I was recently Facebook chatting with my columnist Nate Sanel about the topic of getting kids active, and as a dad he shares a similar interest in the topic. Nate has a passion for topics relating to nutrition, and he asked me if I had ever seen Jamie Oliver’s TED talk about teaching kids about food. I hadn’t, and my wife and I watched it last night. It’s one of those videos that really makes you stop and think. I like to be active, but my diet is far from pristine. Sometimes I need a reminder that I need to set a better example for my kids, and Oliver’s video really hammers this home (my wife does an amazingly good job of making sure that we eat well, I wish I were more like her in this regard).

Anyway, I wanted to share the talk here, it’s really well done and I highly recommend that you watch it:

In the issue of RT, my good friends Jay Dicharry (a physical therapist) and Mark Cucuzzella (a family doctor) wrote a multifaced guide to minimalist running as it relates to the little ones. There are multiple articles, a guide to what to look for in kids shoes, reviews of selected minimalist kids shoes (I’ll share some of my thoughts on these soon – you can find some of my top picks in the Zappos ad in my right sidebar), and even a summary of a pilot study on the effects of footwear on the running gait of children.

I highly recommend that you check it out (full text of the article is available on-line) – here’s an excerpt from one Dicharry’s opening article about childhood foot development and how it relates to footwear:

In essence, we still practice the ancient art of Chinese foot-binding. Glance over at the foot of any newborn and you’ll notice that the widest part of their foot is not the ball of the foot but their toes. Then take a look down at your foot. You’ll likely notice that these feet don’t look the same. The narrow toe boxes in athletic and fashion footwear have changed the alignment of our feet, just like braces once did to legs. We’ve been taught that a pointy shoe looks normal — both fashionable and fast — and we’re willing to change our foot shape to accommodate this look.

In addition to shoes that bind the foot and change its shape, we typically put kids in shoes that are too stiff to allow natural flexion. Typical running shoes are produced for a man weighing 150-plus pounds and a woman weighing 130 pounds or more. Many of the same materials are used in the construction of shoes meant for kids who weigh a fraction as much. And the smaller physical size means that all that stitching and those material attachment points net a much stiffer shoe than the adult versions. Kids don’t have the physical weight to flex these shoes.

Is this a problem? Yes. The foot is designed to move. And that movement helps strengthen the muscles, which in turn impact the changes in our natural alignment throughout our development.

I’ve had the privilege of working with a number of runners who grew up sans shoes, and their feet are different from ours. As adults, these runners don’t rely on stiff shoes because they’ve developed strong, stiff feet. Years of barefoot movement have resulted in robust muscular attachments to anchor and stabilize the foot. The average Western foot — having grown up dependent on shoes — pales in comparison.

“…if we can encourage kids to run naturally, the way they already know how to, and to feel strong and grounded in their bodies and free in their feet, why wouldn’t we?”

My own kids have been in Merrell Kids Trail Gloves for most of this school year, and I rarely ever discourage them from going barefoot when they want to. I’m encouraged that additional options are starting to appear beyond the Vibrams and Merrells – New Balance recently released the Minimus KT20 for kid’s (bought a pair for my 8yo son), and Skechers has a kid’s version of the Go Run on the way (my daughter has a pre-release pair and loves them – 4mm drop, light, super-flexible, and lacks the midfoot ‘bump’ found in the adult version).

I highly encourage you to head over and give Arnold’s article a read: http://www.outsideonline.com/blog/mini-minimalists-are-barefoot-shoes-good-for-kids.html.

My goal with Benjamin is to avoid for as long as possible having him wear a constrictive, stiff shoe with excessive cushioning and a lifted heel. I simply cannot understand why a 30 pound child would ever need a shoe like this, or why we insist on moving them into this type of shoe the moment they emerge from toddlerhood. He can walk around all day in his Elmo Robeez without complaint, and I see no reason why the simple act of getting older means that he needs a shoe built like a tank. Call me crazy, but given all that I have learned over the past few years, this is something I feel very strongly about.

