Children's Footwear: Launching Site for Adult Foot Ills

OCTOBER 2002 • PODIATRY MANAGEMENTwww.podiatrym.com 83

Amaze of mythologies has sur-rounded the foot and foot-wear of infants and children

for generations. Medical practition-ers, especially podiatrists, orthope-dists and pediatricians, have been inthe front lines of shaman-like atti-tudes and therapies concerning thefoot-shoe relationship of juvenilesand the hazards of the growing foot.

As a result, by the time the averageshoe-wearing child has reached the ten-der age of seven or eight, his or her feetclearly reveal a visible loss of anatomi-cal and functional normality. The med-ical practitioners are quick to attributethis to the wearing of “improper” or“ill-fitting” or out-grown shoes—not re-alizing that there is no other kind be-

cause all (99 percent) of juvenile foot-wear, regardless of price or brand, is“improper” and “ill-fitting”.

Back in the 1960’s and in themany prior decades, there were

dozens of manufacturers of juvenilefootwear with prestigious brandnames, and all claiming dedication to“healthy child foot development.” Toname a few: Stride Rite, Buster Brown,

American Juniors, Step Master, Bun-tees, Mrs. Day’s Ideal Baby Shoes, Dr.Posner, Markell, Educator, Stepmaster,Junior Arch Preservers, Child Life,Clark’s of England, Jumping Jacks, Lit-tle Yankees, Edwards, Proper-Bilt,Trimfoot, Pro-Tek-Tiv. Europe boastedsimilar leading brands devoted to“healthy child foot development.”

Almost all of those once-promi-nent brands are deceased today, thevictim of low-cost imported shoes(now comprising 94 percent of all U.S.footwear consumption), plus the inva-sion of the sneaker boom, which beganin the early 1970s and today domi-nates the juvenile footwear market.

For decades prior to 1970 it wasestablished custom that for aboutnine months of the school year,

By William A. Rossi, DPM

Continued on page 84

Children’s Footwear:

Launching Site for Adult Foot Ills

It’s time to advocate shoelessness for kids.

Prior to 1970 fromSeptember to mid-June,all children wore sturdyleather “school shoes.”

was clothed in a holy shroud. Nobody saw the devilslurking inside.

Nothing Has ChangedChildren’s footwear today is made, fitted and sold

by the same naïve rules as a half-century and more ago.The dinosaur hasn’t moved an inch. And the medicalpractitioners, usually the tail on the dinosaur, continueto prescribe or recommend children’s footwear by thesame seriously flawed rules of the past.

The consequences? No shoe-wearing American orEuropean adult owns a normal or unspoiled footanatomically or functionally. By “normal” or “natural”is meant in comparison to the pristine feet among theestimated one billion people of the world that gothrough life unshod.

Almost all (95 percent or more) of these physicallydeprived feet of adult Americans and Europeans beginin childhood with the wearing of faultily designed andconstructed footwear, starting in infancy.

And all of this has occurred under the presumed“health guardianship” of the foot-related medical spe-cialists: the podiatrists, orthopedists and pediatricians.

Myths About the Growing FootToday we continue to use the same “rules” for child

foot care and footwear as we did half a century and moreago. Shoe people and medical practitioners alike contin-

September to mid-June, all children wore sturdy leather“school shoes” and for summer switched to sneakers.

Year round, an important part of the marketing pro-gram of the juvenile shoe producers was not only na-tional advertising but also a steady stream of “educa-tional literature” in the form of pamphlets and bookletsdistributed to stores and parents. These materials de-scribed and illustrated child foot anatomy, the foot-growing process, the importance of proper shoes andproper fit, cautioning about outgrown shoes, etc. Andof course, concluding with the merits of the sponsor’sshoes “dedicated to healthy child foot development.”Significantly, the manufacturers spent not a penny forfoot or shoe research.

Influential magazines like Parents and My Baby be-came channels for “public education” on child footcare and children’s shoes—though never a critical wordabout the footwear itself, which could jeopardize adver-tising income from the manufacturers. It was a simplequid pro quo arrangement.

It was generally accepted by parents and medicalpractitioners alike that “proper footwear” was widelyavailable for children, and if shoe-related foot disordersdeveloped it was due to “ill-fitted” or “outgrown”shoes. There was little or no questioning the inherentdesign and construction faults of the shoes themselvesby medical practitioners or others. Children’s footwear

Children’s Footwear...


84 www.podiatrym.comPODIATRY MANAGEMENT • OCTOBER 2002

Figure 1: Left, correct fit with hallux joint matching ball joint of shoe; center, with grow-room allowance hallux-joint moves back,no longer mating with the shoe’s ball pocket. Right, grow-room allowance creates a mismatch of ball flex line of foot and shoe.

