There is nothing quite like watching your little one take his or her first steps... This little human who has been exploring their world on hands and knees is now toddling around upright! As a pediatric physical therapist, I am often present for the achievement of this exciting milestone!

In my experience, many parents believe that their child should be wearing shoes as soon as they take their first steps, if not before. “Maybe if she had some hard-bottomed shoes on it would help with her balance.” This could not be further from the truth! New walkers must be able to feel the ground beneath their feet in order to develop balance reactions, fuel their sensory systems, and strengthen the muscles in their feet. Some parents are also concerned about germs or injuries that could result from being barefoot, when in reality, our skin is a barrier against microorganisms and can be toughened by walking barefoot.

In this article, we will discuss the basic make up of the foot, normal foot development, when to be concerned about your child's foot posture, and how shoe wear, or lack thereof, can foster development. 

The strong and fabulous foot1, 2

Do you ever stop to think about how our feet support the entire weight of our body as we walk, jump, dance, run, and explore our world? Our feet are made up of 28 bones and have almost as many joints as our hands, making the possibilities for movement endless. Our feet also have more nerve endings than any other part of the body and their interaction with the environment is important for building neurological pathways in the brain and strengthening our sensory and proprioceptive systems. Proprioception is the body’s awareness of its position and movement in space and is obtained through information from receptors in joints and muscles. If we cover our children’s feet in shoes, we are eliminating opportunities for their brains to grow new neural connections. 

Normal foot development3, 4

Many parents become concerned when they observe that their new walker has “flat feet”. Not to worry, as this is completely normal! The arch on the inside of the foot, also known as the medial longitudinal arch, is not present at birth and this area consists of a fat pad early on. The development of the medial longitudinal arch occurs between 2 to 6 years old and is not fully developed until 6 years of age. Almost all new walkers have a flexible flatfoot, meaning the arch is not visible in weight bearing postures, such as standing, but can be observed in non-weight bearing positions, such as sitting. 

If you are concerned about your child’s foot posture, you can perform this quick test to confirm that your child does indeed have a flexible flatfoot. Observe her foot shape in sitting (foot free from the floor) and also when she is standing on tiptoes. If you observe an arch on the inside of the foot in these two positions but not in weight bearing (standing), then your child has a flexible flatfoot. 

Fig 1. Carr, J. B. 2nd, Yang, S. & Lather, L. A. Pediatric Pes Planus: A State-of-the-Art Review.

Treatment of the flexible flatfoot is generally not necessary. As your baby moves around barefoot and across a variety of surfaces, the muscles in her foot and ankle will strengthen and the arch will begin to appear. Flexible flatfoot usually resolves by the age of 10, yet in some people it persists into adolescence and adulthood, which can be considered normal. Studies have shown that shoe modifications or inserts are not beneficial in treating flexible flatfoot. Wearing shoes as a toddler and child has even been found to increase the prevalence of flatfoot. In a study of 2300 children between the ages of 4 and 13, flatfoot was most common in children who wore closed toe shoes (13.2%) and least common in children who were barefoot most of the time (2.8%).5

If you have an older child or teenager complaining of foot pain, it may be worth referring her to an orthopedic doctor for further evaluation. Pain could indicate a rigid flatfoot. Furthermore, families with a history of painful flat feet and special shoe wear may want to keep a closer eye on their little one’s foot development as there could be a genetic link.

Barefoot is best! Shoes are not necessary for function6

Podiatrists believe that structural and functional changes in the foot can result from having to conform to the shape and constriction of a shoe, rather than being allowed to develop naturally.6 And the younger the foot, the greater the potential for damage.6 Allow the foot to develop naturally by keeping your new walker, toddler, or young child barefoot most of the time! 

Have your child engage in sensory experiences both indoors and outdoors barefoot, such as jumping in puddles, walking through a pile of crunchy leaves, walking across dry and wet sand at the beach, and feeling different textures throughout the home with their feet. This will increase the number of developing neural connections between their feet and their growing brains. Walking barefoot across uneven surfaces, such as pebbles, slippery ground, or up or downhill, can assist with balance reactions and strengthening the muscles and ligaments of the feet. Being barefoot allows the toes to grip the floor to help with balance. Further, the arch on the inside of the foot is strengthened by rising up onto tiptoes, an action which can only be fully achieved when barefoot. When your child is barefoot, she will also feel less inclined to look down when she walks as she can already feel the floor beneath her using her sensory system. 

Inevitably, there will be times when you will want to put a shoe on your toddler, such as when exploring a public park or walking along a city sidewalk. In these cases, I would recommend a lightweight, flexible sneaker. I tell parents to find a shoe that they can easily bend in half to ensure that the sole is flexible enough. But remember, barefoot is best for your little one in order to support the development of her musculoskeletal and nervous systems. Your little one loves to play in the dirt, mud, and puddles and will feel even more connected to her play if she can participate with her feet! 

Sources:

  1. Pica, Rae. “Shed those shoes: Being barefoot benefits brain development and more!” Rae Pica Keynotes & Counseling, http://www.raepica.com/2017/09/barefoot-benefits-brain-development-2018/.
  2. Flegal, Kacie. “Barefoot Babies.” Natural Child Magazine, http://www.naturalchildmagazine.com/1210/barefoot-babies.htm.
  3. Carr, J. B. 2nd, Yang, S. & Lather, L. A. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 137, e20151230, doi:10.1542/peds.2015–1230 (2016)
  4. Campbell, S., Palisano, R. & Orlin, M. (2012) Physical Therapy for Children, Fourth Edition. St. Louis, Missouri: Elsevier Saunders. 
  5. Rao, U.B., & Joseph, B. (1992). The influence of footwear on the prevalence of flat foot. Journal of Bone and Joint Surgery (British), 74, 525.
  6. Murphy, Sam. “Why barefoot is best for children”. The Guardian, 9 August 2010,  https://www.theguardian.com/lifeandstyle/2010/aug/09/barefoot-best-for-children.

Julieann Berg

Julieann moved to San Diego from Philadelphia, where she was born and raised. She earned her Doctorate in Physical Therapy from Columbia University in 2017, where she graduated with honors and honed in on pediatrics during her third year of study. She graduated from Temple University with a Bachelor's degree in Kinesiology and a minor in Dance in 2014. Julieann has experience treating children birth to 5 years in a home setting, as well as premature infants in a Level III NICU. Julieann prides herself in treating the entire child and takes into account the interaction of all body systems, as well as the child’s personality, when developing a treatment plan. Julieann enjoys staying abreast of the current research in her field and can often be found reading a journal article. When she isn’t at work, Julieann is most likely moving her body in dance class (her lifelong passion!), practicing yoga, trying out new restaurants or recipes, or rooting for Philly sports teams.

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