Staheli LT.
Department of Orthopaedics, Children's Hospital and Medical Center, Seattle, WA 98105.
1. Optimum foot development occurs in the barefoot environment.
2. The primary role of shoes is to protect the foot from injury and infection.
3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility.
4. The term "corrective shoes" is a misnomer.
5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications.
6. Shoe selection for children should be based on the barefoot model.
7. Physicians should avoid and discourage the commercialization and "media"-ization of footwear. Merchandising of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession

Lisa C. Moore
Doctor of Chiropractic Auburn California
During foot development, it is important for bones, muscles, blood vessels and nerves to have room to grow without restriction.
As the beginning walker stands up and takes his first tentative steps, the muscles of his feet grip the floor and the toes separate to help the child have better balance and control. If her feet are confined within a rigid shoe, the toes cannot operate in this way, nor can the muscles of the foot and ankle develop the strength necessary to hold her upright.
Throughout a lifetime, foot health depends upon the flexibility of the structures involved. This begins in infancy and continues as we grow. If we wear rigid shoes, the bones cannot move freely, resulting eventually in crippling arthritis.
From a Chiropractic standpoint, spinal health is connected to foot health. Inflexible feet affect all the joints above, including the spinal column. Many times, pelvic imbalance originates in foot distortion such as fallen arches or dropped metatarsal bones. Every step a person takes translates into either stability or instability for all the structures above. This process begins with that first step
Soft soled baby shoes allow the beginning walker to grip the floor, developing strong ankles and flexible foot bones.
This creates a solid foundation for bone and muscle formation in the rest of the body, especially the spinal column. A level pelvis and straight spine depend upon healthy feet through out our entire lives, beginning in infancy.

Hartford Courant
independent expert, summer 2000.
"Please welcome a new arrival to the list of obsolete wisdom for parents: Babies walk best in stiff leather shoes.
Not true, say researchers at Connecticut Children's Medical Center who spent months studying the way babies learn to walk. With the help of computer-assisted foot pressure sensors and slow- motion video, researchers learned that, from their first steps, babies walk with a rocking heel-toe motion, just like adults.
The findings toppled the long-held conventional wisdom that the first steps are flat-footed stomps. With that assumption, the stiff, high -topped baby shoe was born, designed by shoe companies to support flat-footed steps and wobbly ankles.
But babies' ankles, it turns out, are perfectly stable from the beginning, making the traditional high topped shoe unnecessary.
The conclusion, said Sylvia Ounpuu, a movement specialist at the children's medical center who directed the study, is that barefoot is best for babies."

Community Paediatrics Committee, Canadian Paediatric Society (CPS)
Paediatrics & Child Health 1998; 3(5): 373
Reference No. CP98-02 (Formerly MS98-02)

Shoes are selected for protection, not correction. Myths often confuse parents who are buying shoes for their infants and children.
The Community Paediatrics Committee no longer accepts the old belief that a baby must wear shoes soon after birth. Keeping a baby out of shoes in warm, dry conditions is a good idea because walking barefoot develops good toe gripping and muscular strength. Indeed, there is increasing evidence to suggest that wearing shoes in early childhood may be detrimental to the development of a normal longitudinal arch.
Until toddlers have been walking for at least a few months, the only purpose of footwear is to protect the child's feet and to offer some grip on a smooth surface. For pre walkers, shoes are not necessary. Ankle boots do not necessarily give more support than low-cut shoes, but are useful because they are harder for children to remove. Shoes must fit the foot properly at the heel and allow enough room for the toes, leaving about 1.25 cm between the longest toe and the tip of the shoe, measured standing up. This allows for sufficient movement of the toes and reasonable room for growth. Never buy shoes unless the child is present to try them on. Soft-sole footwear for protection and warmth is appropriate. For early walkers, shoes provide better fit, stability and safety than sneakers. Used shoes that have lost their shape should be avoided.
Corrective shoes are a misnomer and are rarely needed in physically normal children. The appearance of the foot changes with growth. Ninety-seven per cent of all children younger than 18 months of age present with flat feet, due mostly to a fat pad under the foot. At age 10 years, only 4% of children will still have flat feet. Children with mild or moderate flat feet need no specific treatment or corrective shoes. They should not be restricted from any physical activities. For severe flat feet, if accompanied by related pains in the legs or knees, longitudinal arch supports, scaphoid arches, Thomas heels and other orthotics may be tried.
Simple metatarsus adductus initially may be treated with passive stretching exercises. If the metatarsus adductus is not reducible, meaning that the forefoot does not return to a neutral position, splints and/or cast treatment in early infancy may be required. In toeing with tibial torsion tends to improve with age. Patients with persistent in toeing with tibial torsion leading to functional impairment should be referred to a paediatric orthopaedic surgeon.
Children's feet should be left alone as much as possible. Prescribing shoes to attempt to 'correct' physiological flat feet, knock knees or bow legs is not useful for the child and expensive for the family. Doctors can avoid over treatment of mild to moderate variations by explaining this to parents in a reassuring way.