Pediatric Orthopedics

A common question that arises in online forums and clinics is at what stage a child "needs" shoes.

It's important to emphasize that the following discussion pertains to healthy infants and children without any conditions affecting their foot posture, structure, or stability when standing.

A baby who isn't walking yet doesn't require shoes. But does a walking baby need them?

Until recent times, human evolution didn't involve shoes (certainly not at an early age). This suggests that our feet have developed for walking barefoot. Shoes serve purposes of warmth, protection, and aesthetics. They likely don't hold much importance for a baby who's just starting to walk and is in a warm and safe home environment.

Soft shoes designed for the early walking stage are a nice accessory (and sometimes expensive), but it's not certain that they're necessary. Large, heavy, or rigid shoes hinder the baby's ability to feel the ground, lift the foot during a step, and strengthen the calf muscles and foot arch to stabilize themselves.

There's very little scientific research on this topic, but it can be assumed that allowing walking without shoes is a beneficial process. We recommend allowing children to start walking without shoes and continuing to allow barefoot walking wherever possible (or with socks) in safe environments.

Congratulations! Your child has finally completed five steps on their own without your support, a mobile toy, or the white walls. Just before you rush to the nearest shoe store to purchase those supportive, soft, and flexible first walk shoes...

Dr. Udi Lebel, Director of the Pediatric Orthopedic Department at Shaare Zedek Medical Center, explains why in most cases, it's advisable to wait a bit and leave your child barefoot.

Parents are excited. Just before you want to spend your hard-earned money on sophisticated first walk shoes, Dr. Udi Lev, Director of the Pediatric Orthopedic Unit at Shaare Zedek, explains why, in most cases, it's better to leave them shoeless.

He smiles. Your baby has flipped, crawled, and their digestive system has already adapted to the world outside the womb. Now your baby's face a new and particularly challenging task – walking! Research conducted among populations of 'barefoot' individuals, such as Africans, Asian Indians, and others, suggests that in most cases, their foot arches are healthier. (It's worth noting that there isn't much research on this topic.) "There's no reason to assume that wearing shoes is beneficial," Dr. Lebel explains. "Clearly, in colder regions, protecting the feet is necessary, and this likely led to the concept of 'first walk shoes' that we know today. But these shoes are essentially no more than socks," he adds.

"Your child doesn't really need you to intervene in their steps."

"Let's start with one step back," Dr. Lebel explains. "Healthy children begin walking between the ages of one and two. If the child is healthy, there's no significant need to worry if they're not walking by the age of two."

"From our perspective, a 'first walk shoe' should essentially be walking barefoot. The reason for this is that we're disrupting the child's ability to learn about their environment and sense the world around them in a fundamental way. We believe the child needs to feel the ground. Sensation is meaningful for infant development, and so we shouldn't 'interfere' with their ability to feel: pavement, grass, stones, soil, sand, or even a carpet. Putting shoes on a child is similar to raising a child with gloves. We don't want to do that. There isn't a substantial research foundation for this topic either, but if the child isn't cold, doesn't have thorns, sharp objects, or other harmful elements, if the pavement isn't too hot for them, and if there's no risk of injury – the shoe is unnecessary."

"Furthermore, we don't recommend trying to guide healthy children with walking aids. There's not much benefit in devices like walkers and walking trainers, as walking is a stage dependent on brain maturation and the interplay of muscles, visual coordination, and balance. It's not dependent on muscle maturation. A child can stand from a very young age and can testify to that. It's advisable to let the child walk with support as they wish, until the triangular muscle system matures."

And if we've already given in to the trend... Which shoes are worth buying?

"It's best to let children develop as long as possible without shoes. This way, they'll receive stability from the foot arch itself rather than from the shoes. For children who find it slightly more challenging, we recommend shoes that hold the ankle and provide more stability. Very often, the shoe overly complicates the child's walk, making it harder, especially in winter. Winter walking is always more cumbersome than summer walking, enjoyed by 'barefoot' kids. A 'first walking shoe' should be very simple, and there's no need for overly sophisticated and expensive shoes. And it's important that they're cute too ."

As the new school year approaches, it's important for you to know that before you invest in choosing a 'high-quality' backpack, the content of the backpack matters just as much. The malls are flooded with the maximum discounts leading up to the return to school, offering a variety of backpacks at different prices, some of which are labeled as 'orthopedic' and are presented at an inflated price, claiming that they will protect your child's back. Dr. Harel Arzi, Director of the Pediatric Spine Clinic at Shaare Zedek Medical Center, explains that there's no such thing as an 'orthopedic' backpack, and he recommends choosing a backpack that is comfortable, with padded straps.

"Generally, the structure of the backpack isn't the issue, but rather the weight of the books and school supplies inside it. Trolley backpacks are very common, though the tendency to overload them with a larger quantity of heavy books leaves the child dealing with too much weight. In order to protect your child's back, it's advisable to try to coordinate with the teacher a work plan during the year that takes into account your child's small back," Dr. Arzi explains.