PARENTS beleaguered by the cost of children's footwear may be relieved to hear that the best thing for growing feet is not those adorable, miniaturized glow-in-the-dark running shoes, or the sensible Oxfords or even the K mart flip-flops. Wearing no shoes at all is better, according to some orthopedists.
In a new review that confirms and expands on what many pediatricians have been saying of late, Dr. Lynn T. Staheli, director of orthopedics at Children's Hospital and Medical Center in Seattle, has concluded children with the healthiest and most supple feet are those who habitually go barefoot.
The myth of the good, solid shoe is like the fallacy of communism, said Staheli. "People do better when they're free, and the foot does better when it's free."
Staheli was led to his conclusion by anthropological studies of people around the world who do not wear shoes.
"If you look at a place like China and you compare the feet of those who don't wear shoes with the feet of those who do, you find that the non-shoe-wearers have better flexibility and mobility," he said. "Their feet are stronger, they have fewer deformities and less complaints than the shoe wearing population."
Staheli said in Western nations, children must often wear shoes to protect feet against snow, broken glass or the occasional hypodermic syringe on the sidewalk, among other things. But he said the more closely a child's shoe resembles the barefoot state the better.
A child's shoe should be lightweight, flexible and shaped more or less quandrangularly, like the foot, he said. Above all, the shoe should not have the arch inserts or stiff sides once deemed necessary for foot support. And whenever the ground is safe enough to do so, he said, parents should allow their children to roam around unshod.
The new report appears in the August issue of the journal Pediatrics, and it has been greeted with considerable approval.
"The bare foot is the ideal position," said Dr. Lowell D. Lutter, assistant clinical professor at Gillette Children's Hospital in St. Paul, Minn. "Children's shoewear has two functions: to protect and to decorate. Anything past that is an unnecessary use of resources."
Staheli, a respected pediatric orthopedist who himself has studied children's footwear, is particularly opposed to those shoes branded "corrective" or "orthopedic" and which some doctors still advocate as a method for straightening foot and leg deformities, such as flat feet, pigeon toes, knock-knees or bowlegs.
Staheli and many other orthopedists denounce that sort of medical intervention as unnecessary. For one thing, they say, there is no evidence corrective shoes correct anything. For another, the supposed deformities correct themselves over time the vast majority of cases.
"In the orthopedic community, there's a real cynicism about orthopedic shoes," said Dr. Francesca M. Thompson, an orthopedic surgeon at Roosevelt Hospital in New York. "Mother nature takes care of nearly all orthopedic problems on her own. What a child needs is protection from cuts and things, not an ugly brown shoe."
Staheli recommends that shoes be considered like any other item of clothing.
"You don't think of clothing as something that will influence the development of the trunk or the arms," he said. "It's worn for comfort, and the same should be planned for the shoe."
Some pediatric orthopedists disagree with Staheli, considering his an extremist position. They insist that there is still a place for corrective shoes in cases in which children's foot problems do not improve over time. Left unattended, they said, foot and leg problems in childhood can lead to considerable discomfort in adulthood.
"The author of the article has a vendetta" against corrective shoes, said Dr. Seymour Zimbler, a clinical professor of pediatric orthopedics at Tufts University School of Medicine in Boston. "With some mild deformities, I believe a shoe with some correctives has an ability to help, but it's difficult to prove."
Staheli said that his new review is not an attempt to undermine the children's shoe industry, but rather to summarize prevailing opinion about how the foot normally develops and how best to encourage its healthiest growth.
Most babies are born with what look like foot abnormalities. Nearly all have flat feet, because the foot bottom is covered by a thick pad of fat and because it is only through walking that the intricate mesh of muscles and ligaments in the foot strengthen and pull upward into a genuine arch.
Following 442 children in a study conducted several years ago, Staheli found that in most cases the arch is fully developed by 6 to 8 years of age.
Doctors emphasize that the joints and ligaments of the legs and feet are extremely flexible in a newborn and that they require several years to attain their mature shape and position. As the limbs develop, they may assume any number of unusual variations, nearly all of which are outgrown.