Study: Children’s shoes affect gait later in life

Many young children are wearing shoes that are too small, according to a new study presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). As a result, these children may be at high risk for developing serious foot deformities.

The study, which took place in Switzerland, included nearly 250 boys and girls from age 5 to age 10. Researchers measured the children’s feet as well as their indoor and outdoor footwear to determine whether the children were wearing properly sized shoes. They also compared the footwear measurements to the sizes given on the manufacturers’ labels to see if the shoes were marked properly. Finally, they measured the angles of the children’s toes to learn whether any of the subjects were developing a foot deformity called hallux valgus.

Hallux valgus is a condition that occurs when the big toe begins to angle sideways, toward the second toe, causing a bump on the side of the foot just below the big toe. This bump is called a bunion, and can become swollen and painful. Shoes that are too tight are believed to be one of the leading causes of this condition.

The study found that most of the children tested were wearing the wrong size shoes:

• Outdoor shoes: 
– 52.8 percent were too small for the child wearing them
– 13.3 percent were too big

• Indoor shoes/slippers:
– 61.6 percent were too small
– 10.2 percent were too big

• When compared to the size marked on the shoe:
– 90.2 percent of outdoor shoes were smaller than the stated size
– 97.6 percent of indoor shoes/slippers were smaller than the stated size

“The most striking finding in our study was that more than 90 percent of both outdoor and indoor shoes/slippers worn by the children were too small,” says Norman Espinosa, M.D, an orthopaedic surgeon at the University of Zürich Balgrist in Switzerland. “Interestingly, the shoe sizes given by the manufacturers almost never matched with the true sizes measured by our group.”

Additionally, Espinosa notes, the prevalence of hallux valgus amongst the children in the study was higher than previously reported in the literature. Hallux valgus angles are considered normal when equal to or less than 15 degrees; the results showed that 3.3 percent of the children’s feet had an angle of more than 15 degrees, while 26.1 percent had an angle of 10 degrees to 15 degrees.

To prevent these problems, Dr. Espinosa says that parents should measure their children’s feet every time they purchase new footwear, and that they should consider the actual size of the shoe rather than just the number marked on the inside of the shoe or the box. Also, parents should check for shoe fit every month or so, especially during times of a growth spurt. Many children will often outgrow their shoes well before the shoes are worn out.

“We truly did not expect such a large percentage of incorrectly declared shoe sizes,” he says. “We now know that we should focus on parental education to help prevent early onset of juvenile foot deformity.”