Figure 2: Long or extended medial border shoe countersupposedly for supplementary arch support.

shoe people alike. First, a question:Precisely where, how and why doesa growing foot need support or re-inforcement? One long-commonanswer is that in shoe-wearing so-cieties we walk on non-resilientfloors and pavements, hence thegrowing foot needs to be protectedby a buffer zone device such as abuilt-in arch support in the shoe ora steel shank or separate orthotic(Fig. 3) This has no validity what-soever. From in-fancy on, most ofthe hundreds ofmillions of shoe-less people of theworld habituallystand and walknot on soft ,yielding turf (apersistent mythamong medicalpractitioners) butmostly on un-yielding ground surfaces. Mostshoeless children are raised in suchenvironments in cities like Bom-bay, Manila, Mexico City, Calcutta,Jakarta, Bogotá , etc. where thestreets are either cobble-stoned orpaved or with hard-packed turf.Those uncovered, “unsupported”feet grow with strong, normalarches. (Fig. 4)

A century ago, the rickshaw,which originated in Japan, was thecommon means of transportationin many Asian cities. In 1910,some 18,000 rickshaws and 27,000rickshaw men were registered in

ue to cling to these rules as thoughthey are holy writ. Some examples:

The Myth of “Grow Room”.The shoe should be fitted to the

child’s foot with a half-inch or more of“grow room” at the toe. Others use therule of thumb—a thumb’s width (near-ly an inch) grow-room allowance. Buta shoe so fitted is anatomically a misfit(or overfit) because the foot’s halluxjoint no longer matches the halluxjoint pocket in the shoe. (Fig. 1) Fur-ther, the heel-to-ball and heel fit aremisaligned with the correspondingparts of the shoe. Neither the manufac-turers and retailers nor the shoe-pre-scribing doctors have given any seriousconsideration to this dilemma. Thusthe first rule of “proper fit” is automati-cally disqualified. One additionalpoint: the half-inch or more of growroom with the new shoes automatical-ly moves the foot’s ball flex line a halfinch or more behind the shoe’s flexline. (Fig.1) This creates a conflict be-tween the two flex lines.

The Myth of SupportThe growing foot needs “sup-

port.” This popular myth not onlypersists, but also has led to anarray of abuses by the doctors and

Shanghai alone. The rickshawmen, most of whom began theiroccupations in their late teens, av-eraged 20-25 miles daily, trottingbarefoot, mostly on cobbled orpaved streets and roads. Manystayed at this occupation for 40 or50 years. The feet and arches of al-most all were healthy and excep-tionally strong.

In the same context are the tensof thousands of workers who daily

load and unloadships while work-ing barefoot onthe docks of suchcoastal cities asSingapore, Jakarta,Bombay, etc. Theycarry back loads asheavy as 50 and 60pounds on theirshoulders, walkingbarefoot on thethick planks. And

rarely a foot or arch complaint.The tenacious myth of the nega-

tive effects of unyielding groundsurfaces is long overdue for burial.

But the foot support idea goesbeyond the arch. Doctors and shoepeople alike continue to espouse theinvalid contention that the foot’sinstep and waist also need support—which is why oxford and laced shoestyles with their firm gripping arevirtually standard for prescribedfootwear. But instep and waist sup-port, like the 19th century corset, isconstrictive, and prevents the foot




Figure 3: Steel shank in child’s shoe for “arch support”.

Figure 4: Perfect feet of shoelessyoung boys. Note straight toes andspaces between.

The tenacious myth of the negative effects of unyielding ground

surfaces is long overdue for burial.

small percentage with excessivepronation, the heel should be al-lowed full freedom of movement fornormal exercising of the Achillestendon and ankle structure.

There are pronounced differ-ences in the strength and power-liftcapacities of the heel tendon be-tween shoeless and shoe-wearingpeople, again emerging from thechildhood years of foot develop-ment. This has an enormous influ-ence on postural balance and gait

stamina. A dramat-ic example of thisis seen among themarathon runnersfrom African na-tions such as Kenyawhere barefooted-ness is the com-mon custom withthe majority of thepopulation. Overthe past decadetheir runners havewon over half of

the first ten places in most of themajor marathon events in Americaand Europe. Much of this can be at-tributed to not only the unimpededdevelopment of their feet through-out the juvenile years, but to thefull-power strength of the heel ten-don so vital to the stride stamina re-quired in marathons.

The Myth of Pronation“Pronation” has become one of

the holy words in podiatric scrip-ture. But as with most nebulousterms it defies tangible form. Whilewe commonly speak of “excessive”pronation, there is still no estab-

lished or measurable stan-dard for normal versus ab-normal pronation. Prona-tion therapy thus becomeslargely opinion or judg-ment therapy.

This spills over into ju-venile footwear and built-in pronation “controls” viaextended shoe counters,tilted heel seats, reinforce-ment straps, heel cups, etc.But contrary to pronationcontrols, the rearfoot begsfor freedom of movementwithin reasonable bounds.Over-medicated shoes im-pose unreasonable limitson those boundaries.

from expressing its normal stretchand contraction action on weightbearing.

Further, laced-type footwear, themost common worn by juveniles, isconstrictive. Most kids tight-lacetheir shoes. This imposes pressureon the dorsalis pedis artery, restrict-ing normal blood flow through thefoot 16 hours a day.(Fig 6)

The Myth of The “Snug-Fit”Rule

Shoe people,along with many ormost medical practi-tioners, advocate“snug fit” at theball—again for “sup-port”. The snug-fitrule is seriously neg-ative because it re-stricts one of thegrowing foot’s mostimportant needs:the elastic move-ment of the metatarsals and their sur-rounding tissues with each step.

