Kids’ shoes come up short

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Kids' shoes come up short

http://lowerextremityreview.com/news/in-the-moment-foot-care-3#more-1644

Keeping up with the ever-changing footwear needs of growing children can be a

challenge for parents, but squeezing kids into too-short shoes may put them at

risk for hallux valgus, according to research from the Medical University of

Vienna.

In a study of 858 healthy pre-school children, investigators found a significant

relationship between shoe length and hallux valgus angle, with the relative risk

of lateral hallux deviation increasing as the distance between the toes and the

shoe tip decreased. The results were published on Dec. 17 in the online journal

BMC Musculoskeletal Disorders.

Alarmingly, the researchers also found that the majority of children in the

study wore shoes that were too short, particularly when indoors. Indoor footwear

was at least one size too short in 88.8% of 808 children, while outdoor footwear

came up short in 69.4% of 812 children. (Shoe sizes refer to European sizing;

proper fit was defined as the shoe being 10-12 mm longer than the foot.) The

authors suggested that parents may pay less attention to indoor footwear than

outdoor footwear, based on pre-school teachers' comments that indoor shoes were

often not replaced at all during the course of a school year.

More than half (57.8%) of 789 children had hallux valgus angles of 4º or more,

based on an external footprint-based measurement. Radiographic measurements were

not used for ethical reasons.

Wearers of indoor shoes that were one size too short were 17% more likely to

have a hallux valgus angle of 4º or more, a relative risk that increased to 37%

for shoes that were two sizes too short and 61% for three sizes too short. About

61% of children in the study wore indoor shoes that were two sizes too short.

For outdoor shoes, the increased risk was 5% for one size too short, 10% for two

sizes and 15% for three sizes. The authors suggested that the difference in risk

between indoor and outdoor shoes might be because the indoor shoes were more

likely to be too short, and because pre-school children spend more hours per day

wearing indoor shoes than outdoor shoes.

The shoe-fit findings of the Austrian study were consistent with those of a

University of Zurich study presented in February 2009 at the annual meeting of

the American Academy of Orthopaedic Surgeons. The Swiss research team, which

included one of the Viennese authors, studied 148 children between the ages of

five and 10, and found that 52.8% of outdoor shoes and 61.6% of indoor shoes

were too short.

The Swiss study did not analyze the association between shoe fit and hallux

valgus angle, but it did find that 79.7% of 153 children had hallux valgus

angles of 5º or more. An angle of more than 15º is typically considered

clinically abnormal, but this value was exceeded in 3.3% of children in the

Swiss study – more than the previously reported prevalence of 2.5% in a 1991

study of 10-year-olds that used radiographic measurements, published in the

British version of the Journal of Bone & Joint Surgery.

Further muddying the picture is the Swiss group's finding that almost all of the

shoes were actually smaller than the size given by the manufacturer. This was

the case for 90.2% of 202 outdoor shoes and 97.6% of 209 indoor shoes.

The good news is that research does suggest the effects of too-short shoes can

potentially be reversed simply by swapping them out for a better fit. A 1953

British Medical Journal study of 164 schoolchildren found that the number of

hallux valgus cases dropped from 31 to 12 after one year of wearing

professionally fit shoes; average great toe angle also significantly decreased

across all ages.