How to choose the right shoes for a child with hallux valgus

How is the foot formed in childhood?

Every baby is born with an inherently flat foot. Physiological flat feet in a baby is not considered a pathology. The place on the foot, which then becomes the longitudinal arch, is filled with fat. This fat pad persists in children up to 3 years of age. From the age of three, muscles and ligaments begin to actively develop, and the height of the arches gradually increases. Then, as the child grows, by the age of 5-6 years, a longitudinal arch appears, and already at this age the orthopedist can say with confidence whether the child has flat feet. At 7-10 years of age, a child’s foot is very similar to an adult’s, but its formation is complete by about 12 years of age. By this age, ossification of the cartilaginous structures of the foot occurs, and until this very moment, doctors recognize any position of the foot as physiological and correctable.

Reasons for the development of deviations

We live in an age of high technology, our children are now deprived of proper physical activity on their feet - they rarely run barefoot, especially on a natural, uneven surface - that is, on grass, sand and pebbles. From an early age, children become attached to the computer and TV and spend very little time outside. Their feet do not know the natural load that would force the ligaments and muscles of the foot to work correctly. Therefore, during the development of a child, there is a risk of developing foot deformities.

According to medical statistics, more than 80% of children from 12 to 16 years old have disorders of the musculoskeletal system (various deformities of the feet, curvature of posture). In older age, this can result in pain in the legs and back, leading to osteochondrosis of the spine and arthrosis in the joints.

Doctors most often diagnose young patients with:

• Flat feet.
• Hallux valgus (X-shaped feet).
• Varus deformity (O-shaped legs).

Deformations in a child are congenital or acquired. Congenital defects are diagnosed immediately after birth and, most likely, the mother will be told about it in the maternity hospital. In other cases, the deformities are acquired; they form during the child’s growth. Doctors have not identified or established a single cause for the development of deviations in the formation of the foot in children.

What shoes should you wear if you have hallux valgus?

Special shoes for hallux valgus are necessary in all cases: with mild deformity to prevent its aggravation, with conservative treatment of pathology, as well as in the postoperative period after surgical correction of hallux valgus, to ensure a smooth rehabilitation period and exclude relapses of the disease.

Orthopedic shoes for hallux valgus should be made of high-quality, breathable and hypoallergenic materials. The upper and insole are usually made of genuine leather. The sole should be up to 3 cm high, flexible, but quite rigid, this is necessary to maintain the tone of the muscular system of the foot.

It is important that the toe of the shoe is wide enough and does not squeeze the toes (for ease of walking, the toe is made slightly raised), and the heel is securely fixed on the heel, for which it is extended with additional “sides” covering the sides of the back of the foot. Ankle support is provided due to the presence of a double-sided ankle boot with Velcro or lacing.

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Modern models of orthopedic shoes for hallux valgus are equipped with special instep supports that perform a shock-absorbing function, as well as Salz rollers (an elevation in the center of the orthopedic insole) that provide support for the forefoot. In some cases, orthopedic shoes are sewn to order, taking into account the patient’s type of activity or the characteristics of the course of the disease.

Factors contributing to the development of pathology:

1. Weakened muscles due to lack of exercise.
2. Congenital weakness (underdevelopment) of the ligaments and tendons of the legs.
3. Excessive load on the ligamentous apparatus of the foot due to excess body weight (obesity) in the child.
4. Against the background of insufficient muscle tone (hypotonia).
5. Deviations in the development of the musculoskeletal system
6. The cause is often wearing uncomfortable or soft shoes that do not support the foot properly.
7. Weakened body, prematurity and frequent acute respiratory infections at an early age.
8. Researchers attach great importance to genetic (hereditary) predisposition, endocrine diseases (hypothyroidism, diabetes) and osteogenesis disorders.

Even in ancient times they said that if a person has sick legs, then he is sick all over. And here, over the centuries, nothing has changed and nothing will change. The work of the spine, all other parts of the musculoskeletal system and almost all internal organs is directly dependent on the foot, its functional and shock-absorbing properties.

What insoles are needed for hallux valgus?

Special insoles can be an addition to orthopedic shoes, but can also be used independently in regular shoes. Timely use of insoles from the first, mildly expressed symptoms of deformation allows you to avoid the progression of pathology, reduce pain and discomfort when walking.

Insoles for the correction of hallux valgus are divided into three groups:

• preventive insoles are used with everyday shoes; they are recommended to be worn in the absence of symptoms, but there is a high probability of developing hallux valgus, for example, with flat feet, weakness of the muscular frame of the foot;
• therapeutic and prophylactic insoles are worn during the initial symptoms of the disease to prevent the progression of the deformity; They provide moderate shock absorption when walking and are elastic. Compatible with regular shoes;
• therapeutic insoles are prescribed to correct existing foot deformities. Rigid, tightly fix the foot. It is recommended to wear them in addition to orthopedic shoes.

If the foot deformity has reached a critical stage, when conservative measures become ineffective, it is eliminated surgically. In this case, wearing orthopedic insoles in the postoperative period will speed up recovery and prevent relapse of the disease.