Given this, I’m always on the lookout for decent options for parents who would like to keep their kids in shoes with flat, flexible soles. I happened to be at a Nike Outlet store yesterday afternoon and I happened upon a shoe called the SMS Roadrunner. The shoe looked interesting as it had a flexible plastic sole – all of the cushion was built into the insole, which was removable. Since I get a lot of questions about kid’s shoes (my older kid’s wear Merrell Barefoot Kid’s Trail Gloves and Crocs – the latter are cushioned, but at least are extremely wide and flexible), I thought I’d share this one as it seems like a decent option and it is available in sizes up to 10c (which bridges the gap to where they can fit in something like a Merrell Trail Glove).

Since I just bought them yesterday, I can’t comment on durability, but removal of the insole makes the SMS Roadrunner completely flat and very flexible, and also makes for a pretty roomy little shoe. I’ll try and update this post after he wears them a bit. For now, here are some photos of the shoe, which is available for sale in both boy’s and girl’s colorways at Nike.com.

Mark was kind enough to send me a few pairs of Terra Plana Vivobarefoot Kids shoes for my own children, and my daughter loves them (she has Pally’s) – they have a nice wide toebox, and are flat and extremely flexible. My son, on the other hand, is picky and will only wear Crocs or typical sneakers (though he is almost always barefoot, by his own preference, around the house) – unfortunately, good options for kids running shoes that support natural foot function are simply not available yet (things will thankfully be improving soon if rumors I hear from a big company are correct – stay tuned). Anyway, given my frustration, as well as that of a number of readers who have contacted me about this issue, I asked Mark if he would be willing to write a guest post about children and shoes. Mark happily obliged, and his expertise as both a physician and shoe store owner makes for a very informed and unique opinion on the topic. Enjoy – be sure to share your thoughts and/or experiences in the comments!

Thoughts On A Proper Child’s Shoe

As a family physician, I firmly believe that children should play in their bare feet or in activity shoes that complement natural foot development and proper biomechanics of movement. Runners, walkers, coaches, and the medical community are all awakening to the benefits of allowing proper natural foot motion to occur in all of our daily activities. Leaders in the running mechanics, sports medicine, dancing, and yoga/tai chi communities all understand that the smartest design that will ever be developed for human movement and injury free activity is the human foot itself. Running shoe companies are slowly hearing this message and adapting their product lines to create footwear that allows your foot to behave like a foot, but most have only applied this new thinking to adult models. Unfortunately, the modern shoe industry and its marketing machine effectively convince parents that when running, a child should wear miniature versions of traditional adult running shoes; almost all of which have elevated heels, extreme cushioning, and some form of motion control technology. Many dress shoes for children are also stiff and overly supportive. Personally, as a doctor I firmly believe that the strongest form of support for a child is a strong foot that is flat on the ground.

Here’s an important point to keep in mind – a child’s foot is not a miniature version of an adult’s foot. In early development, a child’s foot is widest across the toes. If our population wore shoes that were designed with this functional shape from birth, most adults would also have feet with the greatest width located across the toes, and the toes would be perfectly aligned with the metatarsals (the long bones in midfoot). Most of a child’s developing foot is composed of cartilage, which is gradually replaced by bone. If the cartilage is deformed by badly shaped or rigid shoes, the bones will take on the deformed shape. More than 80% of foot problems, bunions and injuries are a result of misshaped and inflexible shoes. It’s vital that kid’s shoes allow enough room for natural growth, until the foot bones mature. This doesn’t happen until ages 18-19 for girls and 20-21 for boys. Simply put; inflexible, poorly shaped shoes are potentially harmful – they restrict the natural movement and development of the foot.

