A maze of mythologies has surrounded the foot and footwear of infants and children for generations. As a result, by the time the average shoe-wearing child has reached the tender age of seven or eight, his or her feet clearly reveal a visible loss of anatomical and
functional normality. The medical practitioners are quick to attribute this to the wearing of “improper” or “ill-fitting” or out-grown shoes—not realizing that there is no other kind because all (99 percent) of juvenile foot-wear, regardless of price or brand, is
improper and ill-fitting.
It has been generally accepted by parents and medical practitioners alike that “proper footwear” was widely available for children, and if shoe-related foot disorders developed it was due to “ill-fitted” or “outgrown” shoes. There was little or no questioning the inherent design and construction faults of the shoes
themselves by medical practitioners or others. Children’s footwear was clothed in a holy shroud. Nobody saw the devils lurking inside.

Nothing Has Changed
Children’s footwear today is made, fitted and sold by the same naïve rules as a half-century and more ago. And the medical practitioners, continue to prescribe or recommend children’s footwear by the same seriously flawed rules of the past. The consequences? No shoe-wearing American or European adult owns a normal or unspoiled foot anatomically or functionally. By “normal” or “natural” is meant in comparison to the pristine feet among the estimated one billion people of the world that go through life unshod. Almost all of these physically deprived feet of adult Americans and Europeans begin in childhood with the wearing of faultily designed and constructed
footwear, starting in infancy. And all of this has occurred under the presumed “health guardianship” of the foot-related medical specialists.

The Myth of Support
The growing foot needs “support.” This popular myth not only persists, but also has led to an array of abuses by the doctors and shoe people alike. First, a question: Precisely where, how and why does a growing foot need support or reinforcement? One long-
common answer is that in shoe-wearing societies we walk on non-resilient floors and pavements, hence the growing foot needs to be protected by a buffer zone device such as a built-in arch support in the shoe or a steel shank or separate orthotic. This has no  validity whatsoever. From infancy on, most of the hundreds of millions of shoeless people of the world habitually stand and walk…mostly on unyielding ground surfaces. Most shoeless children are raised in such environments…where the streets are either cobble-stoned or paved or with hard-packed turf. Those uncovered, “unsupported” feet grow with strong, normal arches.

Heels and Toes
For centuries, right to the present day, one of the most foot-negative features on juvenile shoes has been the use of raised heels. Relative to body height, a one inch heel worn
by a child of seven is the equivalent of a two-inch heel worn by an adult. So almost all children above age seven are wearing “high” heels the equivalent of two inches in
height—and neither the shoe industry nor the doctors has any idea of this absurdity occurring before their eyes. A raised heel of any height under the foot of a growing child
automatically destabilizes the foot and the whole postural column. Such a foot is thus predestined to grow with anatomical and functional faults—much the same as a young tree planted with its trunk on a slant. The heels usually start with “first walker” shoes (10th to 12th month) and have a 3/8th-inch lift called a “spring heel” which is supposed to add forward “spring” to the step and aid in the walking. But the spring heel actually unbalances the body column and disrupts the natural balance and forward movement of the infant.
An elevated heel of any height on a child’s shoe shortens the growing Achilles tendon—the beginning of a permanent tendon shortening that begins in infancy and continues through a lifetime for all shoe-wearing people. Further, the elevated heel shortens the plantar fascia (arch) by contracting the foot and shortening the distance between
heel and ball. An elevated heel on the footwear of small, growing children is both
absurd and cruel. Among young children there is no demand or clamor for heeled shoes. The heels are imposed on the children by the shoe manufacturers, taken for granted by the parents, and accepted without question by doctors.
No footwear for children (or adults*)…should be made with an elevated heel. Exceptions might be made for girls shoes beginning about age ten if desired for peer fashion reasons. This allowance would be made on the grounds of right of choice—though not the rightness of choice.

Anti-Foot Lasts / Loss of Toe Function
Almost all Lasts for children’s footwear, including sneakers, are “crooked” in contrast to the straight-axis alignment of the foot, heel-to-toes. This has long been one of the chief causes of anatomical and functional foot deformity that begins in childhood and  continues throughout all the adult years. Why this obstinate continuation of crooked-last shoes that are so obviously anti-foot health? Tradition again. Shoes have been made on crooked lasts for centuries, so the manufacturers, along with the shoe retailers, continue to remain blissfully ignorant of this visible conflict between foot and shoe and hence resist or refuse change.
In any shoe-wearing society, by age eight or nine, the toes of most children have lost up to 50 percent of their natural prehensile and functional capacity. They are no longer strong, finger-like, ground-grasping organs but weak appenditures at the end of the foot. By early dulthood the toes will reveal visible symptoms such as tapered shape, bunions, crooked or hammer toes, nail disorders, etc.

