measures of walking and running in three common types of footwear compared to bare feet. Gait Posture. 2020 Sept;81:218-224. doi:10.1016/j.gaitpost.2020.07.147. Epub 2020 Aug 7. PMID: 32810697. 

5. Gould N, Moreland M, Alvarez R, Trevino S, Fenwick J. Development of the child’s arch. Foot Ankle. 1989 Apr;9(5):241-5. doi: 10.1177/107110078900900506. PMID: 2731836.

6. Staheli LT. Shoes for children: a review. Pediatrics. 1991 Aug;88(2):371-5. PMID: 1861942.