Research and education efforts from places, people, and organizations like the University of Virginia SPEED Clinic, Dr. Daniel Lieberman of Harvard University, and Chi Running are together allowing runners and walkers to re-look at old concepts related to form and footwear. More importantly, innovative shoe manufacturers such as Newton Running, Terra Plana Vivo Barefoot, Vibram, Kigo and newcomers Altra and STEM are now producing foot-friendly shoes that people can use to more effectively apply new concepts in their own self-experiments. It is hard to find a single one of the now thousands of runners and walkers who have made proper changes in their gait, and complemented this with footwear void of elevated heel/motion control features, who wants to return to the old way of heel crash pads and inefficient gait.

Currently, almost every running shoe company has products in development supporting natural running, and we are beginning to see the very first steps by many of them away from heavy cushioning and elevated heels. Again though, most of these new shoes are being made solely for adults. Outside of a few select brands, with Terra Plana Vivo Kids being the model (see the photo of the TP Pally to the left), a void exists in the development of proper youth footwear, where natural foot function and development are perhaps most critical.

Unfortunately, the medical establishment often fails to recognize what to many seems so obvious – a child’s foot is best off when it is interfered with the least. For example, without any supporting evidence, the President of the American Academy of Podiatric Sports Medicine (AAPSM ) David Davidson made this comment when asked about children’s footwear by Running Times Magazine “Kids should not be running in minimalist footwear at all, and as in other shoes, should be wearing brand name running shoes with good motion control, cushioning, etc…” I believe the opposite. I feel children should run barefoot as much as possible, and when they need a shoe, they should wear one that allows the young foot to develop its natural strength, support, and function. Parents should think twice before heeding the message that their children need “sturdy” or “supportive” shoes. As Dr. Lieberman demonstrated so well in his landmark paper in Nature (Jan 26, 2010), footwear can have a large influence on natural gait.

I find it highly unusual and there are no supporting documents to the APMA (American Podiatric Medical Association) parent flyer which states that parents should “Select a shoe that’s rigid in the middle. Does your shoe twist? Your shoe should never twist in the middle.” Curiously, right below that piece, and written in fine print, there is this accurate statement: “Step three does not apply to toddlers shoes. For toddlers, shoes should be as flexible as possible.” I’m left wondering “So at what time does a toddler become a child and we bind their feet up?”

As a parent and physician I believe that the APMA statements could cause harm in a developing child’s foot. A foot builds its own intrinsic support via communication with the ground, building strength and stability through proprioception, and allowing normal force loads to be applied to the areas that nature intended. If you change anything from what is normal in a developing child, then you proceed at your own peril. For example, when I was a child the APMA suggested bracing as a treatment for intoeing (feet that turn inward instead of pointing straight ahead) – fortunately this practice has been banned. The results were extreme tibial rotation and for me, I wound up needing patellar tendon realignments at age 13 due to completely misaligned tibia and patellas (kneecaps)….I missed a large portion of my high school running due to this.

A parent will almost always do what the experts say is best for their children, and the APMA statement that is mentioned above is one that I would challenge. Do I have studies for this….unfortunately, not good ones. Conceptual and evolutionary evidence is the best we have here. For one example, we see many high school runners with hallux valgus — “big toes pointed in.” Hallux valgus is generally caused by ill-fitting shoes with a pointed toebox. Furthermore, most runners, both young and old, cannot stabilize and balance on one foot. To run properly, you must be able to do this.

The next time you are in a park, watch a child run barefoot (see video below). Notice the relaxed movement and foot placement. They lean slightly forward and their legs fall out behind them. They do not strike hard on their heels. Then watch the child with the highly cushioned or supportive shoe. The difference is easy to see.

5yo Barefoot Running in Grass from Runblogger on Vimeo.

So what are the important features to look for in a child’s shoe?

· Ultra-thin soles to allow proper proprioception, neuromuscular activation in the entire kinetic chain, and to complement the body’s natural ability to absorb ground forces.

· Low, flat to the ground profile – shoes should allow all play activity that involves climbing, running, and jumping. Shoes should enhance lateral movement since the foot will not be up on a platform or have a slope from heel to forefoot.