Infants Shoes
In all shoe-wearing societies…the anatomical deformity and functional delinquency of the foot begins at about the sixth or seventh month when the infant, still in its crib, is fitted to pre-walker shoes, a laced bootie. Despite the fast-growing foot, the crib shoes
are worn until about the 11th or 12 th month when the infant begins to walk and is fitted to its first shoes—again a laced bootie, but a firmer sole. It’s as though the parents, shoe people and doctors can’t wait to begin the primitive process of foot-wrapping, little different than the old Chinese footbinding customs that began when the girl was about
age six.
The infant, displaying more common sense than the parents, shoe people or doctors, struggles to pull off the alien wrappings on its feet. These are primitive conditions and attitudes when the foot is at its most vulnerable stage. But under prevailing practices, the infant foot is usually pre-doomed to a high-risk life ahead.
Surveys reveal that, for parents, the single most memorable event for them during an infant’s life span is its first steps. With those first steps the infant is now ready for prime time. So onto its feet go its “first-stepper” shoes. And suddenly, the infant, having successfully launched its walking career barefoot, finds itself struggling to maintain balance and locomote with stiff, constrictive, alien objects on its feet. It labors to take “normal” steps with shoes on—a physical and biomechanical impossibility…First, the shoe’s soles…are one-fourth to three-eighths of an inch thick. They automatically prevent 80 to 90 percent of the child’s normal flex angle. The steps are pancake-like, seriously hampering the gait mechanics. The thick soles commonly used on infant shoes and sneakers are an absurdity. Infants never wear out their shoe soles.

What these experiences clearly demonstrate is that if the foot is permitted to reach adulthood unspoiled by shoes, the foot will be a quite different object anatomically and functionally than the foot shod from infancy into adulthood. Hence the obvious conclusion: In any shoe-wearing society there is no such thing as a natural or “normal” foot anatomically and functionally.
The shoe-wearing foot has been anatomically conditioned from infancy to acquire the faulty shape to adapt to the faulty shoe. This contradicts the rule: you can’t fit a square peg into a round hole. But you can. You simply shave the corners or edges of the square peg until they are rounded, and the once-square peg fits neatly into the round hole. This is precisely what happens to all shoe-wearing feet. So we arrive at the deceptive illusion that all once-square-pegged feet are “normal” because they fit into the round hole.

Where To From Here?
An excerpt from a U.S. Department’s public statement: “Our studies show that the most criticized factor contributing to the controversy about orthopedic footwear is the lack of knowledge or training of most medical practitioners…The attending physician or medical
specialist is not normally schooled about footwear.” It has long been assumed that children’s footwear is generally healthful because it allows for normal foot development by avoiding the “sins” of adult footwear (high heels, pointed toes, vanity, too-
small sizes, fad fashions, etc.). This is seriously naïve. Over the past 50-100 years virtually every branch or specialty of medicine has made substantial contributions to disease prevention and health improvements in its field. Only podiatry has failed on this score. While podiatry has made appreciable advances in the treatment of foot disorders, it has added almost nothing to the science of prevention.

Here are two proposed steps for launching the initiative:

1) A mass professional policy urging parents to keep their infants shoeless through the first three years. This would give the foot a healthy head start.

2) Urge all parents to adopt the shoeless-at-home-rule for their children through age 12, and suggesting that the parents apply the same rule or habit to themselves.

Once introduced, the shoeless-at-home habit is eagerly adopted by juveniles because of the “freedom” feeling. Having acquired the shoeless habit up through age 12, most children will continue with it well into the late teens and often beyond. The obvious consequence would be a marked improvement in child foot health and continuing
into the adult range over the subsequent years. The APMA should assume leadership here by taking an official stance and using the muscle of its public relations sector. Podiatrists would supplement this by similar advice and guidance to office patients. So, while teens would likely continue to go shoeless at home, they would adopt and wear the peer fashion footwear outside. But by then healthy child foot development will have gotten off to a vigorous head start—something that rarely occurs in any shoe-wearing society.
Podiatry must now begin exchanging the old platitudes concerning the foot/shoe linkage in child foot development for the new realities. It must confront the simple premise that children’s feet fare better without rather than with shoes.

Dr. Rossi, a shoe industry consultant, has written eight books and over 400 articles, including extensive additions on leather and footwear in Encyclopaedia Brittanica.