First Pair of Shoes

Dear Lisa,

My baby is 9 months old and I need to know what type of shoes I should get for her. “How can I tell if the shoes I buy fit correctly?”

“Need First Pair of Shoes”

Dear “Need First Pair of Shoes”,

Before babies walk they need their feet covered for warmth and protection. Slippers, slipper socks, booties, moccasins or fabric shoes can be used. These foot coverings may be slippery and are not recommended for children who are walking or learning to walk. When choosing infant shoes or foot coverings you should make sure that they do not fit too tightly. The toes should not curl under when wearing them. (1) “Feetie Pajamas” are also commonly used to keep a baby’s feet warm. These pajamas many times shrink in the wash and fit too tightly which can constrict the movement of your baby’s feet. Many of the children that I took care of developed rashes on their toes and damage to their nails because the “Feetie Pajamas” were too tight. If this occurs, you can still use the pajamas as long as you remove the slipper portion first. When the pajamas are not on your child you can cut off the slipper part of the pajamas. This way your child’s feet can hang out of the bottom of the leg of the pajamas and will not be constricted.

Once a baby begins to walk a shoe with a flexible sole, sufficient to protect the foot should be used. (1) The shoe should be flexible enough so that it permits normal motion and use of the muscles. High top shoes help keep the shoe from falling off and prevent the child from pronating or walking on their toes. (1) Toe walking is not beneficial to the growth and development of a child’s foot or ankle. It is very difficult and almost impossible for a child to put her foot in a position for toe walking when wearing high tops shoes. Because of this many Doctors and Nurse practitioners recommend work boots for children who walk on their toes.

The purpose of shoes for children is to protect their feet from injury. Early walkers tend to walk into things, step on their own feet or scrape their feet on the ground when getting up. For older children, protection is needed during rough play, in case another child steps or jumps on their feet or in case they drop a heavy object on their foot. When shopping for sandals, choose ones with a closed toe area. Open toe sandals are not recommended for children because they do not protect the toes from injury.

When fitting a child in shoes the big toe should be a “thumbs width” from the end of the shoe when your child is in a weight bearing position. (1) The way to measure this is to put the shoe on your child, and then have her stand up. Next place your thumb at the tip of the shoe where the child’s big toe is. When pressing on the top of the shoe over the tip of the shoe you should feel the tip of the child’s big toe. You should not feel your child's toe under your thumb, nor should there be a space between the edge of your thumb and the beginning of the child’s toe. Following this, you should check the width of the shoe. The material over the widest part of the shoe should be supple enough and wide enough to allow a small amount to be pinched. (1) In addition, the shoe should be narrow enough in the heel to fit snugly (1) If the heel slips out of the shoe when the child walks the shoe does not fit correctly. This rubbing of the shoe against the heel with walking can cause blisters on the heel. Other symptoms of ill fitting shoes include the development of corns(which occur due to pressure on the little toe) calluses, and over-riding toes.

Frequently children who come into the doctor’s office with a limp or painful feet are found to have shoes that fit incorrectly. (1) If a child with no history of a fall or injury suddenly develops a limp or complains of foot pain, the first thing to do is to take off the shoes. Make sure there is nothing in the shoe and no bruise or rash on the bottom of the feet. If the limp and foot pain goes away and doesn't reoccur with a different pair of shoes, ill fitting shoes were probably the cause of the problem. If the pain or limp returns you should bring your child to the doctor's office for an evaluation.

(1) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:847-848.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infant Development