The Myth of Ankle SupportOne long-held reason for booties

in preference to low-cuts for infantsis the persistent belief that the ankleneeds “support”. But to the con-trary, the ankle needs exercise fordevelopment. Ankle support is theequivalent of a restrictive corset. (Fig5)

The Myth of Heel Support“Heel support” via heel-gripping

back part fit and firm counters is an-other myth in the child foot devel-opment rulebook. Except in the very

Sneakers: Not The SolutionShortly after the jogging-physi-

cal fitness boom began in the early1970s, sneakers, which have becomestatus-lifted and known as athletic,sport or athleisure footwear, showedspectacular growth in consumptionby adults and juveniles alike.Whereas in early years the sneakerhad been a summer-wear shoe, nowsuddenly, heavily ornamented andmedicated, it was worn year-round.Today, it has largely replaced con-ventional leather shoes for children.

Up to some 35 years ago mostmedical practitioners advised par-ents against habitual or frequentwearing of sneakers by children pri-marily because sneakers lacked sup-




Figure 6: Pre-walker sneakers withthick traction soles and double-knot-ted lacing

Figure 5: Metal stays formerly used in correctiveshoes for “ankle support”.

Figure 7: Child’s sneaker with tractionsole and “toe spring” at tip.

The chance of proper fit

with sneakers is much lower

than with conventional shoes.


ments vary brand-to-brand, style-to-style. Conclusion: the chance ofproper fit with sneakers is muchlower than with conventional shoes.

2) All sneakers have high tractionplastic or rubber-type outsoles. Thesecause the foot to suddenly “brake”

with each step (an average of 20,000steps a day for an active child). Thisresults in a forward sliding of the footinside the shoe and a jamming of thetoes against the tip of the shoe. Thisrepeated toe trauma is the equivalentof wearing outgrown shoes (Fig. 7)

port and also were unhygienic. Butsneakers gradually evolved in to“athletic” and “sports” footwear andwon medical approval—now citedas being more healthful becausethey are lighter weight, more flexi-ble, have more breathable uppers,provide better support and are easierfitting—none of which is true. To-day’s sneakers are as foot-negative asthe conventional leather shoes forchildren. Here are some of thespecifics why:

1) Most children’s leather shoescome in half sizes. Many juvenilesneakers are available only in fullsizes. Conventional children’s shoesuse the more precise width system ofA-B-C-D-etc., where the measure-ments are largely standardized. Al-most all sneakers use the looser N(narrow) M (medium) and W (wide)designation where the measurementsare not standardized. That means anM width can actually be an N or Wor vice versa. Further, the measure-

3) Sneakers create an unventilat-ed hothouse for a child’s foot. First,the snugly laced shoe creates aclosed rim at the top and preventsentry of air and ventilation. Second,the repeated traction action result-ing from the high-traction soles in-creases inside-shoe friction and con-sequent heat and perspirationbuildup—a highly unhygienic envi-ronment.

4) Contrary to both popular andprofessional opinion, sneakers arenot more flexible than conventionalshoes. The deceptively easy bend ofthe sole is behind the metatarsalflex line across the foot and there-fore in conflict with the foot’s nor-mal flex line angle. The easy flexionof the sneaker sole is both an illu-sion and a delusion.

5) Sneakers have much greater“toe spring” than conventionalshoes. Toe spring is the upslant ofthe shoe’s toe tip, creating a spacebetween toe tip and ground. Thiscan be readily seen by placing a



Significantly, throughout this

medical uprising theofficial voice of the APMA

remained silent.

A study conducted by SATRA,the prestigious British shoe researchorganization, has found out that therepetitive traction/friction action ofthe sneaker sole generates 50 per-cent more foot perspiration thansmooth surface soles under the samewear conditions.

Tests conducted by the U.S.Army Research Laboratory in Natick,Massachusetts, shows that in desertheat foot temperature rises to 100-103 degrees F in regular army boots,but as high as 120 degrees in sneak-ers. However, a survey by Lynn Sta-heli, M.D., published in Pediatrics in1980, found that 65 percent of pod-iatrists and 77 percent of pediatri-cians considered sneakers either suit-able or preferable for the infant foot.

Summed up, despite the numerousfaults of conventional shoes for chil-

sneaker on a table and looking at itin profile. This is contrary to the nat-ural ground-touching position of thetoe tips for ground-grasping action.

Exaggerated toe spring alters thelevel plane of the toes and nullifiestheir normal function. Why the ex-treme toe spring in sneakers? Be-cause the thick and inflexible soleprevents normal foot flexion in steppush-off, the outsole is given a rock-er design to allow a forward rollingmotion as a substitute for the nor-mal foot-flexing, toe-grasping step.This same exaggerated toe spring isfound in all adult sneakers as well.

6) The sneaker’s thick tractionsole for juveniles is unnecessarilylong wearing. This commonly re-sults in outgrown footwear becauseparents assume that there’sstill “good wear” left in theshoes. This, of course, leadsto squeezed and misshapentoes and misalignedmetatarsals.

7) It is commonly as-sumed that sneakers arelighter weight than conven-tional shoes. It isn’t true.Modern sneakers no longerhave lightweight canvas up-pers, but uppers of ruggedleather. When these arecombined with the heavysoles, the average sneakerusually weighs more thanthe average leather shoe. Ad-ditional shoe weight increas-es footlift load, which overthe course of a day of 20,000footlifts can make a differentof several tons, imposing un-necessary energy drain onfoot and leg.

dren, sneakers have even more. Sneak-ers, therefore, are not the solution.

