The foot takes the shape of the shoe, not vice versa. Improperly fitted or manufactured shoes may be the primary cause of acquired foot deformities and problems. Shoes that do not fit properly can deform an otherwise-normal foot, resulting in hammertoes, hallux valgus, bunionettes, corns, and, ultimately, the need for surgery.

Parents often ask the physician when their child should begin wearing shoes and what kind of shoe should be worn. In answering these questions, the reasons for wearing shoes must be borne in mind. The shoe has two functions, the most important of which is protecting the feet from trauma and extreme temperatures. Protection implies comfort; therefore the shoe must fit properly to prevent discomfort to the foot. The 2nd function of the shoe is to provide style. Older children will often sacrifice comfort for style despite parental or medical advice to the contrary.

Support to the foot and ankle is not a function of the shoe except when a pathological condition is present. Athletes in all sports that place the feet and ankles under severe strain wear low shoes that have soft uppers. Ski boots are worn not to support the foot and ankle but to make them one with the ski, to ensure response to movements originating in the knee and lower leg. Babies and toddlers usually wear ankle-high shoes, not to provide support to the foot and ankle but to make removing the shoes more difficult for the child.

Style is the only reason for a baby to wear shoes at all until the child begins walking outdoors or is taken out in cold weather. Some babies may gain a certain degree of stability from hard-sole shoes when beginning to stand, but this circumstance has not been shown to enhance learning to walk. In fact, shoes that are rigid prevent foot motion and may diminish the development of the intrinsic musculature of the feet. Properly fitting shoes that have flexible, smooth soles and soft uppers should be recommended initially and subsequently. They need not be expensive. Toddlers can go barefoot in a protected environment, such as indoors. Sneakers are perfectly adequate for summer wear and for winter indoor wear for older children, but toddlers may stumble in sneakers, which can stick to the floor during the stance and step-off phases of the toe-to-heel gait that typifies this age group.[1] [2]

Determining the proper fitting of shoes involves no great science. Given that the foot widens while standing and through the day, these measurements should be made later in the day, with the child standing, and should apply only to the time the shoes are newly acquired. Both feet should be measured, given that one foot is often larger than the other, and the shoes should be fitted to the larger foot. The counter should hug the heel snugly; the length should allow a fingerbreadth (½ inch) between the tip of the great toe and the toe box. (BOX 183-2 describes the parts of the shoe.) The foot should fit snugly into the widest part of the shoe; but the width should not crowd the ball of the foot and should allow the toes to extend without wrinkling the upper. While still in the store, parents should have the child walk in the shoes to ensure comfort. The shoes should not be expected to stretch to fit. If shoes do not fit, then they should not be purchased. Shoes in good condition can be handed down from one child to another.

The frequency with which shoes should be changed depends on the rate of growth of the feet, the quality of the shoes, and the degree of their use. Parents are usually able to tell when shoes become too small (or rather, feet become too large) without professional advice. The toes will be felt to press against the toe box, and getting the shoes on or having the child keep them on will be increasingly difficult.

Lightweight cotton, nylon, or wool socks that adjust to the length and width of the foot present no problem in the attainment of maximal foot comfort for children of all ages.

• Last: the wooden or metal form on which a shoe is constructed. Shoes for regular use are built on a straight last; shoes designed to deviate the forefoot outward are built on an out-flare last; those designed to deviate the forefoot inward are built on an in-flare last. Actually, most shoes sold for general use in the United States have an adducted forefoot last rather than a truly straight last.
• Sole: the part of the shoe that covers the ventral surface of the foot. It consists of the outsole, usually made of firm leather, rubber, or synthetic material that comes in contact with the surface on which the shoe is placed and the insole, made of soft leather or synthetic material that comes in contact with the plantar surface of the foot.
• Heel: elevates the rear portion of the shoe. It is also made of leather, rubber, or synthetic material. It is usually absent in the shoes of infants and toddlers. The heel may be low and flat (common sense), somewhat higher (military), or more elevated and tapered (Cuban or high). The Thomas heel is of medium height and has a forward medial extension.
• Shank: the part of the sole between the forward most edge of the heel and ball of the foot. A narrow flat piece of steel is sometimes placed between the inner and outer soles to prevent flexion of the shank of the shoe.
• Counter: firm material placed above the heel between the outsole and insole and provides a shelf for the rear portion of the foot. It may be extended forward on the medial aspect of the shoe to provide added support to the instep.
• Upper: the top of the shoe. It may be made of leather or a variety of other materials. The upper of low shoes (Oxfords) rises to a point below the malleoli; the upper of high shoes extends above the malleoli.
• Toe box: the front end of the upper that accommodates the toes. It is often made of a firm material to also protect the toes.
• Welt (or vamp): the part of the upper attached to the sole.