Baring their soles

Sandra Brown's children, Lauren, 7, and Christian, 5, love running around the family's backyard in their bare feet.

"I had a hard time keeping shoes on their feet when they were younger," said Brown, of Latrobe. "When we go to the beach, I purchase water shoes and play sandals for them, but they won't keep them on. They love the sand on their feet."

When warm weather arrives, many children -- and adults, too -- can't wait to kick off their shoes and feel the grass tickling their toes. For some folks, summer wouldn't be complete without a barefoot splash in a mud puddle or a shoeless walk on a sandy beach.

Doctors, though, are divided about the benefits of going barefoot. It's all about where you're walking, they say.

Greensburg pediatrician Dr. Pascal Spino encourages parents to let young children run around barefoot -- but only indoors.

"Usually when a child begins to walk, shoes are not necessary. Allowing children to walk indoors without shoes helps to develop the bones and muscles of the feet," he said.

But the great outdoors is another story.

Plantar warts and itchy athlete's foot can be spread by contact, either at poolside or in the locker room. Sun-soaked sidewalks can get hot enough to burn the skin. Little feet can be stung by bees or hurt when kids step on sharp objects such as nails, pins, broken glass, seashells or thorns.

"Children with normal feet can wear flat-soled shoes and flip-flops outdoors, especially in locker rooms and around the pool to protect the feet from plantar warts," said Dr. Paul G. Krouse, a podiatrist in Latrobe. The painful warts on the sole of the foot are more prevalent in children than adults, because kids tend to go barefoot more often, he said.

Alexis Gobbel, 7, and sister Makenzie, a kindergarten student, never go anywhere without proper footwear, said their mother, Jessica Gobbel, of Latrobe.

"I worry they'll get stung by a bee if they go barefoot," she said. "The children wear flip-flops or water shoes when we go on vacation. They've never had any problems with their feet."

Little ones with foot problems have special concerns.

Lisa Zilliot's youngest son, Ben, 1, was born with flat feet, a trait inherited from his father and paternal grandfather.

"Ben's doctor told me to let him run around barefoot in the house, so his arches would develop naturally," said Zilliot, of Latrobe. "I've purchased sandals for Ben to wear outdoors, but he won't keep them on. They're too uncomfortable for him."

Zilliot's other children -- Jessica, 14, and Evan, 7 -- favor athletic shoes with lots of foam cushioning inside, so she purchased a pair for Ben, too.

"He seems to be comfortable in them," Zilliot said.

Krouse said athletic shoes offer more support than flimsy sandals. The built-in arch support may be helpful, too.

"For children who have genetic, inherited health problems such as flat feet, it's usually better if they don't wear shoes with flat soles," he said. "These children need to have supportive soles. And when they walk around in their bare feet, it can aggravate the problem."

A doctor should check the alignment and mobility of a baby's feet at four to six months of age, before the child starts walking, Krouse added.

Steps can be taken early to correct problems such as clubfoot or "pigeon toes."

"This is when the congenital deformities can be taken care of with casting to straighten out the normal alignment of the bones of the feet," he said.

For outdoor play, Spino said, standard shoes are the best footwear for children.

"I don't approve of flip-flops, sandals or plastic 'jelly' shoes," he said. "Even those cute infant booties should be discouraged, because they may cause binding of the feet or painful squeezing of the toes."

Proper fit is important, Spino stressed. Several years ago, he recalled, a young mother brought her screaming infant into his office for treatment. The mother didn't know why her child continued to scream and cry.

"As soon as we took off the baby's shoes, he stopped crying," Spino said. "The shoes didn't fit properly and were pushing the baby's toes together in a painful way."

The American Academy of Orthopaedic Surgeons calls ill-fitting shoes a significant public health risk for both children and adults. They can cause bunions, corns, calluses, hammertoes, ingrown toenails and other disabling foot problems, the organization says.

Eight of every 10 children have trouble with their feet because their shoes don't fit correctly, the academy reports. Proper fit is essential, since the cartilage in a child's foot does not completely harden until age 18 or later.

"Once the bones get harder, it's more difficult to correct the deformity without surgical intervention," Krouse said.

Parents can check for outgrown or poorly fitting shoes by looking for worn areas, turned-up toes and other telltale signs. If the toe area of the sole is badly worn, the shoe may be too small. If the end of the shoe is turned up, it may be too big. And if the sides are showing more wear than the rest of the shoe, it may be too narrow for the child's foot.

Spino said the most expensive shoes are not necessarily the best.

"It's better to buy a child two $50 pairs of shoes than one pair of $100 shoes, so there can be rotation of the shoes," he said.

Alternating between two pairs gives shoes a chance to dry and air out between wearings.

"When the shoes begin to break down or wear out, it's time for parents to purchase new shoes for their children," Spino said.

He advises parents to examine children's shoes before buying them. Check for overall flexibility; a stiff, supportive heel; adequate cushioning inside; and a built-in arch.

"It's very important to have the proper fitting shoes," Spino said. "Once a year parents should measure the length and width of both their children's feet, because feet tend to be different sizes."

Sport-specific shoes can help performance and protect the feet. But avoid rubber cleats children younger than 10, because they have the potential for harm, Spino advised. And watch for shoes that slip at the heel; they can cause ankle injuries.

"Expensive sneakers have become a status symbol," he said, "but the condition of the shoes is more important than the expense."

Additional Information:

10 tips for shoes that fit

2. Try on shoes with the socks or hose you intend to wear with them.

3. Buy the right size. Don't choose according to the number marked inside; see how the shoes feel on your feet.

4. Match shoes to the shape of your foot. (Step into a pan of water, then onto a sheet of colored paper. Look at the footprint -- is your foot straight• curved• high-arched• flat?)

5. Wiggle your toes. Is there room for them to move inside the 'box' at the toe of the shoe?

6. Check for length. Allow about half an inch of space between the tip of your longest toe and the end of the shoe.

7. Check for width. The widest part of your foot should match the widest part of the shoe when you're standing on one foot.

8. Avoid shoes that slip. If your the back of your foot slides in the heel cup, the shoe doesn't fit properly.

9. Take a walk. Put both shoes on and stroll around the store to make sure they feel comfortable as you move.

10. Don't expect shoes to stretch out. if they feel tight in the store, select another size or style.

SOURCE: American Orthopedic Foot and Ankle Society, American College of Foot and Ankle Surgeons