Habitually barefoot children risk foot deformities wearing ill-fitting school shoes: study

School shoes sold in SA are not all suitable for habitually barefoot children because they are too short, narrow or long for their broad feet, say researchers at Stellenbosch University.

According to a new study published in BMC Paediatrics involving almost 700 children, about 60% wore shoes the incorrect length, risking developing abnormalities such as foot arthritis, clawed and retracted toes and heel spurs.

Other deformities associated with ill-fitting shoes include hallus valgus, a progressive foot deformity that affects joints and leads to significant functional disability and foot pain. Researchers say these foot problems can lead to changes in the biomechanical alignment of the body, negatively affect walking and cause pain and other musculoskeletal conditions such as knee osteoarthritis and lower back pain.

“Our research shows that habitually barefoot children wear school shoes that are either too short, too long or too narrow for their feet. Wearing ill-fitting shoes regularly can have a negative impact on the development of their feet, which can lead to various foot abnormalities and musculoskeletal problems such as lower back pain later in life,” say Marise Breet and Ranel Venter from the department of sport science at Stellenbosch University.

In the study they set out to determine if the length and width dimensions of prescribed school shoes matched the foot dimensions of habitually barefoot children aged six to 16 in rural and urban SA schools. A total of 77 school shoes of different brands and styles available were measured.

Children who are habitually barefoot often have wider feet compared to those who wear shoes regularly.

Breet and Venter measured the feet of 698 children (431 girls and 267 boys). They measured the length and width of different brands of school shoes. The maximum heel to toe length and foot width, with an added 10mm toe and width fit allowance per participant, were compared to the corresponding school shoe length and width.

“Our results show that comparing the shoe length and maximum heel-toe length of participants, as well as taking 10mm toe allowance into account, 59% of children wore shoes that were not the correct length. With regards to the shoe width and the added 10mm of width fit allowance, 98% of the shoes worn by the children were too narrow for their feet.

“Given the width dimensions of the shoes in our study, many children in SA will not have the option of a school shoe with a wider forefoot as this is not available."

Most notable external factors influencing the development of the paediatric foot are climate, socioeconomic status and shoe-wearing habits. Growing up barefoot compared to growing up shod influences paediatric foot arch morphology, foot pliability and motor performance. Shoes have been identified as an external factor that could significantly influence foot development as well as gait in children.

According to the researchers, there are several possible reasons for the prevalence of ill-fitting shoes. One is that shoe manufacturing is predominantly influenced by fashion trends rather than orthopaedic and biomechanical research. Shoe manufacturers don’t always have the right data to design a standard shape from available measurements and consequently focus on shoe length as a basic measurement without considering the other dimensions.

“Recent research has indicated toe and width allowances are not applied effectively. Often too much or too little space is left for the toes inside the shoe to ensure a correct shoe fit. The recommended toe allowance of 10mm should be considered in addition to the heel-toe length of the child to guarantee the correct fit for shoe length. Our shoe manufacturers use a shoe design based on the British system, using foot length as the basic measurement. In this system, each increase in foot length will correspond with a standardised increase in foot girth, based on European data."

The researchers add that the quality of information available on footwear fit and the rapid increase (up to 1.5cm per year) in foot length in children between the ages of six and 14 could also be reasons for ill-fitting shoes.

They recommend that shoe manufacturing companies consider the shoe width of school shoes for habitually barefoot children and adolescents to avoid the long-term negative effects of ill-fitting shoes.

“Shoe designs for these children should produce a shoe to fit the foot properly and mimic the natural shape and dimensions of the bare foot. This should help to enhance the healthy development of the foot.”

The researchers say their study advances and elaborates on existing views on this issue as it places the onus on shoe manufacturers to improve the basic dimensions of available shoes for habitually barefoot children.

“Results from our study could help create awareness of the mismatch between these children’s feet and available school shoes and could also assist shoe manufacturers to make better-fitting shoes for our children and adolescents.”