· The materials should be soft and supple, thereby allowing natural foot function. The shoe should bend easily at the toe joints – this is where a foot is designed to bend to recreate the arch on takeoff. See the TR Treads website on Footwear Education for more on this.

· The toebox should be wide enough to allow natural toe spread (Runblogger’s note: check out this video of running toe splay on ground contact in my 5 year old daughter). Foot support is created by the natural arch of the foot with the great toe stabilizing the arch. When the heel is elevated and great toe deviated toward the second toe (a common design flaw in many shoes which come to a point), this stability is compromised. The foot produces the most leverage when the toes are straight and aligned with the metatarsals. A child’s foot is widest at the ends of the toes (as should an adult’s be if they have been in proper shoes or barefoot).

· A single piece midsole/outsole allowing protection on unnatural surfaces (concrete, asphalt) and natural rough surfaces (rock,trail) while allowing proprioception and natural dissipation of ground reaction forces.

· Upper material should be soft, breathable, and washable.

· Get over the notion that shoes need “traction.” In a moving child the more stickiness and grip, the more heat produced in the foot and braking moments on running activity.

· Discourage the use of thick, heavy socks as these interfere with foot proprioception.

· All efforts should be made to use recycled materials in the construction of the shoe.

· Shoes should be a good value and of comparable price to other children’s shoes.

· Design and colors should inspire fun and play.

· And critical is proper fit. For tips see the Two Rivers Treads Shoe Fitting Guide in their expansive Footwear Education section.

· For another great resource on children’s footwear, read this article by Dr. William Rossi DPM.

Why do I care so passionately about this? The most important reason is that I am a parent and want to do what is best for my children and not be influenced by marketing claims or trends. I have been a competitive distance runner my entire life and am personally involved in multiple projects and grants involving both youth and adult physical fitness. If we can teach proper approaches to pain free activity throughout life then the daily walk or run will be sustainable.

I had both of my feet operated on 10 years ago at age 33 for severe arthritis caused by a combination of improper gait mechanics, lots of hard miles as a collegiate and post collegiate runner, and the negative influence of new trends in footwear such as elevated heels and crash pads. The foot instability this created and greater impact in the great toe joint caused this joint to deteriorate. I had the joints fused in both feet and instead of taking the standard doctor’s advice of not running anymore, I chose to relearn how to run. I also got heavily involved in footwear design and function for runners and children. Read my story here on zero-drop.com.

I have watched my own children dramatically change their movement patterns after discarding the heavy, inflexible “Sketchers with lights” and getting them into slip-on Vivo Barefoot kids shoes. They will not put anything else on their feet now when they need to have shoes. We gave away 180 pairs of Vivo Barefoot kids shoes at Freedom’s Run for our kids run thanks to the combined generosity of Two Rivers Treads and Terra Plana. See story….scroll down. Dozens of moms and kids have thanked me for the discovery they have made (Runblogger’s note: as do I – Mark was kind enough to send me a pair of Vivo Barefoot Kids Pally’s for my 5 year old daughter, and she and I both love them).

The beauty of this field is that it is evolving rapidly, we are all discovering new things, there is no one correct answer, and as a field we are doing the needed research. My personal results as a study of one give me the authority to say that you can retrain how you move, and that footwear does have an influence. I began running barefoot at the beach when I was 12. This was the beautiful movement that I can still remember. Thirty-one years later, I finished in the top 10 for runners over age 40 at the 2010 Boston Marathon in a time of 2:34. I’ve run under 2:35 for a marathon 22 of the last 24 years, with misses only during my medical intern year and in 2009 when I ran a 2:37. My training miles are minimal now for these efforts. Knowledge and application of gait principles and use of optimal footwear allows effortless movement to occur. It’s “no pain…thank you” instead of “no pain…no gain”.

It all starts with the children. Adults make their own decisions but children cannot. We need to see further collaboration among many fields – as Dr. George Sheehan so eloquently stated in 1975:

“If athletes were given less care and more thought, the doctors might come up with some original ideas on why illness persists, why injury doesn’t clear up. If more non-physicians – podiatrists and physiotherapists for instance – could be induced to lend their ideas and talents, we might see a completely new approach to sports medicine. If the athlete had to wait longer for surgery, he might have time to recover from his ailments.”