Heels and ToesFor centuries, right to the pre-

sent day, one of the most foot-nega-tive features on juvenile shoes hasbeen the use of raised heels. For in-fants and tots the shoe heel heightbegins at about 5/8ths of an inch.By age five or six the heel height is3/4ths of an inch, and by age eight afull inch—the same height as on aman’s shoe. Heel heights are thesame on sneakers as on convention-al shoes.

Relative to body height, a one-inch heel worn by a child of seven isthe equivalent of a two-inch heelworn by an adult. So almost all chil-dren above age seven are wearing“high” heels the equivalent of two

inches in height—and nei-ther the shoe industry northe doctors has any idea ofthis absurdity occurring be-fore their eyes. (Fig. 8, 9)

A raised heel of anyheight under the foot of agrowing child automatical-ly destabilizes the foot andthe whole postural column.Such a foot is thus predes-tined to grow with anatom-ical and functional faults—much the same as a youngtree planted with its trunkon a slant.

The heels usually startwith “first walker” shoes(10th to 12th month) andsome have a 3/8th-inch liftcalled a “spring heel”which is supposed to addforward “spring” to thestep and aid in the walking.




Figure 9: Center and bottom, boys’ shoes with one-inch heel;top, with 1-1/2-inch heel.

Figure 8: Left, child’s shoe with one-inch heel. Center and right, classic Mary Jane style for girls, with heels.

heel to ball in a kind of slap motion,bypassing the lateral plantar borderwhich is no longer a player for sup-port or step sequence functions.

An elevated heel on the footwearof small, growing children is bothabsurd and cruel. Among youngchildren there is no demand orclamor for heeled shoes. The heelsare imposed on the children by theshoe manufacturers, taken for grant-ed by the parents, and acceptedwithout question by doctors.

No footwear for children underage eight—and preferably up to theage of puberty—should be made withan elevated heel. Exceptions might bemade for girls’ shoes beginning aboutage ten if desired for peer fashion rea-sons. This allowance would be madeon the grounds of right of choice—

though not onthe rightness ofchoice.

I n a n yshoe-wearingsociety, by ageeight or nine,the toes of mostchildren havelost up to 50percent of theirnatural prehen-sile and func-tional capacity.They are nolonger strong,f i n g e r - l i k e ,ground-grasp-ing organs butweak appendi-

But the spring heel actually unbal-ances the body column and disruptsthe natural balance and forwardmovement of the infant.

An elevated heel of any heighton a child’s shoe shortens the grow-ing Achilles tendon—the beginningof a permanent tendon shorteningthat begins in infancy and continuesthrough a lifetime for all shoe-wear-ing people. Further, the elevatedheel shortens the plantar fascia bycontracting the foot and shorteningthe distance between heel and ball.

Lastly, by raising the foot’s heel,the lateral border of the foot is deniedits normal weightbearing function.The normal step sequence—heel tolateral border to ball—is replaced by

tures at the end of the foot. And byearly adulthood the toes will revealvisible symptoms such as incipienthallux valgus, crooked or hammertoes, cramped toes, nail disorders, etc.

Around the age of nine or ten,pre-pubescent girls nearing thethreshold of “womanhood” and ex-posed to the influences of “fashion”,begin to demand grown-up styles.An example of this occurred in theearly 1960s when “needle-toe”shoes became popular with women.The juvenile shoemakers hoppedaboard the bandwagon and offeredthe sharp-toed shoes for little girls.The latter eagerly responded.

For once—perhaps for the firsttime—the doctors expressed openrebellion. The American OrthopedicAssociation issued a public condem-nation of such footwear. This wasfollowed by sharp criticism of theshoes from the Parent-Teacher asso-ciations. Both influential voiceswere heard in the national press.The shoe producers quickly retreat-ed, withdrawing their needle-toeshoes from the market.

Significantly, the voice of theAPMA remained silent.

Anti-Foot LastsAlmost all lasts for children’s

footwear, including sneakers, are“crooked” in contrast to thestraight-axis alignment of the foot,heel-to-toes. This has long been oneof the chief causes of anatomicaland functional foot deformity that




Figure 11: Natural prehensile and malleable quality of infant foot expressing full freedom

Figure 10


“funny”—despite the obvious leftand right shape of their own feet.

But why were those made onbegins in childhood and continuesthroughout all the adult years.

Why this obstinate continua-tion of crooked-last shoes thatare so obviously anti-foot health?Tradition again. Shoes have beenmade on crooked lasts for cen-turies, so the manufacturers,along with the shoe retailers,continue to remain blissfully ig-norant of this visible conflict be-tween foot and shoe and henceresist or refuse change.

