Choosing shoes for your children can play a critical role in their musculoskeletal development, including their posture.

In general, infants just learning to walk do not need shoes. Infants may go barefooted indoors, or wear only a pair of socks. This helps the foot grow normally and develop its muscles and strength as well as encourages the grasping ability of toes.

Once children are ready to walk as toddlers, their need for properly-fitted shoes is important. In general, a soft, pliable, roomy shoe, such as a sneaker, is ideal for all children. The toe box should provide enough space for growth and should be wide enough to allow the toes to wiggle. A finger's breadth of extra length will usually allow for about three to six months' worth of growth, though this can vary depending on your child's age and rate of growth.

Because high-top shoes tie above the ankle, they are recommended for younger children who may have trouble keeping their shoes on. Contrary to common belief, however, high-top shoes offer no advantages in terms of foot or ankle support over their low-cut counterparts.

Here are some tips when purchasing shoes for children:

• Both feet should be measured every time you shop for new shoes since those little feet are growing. If, as is common, the feet are two different sizes, shoes should be fitted to the larger foot.
• The child's foot should be sized while he or she is standing up with full weight-bearing.
• There should be about one-half inch of space (or a thumb's width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
• Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Look for signs of irritation on the foot after the shoe is tested.
• Put your hand inside the shoe and feel around for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot.
• Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends at the ball of the foot, not in the middle of the shoe.
• Never try to force your child's feet to fit a pair of shoes.
• Shoes should not slip off at the heels. Children who have a tendency to sprain their ankles will do better with high-top shoes or boots.

Children who frequently remove shoes from their feet may be signaling some discomfort. Check your child's feet periodically for signs of too-tight shoes, such as redness, calluses or blisters, which will help you know when they've outgrown their shoes.

Remember that the primary purpose of shoes is to prevent injury. Shoes seldom correct children's foot deformities or change a foot's growth pattern. Casting, bracing, or surgery may be needed if a serious deformity is present. If you notice a problem, please contact our office to have your child's feet examined.