Children’s Feet: How They Grow

Children’s feet are not simply “miniature” versions of adult feet. They are shaped differently from those of adults, and they change as they grow. In the first year of life, the feet are soft and supple, with ample fat pads on the soles. Bones have not fully ossified (assumed their final shape and hardness), and are very flexible. When a child begins to walk, the arch starts to develop and the muscles of the feet get stronger as the feet grow in both length and width. Ossification of the bones in the feet, which takes place over many years, generally is complete by the age of 18 to 20.

Before a child starts walking, the feet do not need to be covered except for warmth or hygiene purposes. It is best to cover them with fairly loose booties (footwear that is too tight can restrict growth and development of the feet). When a child begins to walk, shoes are not necessary when indoors. Allowing a child to go barefoot or to wear only socks helps the feet grow normally and develop strength and muscle tone. It also helps develop the “grasping” action of the toes. Outside or on rough surfaces, toddlers’ feet should be protected in lightweight, flexible footwear.

In the first five years of life, a child’s feet grow rapidly. One study 1  found the following growth characteristics of feet in children from ages one to five:

• Under 15 months: a child’s footwear  increased by 1/2 size about every two months;
• From 15 months to two years:  1/2 size increase occurred every two to three months;
• From two to three years: a 1/2 size increase occurred every three to four months;
• From three to five years: a 1/2 size increase occurred every four months;
• Boys' feet tended to average one size longer and one size wider than those of girls. Width growth remained proportional to length growth throughout the study.

Implications for Footwear

For young children, shoes should provide some degree of rear foot cushioning and stability, and forefoot flexibility. 2   For children of all ages, shoes should have a closure that is easy to use, prevents feet from slipping and helps provide stability.  The upper part of the shoe should be made of material such as mesh, which is capable of wicking moisture away from the foot.  Light weight is best, especially for sports shoes. 3   By age 12, the feet typically are 90% of their  adult size and width. They should be measured every time new footwear and any inserts or orthotics are purchased. Outgrown footwear and any old inserts or orthotics should be discarded. 

Generally, it is not a good idea to hand down shoes. However, for those who might not be able to afford new shoes frequently, gently used “hand-me-downs” can suffice, as long as they are not badly worn or misshapen. Infants who are not yet walking also can wear hand-me-downs. To be on the safe side, always have any used shoes inspected by a shoe fitter or foot health professional.

 It is not a good idea to “recycle” athletic shoes that have been worn by someone else, because shoes tend to conform to the shape of the feet, and wear according to the specific gait characteristics of the person wearing them.  Used shoes will already have molded to the previous wearer’s feet, and will have worn according to that person’s gait.  Therefore, the shoes are unlikely to fit someone else’s feet, and may cause blisters or other foot conditions during activity.  In addition, the wear pattern may result in less protection for key areas of the foot where pressure and shear force are most likely to occur.

The average life of a pair of children’s shoes is four months, depending on the quality of the shoes.  This may be at least in part because children are relatively active (girls take an average of 10,000 to 13,000 steps, and boys take 12,000 to 16,000 steps each day). 4   In addition to walking or running, children may stomp, jump, skid, twist, scuff, kick, etc. Despite this activity, however, children may outgrow their shoes before they wear them out, so a child’s growth rate is also a factor in the life of his or her shoes. 

Parents should be attentive to the need to discard and replace shoes that have become too small even though they may not appear to be worn out. Allowing children to wear shoes that don’t fit can create problems, yet many parents persist in doing so. Swiss researchers reported at the 2009 annual meeting of the American Academy of Orthopaedic Surgeons that, based on the foot measurements of nearly 250 boys and girls from age five to age ten and their indoor and outdoor footwear, 53% of the children had outdoor shoes that were too small, and 13% percent were wearing outdoor shoes that were too large. A similar pattern was seen with children’s indoor shoes, where 61% were wearing indoor shoes that were too small, and 10% were wearing indoor shoes that were too large. 5

Another study found that 89% of children examined wore indoor footwear that was of insufficient length (“insufficient length” in the study was defined as footwear that is not at least 10 mm [about ½ inch] longer than the foot of the child wearing the shoes), and 69% of children wore outdoor shoes that were of insufficient length. 6

Based on this information, it is not surprising that many adult foot issues begin in childhood. To help reduce the possibility of longer term foot issues, it is critical for parents to check their children's shoes at least every few weeks to ensure that they still fit. Learn more about preventive foot health for children here.

References

1. N. Gould, M. Moreland , R. Alvarez, S. Trevino, J. Fenwick, Development of the child's arch, Foot and Ankle, 9(5), April, 1989.
2. Janet S. Dufek, PhD, Dana Forrest, MS, and John A. Mercer, PhD, Choosing children’s shoes: Mechanical considerations, Lower Extremity Review, January, 2013, accessed at http://lermagazine.com/article/choosing-childrens-shoes-mechanical-considerations
3. Markus Walther, MD PhD, Dirk Herold, Angela Sinderhauf, Robert Morrison, Children sport shoes—A systematic review of current literature, Journal of Foot and Ankle Surgery  14(4):180-189 April, 2008.  Accessed at http://www.feelmax.nl/feelmax/barefoot-onderzoek/children-sport-shoesa-systematic-review-of-current-literature/
4. Catrine Tudor-Locke, Cora L. Craig, Michael W. Beets, et.al., How many steps per day are enough for children and adolescents?, International Journal of Behavioral Nutrition and Physical Activity, 8, 78; July, 2011.
5. Espinosa, Norman, MD (University of Zurich), presentation to American Academy of Orthopaedic Surgeons Annual Meeting, from article in AAOS Now, March, 2009 accessed at http://www.aaos.org/news/aaosnow/mar09/clinical5.asp.
6. C. Klein, E. Groll-Knapp, M. Kundi, and W. Kinz, Increased hallux angle in children and its association with insufficient length of footwear: A community based cross-sectional study, BMC Musculoskeletal Disorders, 10:159, December, 2009.