A similar example occurred inthe early 19th century when leftsand rights were introduced inshoes. Throughout many cen-turies prior, most shoes weremade on what were known as“straight” lasts, meaning no leftsand rights and either shoe couldbe worn on either foot. When thefirst new lefts and rights appearedin store windows, customerschuckled and refused to buy orwear them because they looked

“straight’ lasts instead of the clearlyobvious left/right shape of the feet?Tradition again. In the 7th century,

the fast-expanding Christianchurch imposed rigid rules andcensorships regarding body expo-sure. It was decreed that clothingworn by the clergy—priests,monks and nuns—was to beloose fitting to conceal the “car-nal temptations” of the bodyform. From this emerged theloose-fitting robes and the flow-ing, ankle-length somber“habits” of nuns. Even the san-dals were made without lefts andrights so as to conceal the natu-ral shape of the foot. The “tradi-tion” continues to this day, andonly very recently were nuns per-mitted to shift to contemporarymodest styling in apparel. So tra-dition has staying power—whichhelps to explain the tenacity ofour crooked-last shoes of todaydespite the obvious and contrarystraight-axis shape of the human


Continued on page 94Figure 12: Sole mates, expressing high ankle mo-bility

that began when the girl was aboutage six.

The infant, displaying morecommon sense than the parents,shoe people or doctors, struggles topull off the alien wrappings on itsfeet. But the parent, with equal de-termination, ties and double knotsthe shoes tighter to prevent theshoes from being pulled off the feet.The infant’s protesting wailing is at-tributed to “cranky moods”. (Fig 12)

In 1980 a group of Thomas Jef-ferson University pediatricians, ledby Jeffrey Weiss, M.D. conducted asurvey and study among scores ofparents, medical practitioners (pedi-atricians, orthopedists and podia-trists) and shoe store managers. Thepublished report, appearing in theMay 1981 issue of Pediatrics, re-vealed some significant findings.Among them:

• 73 percent of the involved in-fants wore shoes before they walked.

• 91 percent of both the pre-walker and first-stepper shoes werelaced hightops; 51 percent hadsome kind of arch lift or “support”and 74 percent had hard soles.

• Most shoe retailers and manu-facturers tell parents that shoes will“help the child to walk properly”

• 75 percent of the store man-agers and shoe fitters included inthe survey recommended hard soleshoes for both pre-walk and first-step wear.

• Fewer than 10 percent of thestore salespeople and fitters saidthey had any training in the fittingof infant or children’s shoes.

• Only 22 percent of the parentsreported receiv-ing advice orguidance fromtheir physicianregarding infantor children ’sshoes—and usu-ally only whenasked.

These areprimitive condi-tions and atti-tudes when thefoot is at its mostvulnerable stage.But under pre-vailing practices,the infant footis usually pre-

foot. Hence an obvious wrong be-came accepted as an obvious right.

Infants’ ShoesIn all shoe-wearing societies

(about 80 percent of the world’s 6.5billion people) the anatomical de-formity and functional delinquencyof the foot begins at about the sixthor seventh month when the infant,still in its crib, is fitted to pre-walkershoes, a laced bootie. Despite thefast-growing foot, the crib shoes areworn until about the 11th or 12thmonth when the infant begins towalk and is fitted to its first shoes—again a laced bootie, but a firmersole. (Figs. 10, 11, 12)

It’s as though the parents, shoepeople and doctors can’t wait tobegin the primitive process of foot-wrapping, little different than theold Chinese footbinding customs

doomed to a high-risk life ahead.Surveys reveal that, for parents,

the single most memorable eventfor them during an infant’s life spanis its first steps. Many mothers feel adeep emotional response at this mo-ment because it signifies a silentdeclaration of independence: thechild in charge of its own mobilityand no longer totally dependent onthe mother. It becomes the secondcutting of the umbilical cord. Manyparents commemorate this auspi-cious moment by having those firstshoes bronzed for posterity.

With those first steps the infantis now ready for prime time. So ontoits feet go its “first-stepper” shoes.And suddenly, the infant, havingsuccessfully launched its walking ca-reer barefoot, finds itself strugglingto maintain balance and locomotewith stiff, constrictive, alien objectson its feet. It labors to take “nor-mal” steps with shoes on—a physi-cal and biomechanical impossibilitybecause the “foot” steps and the“shoe” steps are two alien motionsand opposing forces. (Fig 13)

First, the shoe’s soles, whetherleather or other materials, are one-fourth to three-eighths of an inchthick. They automatically prevent80 to 90 percent of the child’s nor-mal flex angle, 55 to 65 degrees atthe ball. With shoes on there is verylittle heel-to-ball movement, thusdenying the foot its normal step se-quence. The steps are pancake-like,seriously hampering the gait me-chanics.

The thick soles commonly usedon infant shoes and sneakers are anabsurdity. Infants never wear outtheir shoe soles. The like-new condi-tion of the worn infants’ shoes en-courages many parents to delay pur-chase of new shoes, resulting in thecommon outgrown-shoes conditions.

Infant hightops and sneakersshare another foot negative. The toprim of the shoe hugs the foot with asnug Velcro strap, lacing and doubleknotting. This prevents entry of air orevaporation of foot moisture. The re-sult: hot, damp, unhygienic, uncom-fortable inside-shoe climate. Thesesame conditions usually continueinto the tot and older child stages, es-pecially when hightop sneakers areworn. The padded shoe tongue is sup-




Figure 13: Typical infant bootie withspring heel

Figure 14: First-stepper infant struggles for balance in newbooties

backpart stiffeners, waist and instepreinforcements, extended soles, andvarious others. Each was presentedas a significant advance usuallystemming from “extensive re-search”. The ingenuous medicalpractitioners and a malleable publicbecame devoted disciples of the newholy creed.