Footwear designers are a critical part of the future of preventive sports medicine, and they need to start thinking more about our children.

Long may you run…

Mark Cucuzzella MD FAAFP

Associate Professor of Family Medicine West Virginia University

Lt Col USAF Reserves – Coach/Captain USAF Marathon Team

Race Director Freedom’s Run www.freedomsrun.org

Owner of Two Rivers Treads- A Center for Natural Running and Walking

A few additional articles and websites of interest:

· Rossi- Proper Children’s Footwear

· Rossi- Fashion shoes….see page 10 and 11 of this interesting article

· Journal of Family Practice review of functional flat feet in children….this is NOT a disease needing treatment.

· Barefoot Parents Website

· Template for proper fitting of child shoe . Size up at least a half centimeter to allow for sock and foot spread

Medical Consultant for ChiRunning, Newton Running, and the US Air Force Marathon

Image via Wikipedia

“Wow, my heart is beating really hard!” Those were the words that made this one of the best days that I have had in quite some time, and they were uttered by a 5 year old boy. Before I elaborate, let’s step back a bit for some background…

A few weeks ago, my wife informed me that I was going to be the coach of my 5 year-old daughter’s soccer team. I think her actual words we “we are going to be coaching her team,” but with an infant in the family who needs Mom for one of his essential needs, I knew what this statement really meant. She told me that the Recreation Department had called and said that they were desperate for coaches, and that as yet our daughter’s team had nobody to fill the role. Given that my wife and I both played soccer in high school, she volunteered, figuring that we could manage despite our lack of any form of coaching experience. I was a bit apprehensive at first, but I knew that it was time for me to give something back, especially since so many other parents have volunteered their time to coach my kids in other sports that they have played.

One of my biggest sources of apprehension was that although I played soccer for many years and know the rules well, I wasn’t sure how to translate this experience to a group of 4-5 year-olds. Thankfully, my son is also playing soccer this Fall in the next higher age group, and I was able to watch his practice earlier in the week in order to get some ideas. The other thing that I have going for me is that although I tend to be quiet and low-key around other adults, being around kids turns me into a total goofball, and I have no problem horsing around and making a fool of myself if it makes a kid laugh. When I’m with a group of kids, I can shut out all of the adults who might be watching, and truly be myself.

This morning was my team’s first practice. My philosophy was simply to get them moving and laughing, with the only real goal being that they have a lot of fun – it turned out to be far easier than I anticipated. The thing I love about kids is that they live to be active – they spent nearly the entire time running, laughing, and having a blast – it’s a lesson that many adults could learn a lot from. Kids are also so free with their emotions. They wear their joy on their faces openly, and when they are upset about something (like when someone has taken their pink ball), you can tell immediately. I had one little boy who was extremely shy, so his dad helped him out, but eventually he started to get a bit more comfortable. It made my day when he was willing to give me a high five at the end of our practice – it’s funny how such a small gesture can mean so much.

We adults expend a lot of effort in attempts to teach and guide our children, but sometimes, if you take the time to stop, watch, and listen, they can teach you lessons as well. The 45 minute practice went by in a flash, and as I gathered them together at the end I asked them if they had fun. All seemed to have had a great time, and it was at that point that one of the boys made the statement that I opened this post with. His heart was beating hard because he had played hard. In that simple statement, he taught me more than I could ever teach myself about my own exercise habits. After beating myself to a pulp last week out on the road and suffering the consequences of pushing too hard, I decided to run home from soccer practice, about 9.5 miles, and to do so at a slow pace so that I could digest the experience of being “Coach Pete.” Even more, I simply wanted to feel the joy of being outside on a beautiful day, and to experience completely the satisfaction that comes with listening to my heart beat hard because I was having fun doing something that I love.