In March 1948, the FederalTrade Commission, viewing thealarming spread of advertised claimsfor children’s and adults’ “health”shoes, launched its Orthopedic ShoeIndustry Investigation. Includedwere dozens of children’s shoe man-ufacturers and brands. Under theprobe, not a single manufacturerwas able to present valid evidencefor its advertised claims of “healthbenefits” to the shoes. And not one

could show evidence of any viableresearch facility or program behindthe shoes. The so-called therapeuticand corrective shoes were, in short,a huge hype and hoax.

The FTC then ruled that in thefuture, no shoes could carry such la-bels as “corrective” or “health” or“orthopedic” without providing tan-gible evidence of such therapeuticbenefits. While the ruling largelyeliminated the former gross adver-tising claims, it did not, however,eliminate the continued use of “cor-rective” features in the shoes them-selves, nor the shoes being sold for“healthy child foot development”.

But a much more devastatingblow was delivered against this foot-wear by Dr. Lynn Staheli, an ortho-

posed to provide a buffer zone againstthe tight lacing. But it often encour-ages the parent to lace the shoes eventighter so that the tongue can “grip”the foot. (Fig. 13)

Corrective ShoesBetween 1930 and 1970, shoes

for children were often heavily med-icated with a variety of “therapeu-tic” features promising to correct orprevent problems of the growingfoot: excessive out-toeing or in-toe-ing, pronation, gait faults, arch de-velopment, etc. Many shoe manu-facturers and retailers assumed analmost evangelical zeal with thisgospel. Scores of articles appeared innewspapers and magazines preach-

ing the new biblical text of “proper”shoes to assure healthy foot devel-opment.

The directly involved medicalpractitioners—podiatrists, orthope-dists and pediatricians in particu-lar—adopted and preached the newgospel from their own pulpits. Soubiquitous was the movement thatif a child wasn’t wearing such shoes,the parent was made to feel guilty ofchild neglect.

The shoes were mostly oxfordtypes, heavy and inflexible (“sturdy”was the favored term) and carried acargo of “corrective” features suchas arch lifts, anti-pronation inserts,extended counters, foot “balance”features, metatarsal padding,wedges, steel shanks, high and rigid

pedic pediatrician at the Children’sOrthopedic Hospital and MedicalCenter, Seattle. His milestone paperappeared in 1981 in Pediatrics. Itpresented an array of clinical evi-dence against corrective-type foot-wear for children of any age. The na-tion’s pediatricians and orthopedistsboarded his train. Similar and con-firming papers by orthopedists andpediatricians followed. The “anti”voices received strong momentum asthe national media gave wide expo-sure to the medical opposition tocorrective shoes for children.

Significantly, throughout thismedical uprising the official voice ofthe APMA remained silent.

But was this sudden medical up-rising about children’s footwear amere tempest in a teapot? Where

had the doctors been during thosemany prior years?

It was here, in 1981, when theU.S. Department of Health, Welfareand Human Services decided to stepin to establish a sense of balance.While Staheli had delivered a strongblow against corrective shoes, he atthe same time strongly advocatedthe wearing of sneakers by infantsand children. On that score heproved as wrong as he had beenright in his opposition to correctiveshoes. An excerpt from the U.S. De-partment’s public statement:

“Our studies show that the mostcriticized factor contributing to thecontroversy about orthopedic foot-wear is the lack of knowledge or




Figure 15: Shoe manufacturers have a special shoe for every stage from crib to tot

and shoe and the constant severepressures. The young men limpedaround in pain and many becamecasualties during the marching andother rigorous drills. Appreciableshares of the men were dischargedas “unsuitable candidates” for mili-tary service. A similar experience,though to a lesser degree, occurredduring World War II—despite theavailability of sizes up to 22 and

widths up to EEEEEE. The naturalfoot and the boots were incompati-ble. (Fig. 16)

The barefoot Sikhs of India havelong been reputed for their soldier-ing and bravery in battle. Early dur-ing World War II when India wasstill a British colony, the Sikhs wereinducted into the British armedforces and fitted to the “sturdy”


training of most medical practition-ers and their ancillary role in foottherapy...The attending physician ormedical specialist is not normallyschooled about footwear. Conse-quently, many foot problems couldhave been prevented or more effec-tively treated had the involved phy-sician had a better knowledge of thefoot/shoe relationship.”

The long tradition of childrenwearing shoes dates back to the pre-Christian era as a matter of socialstatus. The poor went barefoot as amatter of economic necessity. Slaveswere forbidden to wear shoes as amark of lowly status. Thus, shoewearing was a distinguishing markof economic class and social rank.Children, as “property” of parents,reflected the economic and socialclass of the family. (Fig. 15)

When Theodore Roosevelt andhis American troops stormed thehills of San Juan in the early 20thcentury to annex Puerto Rico fromSpain, one of his first steps to raisethe economic level of the newcolony was to require that everyschool child own a pair of sturdyleather shoes. This same ruling waslater adopted by the governments ofMexico, Bolivia and other LatinAmerican countries.

Immediately after World War IIwhen much of Europe lay devastatedby the massive bombings, one of the“essential exports” under the Mar-shall Plan were shiploads of chil-dren’s leather shoes as a visible markof economic and social recovery.

Anti-Shoe RebellionsCivilized nations and societies

have long had an obsession aboutcovering the foot as though it werean exposed sexual appendage re-quiring a covering as a mark ofmodesty and propriety.

During World War I at Americanboot camps many of the young mendraftees arriving from impoverishedrural areas of Arkansas, Kentucky,Tennessee and other states whereshoe wearing was a rare experiencefor rural children, were assignedtheir first boots. Despite the large se-lection of boot sizes, the fittingsproved largely hopeless due to thesevere shape conflict between foot



to post records of remarkable sol-diery and bravery during the war.

These reflect the identical expe-rience of the infant whose virginalfeet are being fitted to their first pairof shoes. The infant cries rebellious-ly, bunching its feet like a fist andotherwise resisting efforts to cageand imprison its feet and deny themtheir natural freedom.

What these experiences clearlydemonstrate is that if the foot is per-mitted to reach adulthood unspoiledby shoes, the foot will be a quite dif-ferent object anatomically and func-tionally than the foot shod from in-fancy into adulthood. Hence the ob-vious conclusion: In any shoe-wear-ing society there is no such thing asa natural or “normal” foot anatomi-cally and functionally. (Fig 17)

This explains why the averageshoe wearing foot has few problemsfitting into conventional shoes, incontrast to the difficulties experi-enced by the habitually unshod footfitting into the same shoes. The

British boots. After walking a bitthey discarded the boots, refusing towear them, citing pain and restric-tive gait. The British, threatenedwith a mass rebellion, succumbedand made an exception, allowingthe Sikhs to go barefoot in the tradi-tional manner. The Sikhs went on

shoe-wearing foot has been anatom-ically conditioned from infancy toacquire the faulty shape to adapt tothe faulty shoe. This contradicts therule: you can’t fit a square peg into around hole. But you can. You sim-ply shave the corners or edges of thesquare peg until they are rounded,and the once-square peg fits neatlyinto the round hole. This is precise-ly what happens to all shoe-wearingfeet. So we arrive at the deceptive il-lusion that all once-square-peggedfeet are “normal” because they fitinto the round hole.

Are There Alternatives?If infants’ and children’s shoes

contain far more negatives thanpositives, is there an alternative?Yes. And ironically, it’s as old asmankind itself.

ShoelessThe very word itself brings an

automatic rebuff from many ormost medical practitioners—andcertainly an appalling idea in theview of the shoe people. Among themany negatives cited:

• It’s impractical in modern soci-ety. It’s uncivilized.

• It’s unsanitary and unhygienic.• It exposes the foot to such nat-

ural hazards as sharp objects on thefloor.

• The foot needs “support”against the hard floor and other sur-faces.

None of the above has any valid-ity. Our comments here will applyonly to infants and children up tothe age of puberty.

In Japan and other Asian coun-tries it has long been the custom toremove ones shoes before entering ahome, including one’s own home.The same custom is being used byan increasing number of enlight-ened American families. It is one ofthe most civilized of customs.

The idea of “unsanitary” or “un-hygienic” bare feet is far more myththan fact. Most indoor dirt and tox-ins are brought into the home byclothing, and chiefly by shoes,which are the most unsanitary arti-cle of clothing we wear.

The American Leather Chemistsassociation has cited that a pair ofnew boots contains a concentration




Figure 17: The ravages of the agingfoot after a lifetime of shoe-wearing.

Figure 16: Child’s deformed foot atage six—and equally deformed shoefrom foot/shoe conflict

of chemicals and chemical compounds that comprises“a small chemical factory”. These include the thou-sands of chemicals used in the leather tanning and pro-cessing, in the shoemaking process, along with thosecontained in the numerous shoe components and ma-terials. All are exposed inside the home or office, espe-cially when combined with and agitated by inside-shoeheat, perspiration and bacteria. Basing his estimates ontest studies, Dr. Edward Pinckney states in the Journalof the American Medical Association that the average9x12 house rug contains 12 billion “hostile germs” andthat over 90 percent of them arrive there via shoes. (Onthe front door of his own home is posted a sign: “Pleaseremove your shoes at the front entry”)

Throughout the day our hands accumulate a widerange of toxins. We resolve this by frequent hand wash-ing—not by requiring people to wear protective gloves.

Once introduced, the shoeless-at-home habit is ea-gerly adopted by juveniles because of the “freedom”feeling. Having acquired the shoeless habit up throughage 12, most children will continue with it well intothe late teens and often beyond. The obvious conse-quence would be a marked improvement in child foothealth and continuing into the adult range over thesubsequent years.

But wouldn’t this be counter-productive for podia-try by reducing the incidence of foot ills in the mature-age years? No. A half-century ago the nation’s dentistsfaced the same dilemma when fluoride was added tothe water supplies of cities and towns. Today, juveniledental cavities have virtually disappeared and publicdental health has taken a major step forward. Yet, sig-nificantly, the dental profession continues to thrive asnew avenues of dental care open up. Fluoride did notprove to be self-defeating for the dentists.

Where To From Here?It has long been assumed that children’s footwear is

generally healthful because it allows for normal foot de-velopment by avoiding the “sins” of adult footwear(high heels, pointed toes, vanity, too-small sizes, fad




Figure 18: Feet of an 87-year-old Japanese woman whothrough her lifetime has worn only loose sandals or nofootwear at all.

health. If podiatry continues to ig-nore it as it has for generations,then one day the project will beundertaken by the orthopedists orpediatricians who will then behailed for their public service, leav-ing the podiatrists embarrassed fortheir delinquency of public duty.

Here are two proposed steps forlaunching the initiative:

1) A mass professional policyurging parents to keep their infantsshoeless through the first threeyears. This would give the foot ahealthy head start.

2) Urge all parents to adopt theshoeless-at-home-rule for their chil-dren through age 12, and suggestingthat the parents apply the same ruleor habit to themselves.

Information citing why thisshoeless-at-home policy will be ofmajor foot health benefit, presentand future would support the rec-ommendations.

The APMA should assume lead-ership here by taking an officialstance and using the muscle of itspublic relations sector. Podiatristswould supplement this by similaradvice and guidance to office pa-tients. This could be supplementedon the local level by podiatristsusing their authoritative voices vialocal newspapers, TV, or talks beforegroups.

The public press would eagerlyadopt and convey this back-to-na-ture idea. Instead of “shoeless”equating with low economic or so-cial status and an unsanitary condi-tion, it would now be seen as “cool”and sensible and an insignia of theeducated and well informed.

The majority of orthopedists, pe-diatricians and family physicianswho, like the podiatrists, have longlargely ignored the foot/shoe relation-ship in children, would likely adoptthe shoeless-at-home movement asan idea whose time has come.

Today, excluding the 2,900hours of bedtime, shoes are on chil-dren’s feet about 8,400 hours a year.The shoeless-at-home habit wouldcut shoe wearing another 3,000-5,000 hours, (including non-schooland added at-home hours), leavingthe foot shod only about 5,000hours out of a total 11,300 hours forthe year. That would be a huge gainfor child foot freedom—and a major

fashions, etc.). This is seriouslynaïve.

As a result, little if any serious at-tention or research has focused onchild foot health and the foot/shoerelationship. Newspapers and maga-zines periodically publish articles onchild foot care and the importanceof “proper” shoes. Most of these area re-hash of prior articles, often in-cluding quotes by “authorities”(usually podiatrists) who spout thetraditional mantras about grow-room allowance, arch and foot sup-port, correct fit, etc. Meanwhilenothing has changed. Today, mostchildren enter adulthood with thesame health-handicapped feet aschildren of generations past. Andthe incidence of adult foot health isalso essentially unchanged fromthat of a century ago.

Over the past 50-100 years virtu-ally every branch or specialty ofmedicine has made substantial con-tributions to disease prevention andhealth improvements in its field.Only podiatry has failed on thisscore. While podiatry has made ap-preciable advances in the treatmentof foot disorders, it has added al-most nothing to the science of pre-vention.

This vacuum of neglect hasspawned a horde of commercialpredators promising a broad rangeof over-the-counter and mail ordernostrums providing relief or curefor every conceivable foot disorderor distress, and costing the Ameri-can public an estimated $40 billiona year. This is an inevitable naturallaw: the greater the vulnerability ofthe prey, the more aggressive andsuccessful the predators who feedon them.

In this matter of child foothealth we are not confronted withsome profound and complex prob-lem of astrophysics or esoterictechnology. Nor does it involveheavy financial investment for re-search. It is, instead, a visible prob-lem with a simple and viable solu-tion, which can have a major im-pact on both child and adult foothealth. Resolving the problemshould be exclusively the responsi-bility of podiatry as the officialguardian of the nation ’s foot

step toward improved public foothealth.

The footwear industry would, ofcourse, strongly protest against theshoeless-indoors movement. Theywould present all the shopworn argu-ments about the importance of shoesfor “healthy child foot develop-ment.” But the defense would col-lapse for lack of supporting evidence.

However, manufacturers andstores would not be denied theirlivelihood. Shoes have long beenworn for fashion, ornamental, andpeer status reasons. When childrenreach the age of puberty they feelthe pull of peer pressures and sex at-traction, and the lure of fashion be-comes a powerful magnet. So, whileteens would likely continue to goshoeless at home, they would adoptand wear the peer fashion footwearoutside. But by then healthy childfoot development will have gottenoff to a vigorous head start—some-thing that rarely occurs in any shoe-wearing society.

From all this may emerge a hugeserendipitous bonus. The shoe man-ufacturers might be forced or in-spired to reappraise their traditionallethargy and apply serious researchto the child foot/shoe relationship.We could then begin to see footwearthat does not deform and defunc-tionalize growing feet. They could,for the first time in history, begin tomake a genuine contribution tohealthy child foot development.

Podiatry must now begin ex-changing the old platitudes con-cerning the foot/shoe linkage inchild foot development for the newrealities. It must confront the sim-ple premise that children’s feet farebetter without rather than withshoes. Only then can it make right-ful claim to being the guardian ofthe nation’s foot health, beginningwith children. �



Dr. Rossi, a shoeindustry consul-tant, has writ-ten eight booksand over 400 ar-ticles, includingextensive addi-tions on leatherand footwear inEncyclopaediaBrittanica.

Children's Footwear: Launching Site for Adult Foot Ills

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