What are orthopedic, correct, anatomical shoes? What types of orthopedic shoes are there?

Let's understand the terms so that there are no misconceptions.

Orthopedic shoes according to GOST 54407-2011 are shoes whose design is designed taking into account pathological abnormalities in the foot, lower leg or thigh.

Such shoes are called therapeutic, they allow you to correct the deformation and prevent its further development.

Wearing therapeutic shoes is prescribed only by an orthopedic doctor when deformities and pathologies of a child’s foot are identified (clubfoot, valgus deviations, congenital flat feet, cerebral palsy and others).

But it is also generally accepted to use the term “orthopedic shoes” not only for therapeutic, but also for preventive shoes.

Preventive shoes are shoes whose design is designed to prevent pathological abnormalities in the foot.

Preventive shoes are correct, anatomical children's shoes, recommended for healthy children whose feet look the way they should according to their age. Anyone can wear these shoes. This is important to prevent foot deformities.

Thus, two large groups can be distinguished: therapeutic and preventive.

Doctor's answers to common questions

Why are orthopedic shoes for rehabilitation so expensive?

A number of requirements are imposed on postoperative orthopedic shoes: the use of expensive natural materials, hypoallergenic impregnations and developed complex design solutions. The final cost of the model depends not only on the design and quality of the shoes, but also on the manufacturer.

Some domestic models are not inferior in quality to imported ones, while differing in a more favorable price. In addition, you should know that disabled children, disabled people of group 1, as well as low-income and large families can receive shoes for free as part of the state support program.

Can I wear high heels after surgery?

A low-traumatic laser bone removal technique allows you to completely restore the functional activity of the foot and quickly return to an active lifestyle. However, even such a gentle method of eliminating the consequences of hallux valgus does not pass without leaving a trace, and the patient must carefully monitor the condition of the “sick” foot.

Wearing high-heeled shoes is possible after the end of the rehabilitation period, but this is only permissible in rare cases and for a short time. For daily wear, you should choose comfortable orthopedic shoes with a heel height of no more than 4 cm.

Why do orthopedic shoes always put pressure and constrain your feet?

Many patients turn to their podiatrist asking if it is normal for orthopedic shoes to feel a little tight. The Internet and some medical publications indicate that such sensations in the patient can be considered normal, because special shoes must firmly fix and hold the foot.

In fact, any pressure and discomfort while wearing orthopedic shoes indicates that they are not fitted correctly. The fixation of the foot should not be felt physically and should not lead to tissue compression. Incorrect non-professional selection of orthopedic shoes can lead to aggravation of the pathological condition.

How to distinguish orthopedic shoes from fakes?

Today there is a huge number of shoe products on the market that position themselves as orthopedic shoes. In fact, marketers often use this move to attract the attention and trust of customers, but the shoes themselves have nothing to do with medical indications. In order not to make a mistake in your choice and not to overpay for a fake, you should definitely check the relevant certificates before purchasing.

What should orthopedic shoes for children be like?

Let's figure out what details orthopedic children's shoes should contain:

For children's shoes, it is very important that they are made from natural materials. The inside of boots and sandals should use thin, soft leather with a minimum number of seams to avoid chafing the foot. The genuine leather upper will keep your feet from sweating.

Hard ass

A hard back is a must have! According to GOST, it is not allowed to manufacture shoes for toddlers and preschool children with an open heel. The baby's heel must be fixed, without the possibility of falling to one side or another, so that the baby learns to place his foot correctly. Shoes with a soft heel or a completely open heel do not secure the child’s foot; collapse and subluxation are possible. Even a healthy leg may not withstand this load and become deformed. When buying shoes, be sure to check for the presence of such a heel - just press your fingers on the heel with force. The heel of a quality shoe should not sag.

Therapeutic orthopedic shoes have a higher heel compared to preventive ones. A high, rigid ankle boot secures not only the talocalcaneal joint, but also the ankle joint, which, with constant wearing of such shoes, forms the correct development of the articular surfaces and prevents the further development of deformity.

In therapeutic sandals and boots, the back goes into even more rigid boots on the sides - they additionally hold the child’s leg in the correct position. Such shoes may not always be comfortable, but many children can only learn to place their feet correctly thanks to this.

At the same time, shoes with a hard heel are as comfortable as possible, thanks to the presence of a soft edging along the inner surface of the heel, which protects the shin from chafing when the child moves.

Arch support

What is an instep support in children's shoes? An instep support is a special inclusion in the form of a cushion in the insole of a shoe. Located on the inside of the insole, under the longitudinal arch of the foot. Provides maintenance of the spring function of the foot, reducing the load on the spine and joints, promotes the correct formation of the arches of the foot, and turns the foot outward.

Preventative footwear must have an instep support. It should be moderately soft and elastic in order to force the foot to work when walking.

Therapeutic shoes should not have an instep support, or the insole-instep support should be removable to allow the insertion of an individual insole, which was recommended by the doctor, taking into account the specific pathology of the child’s foot.

Sole

Particular attention should be paid to the sole. In order not to disrupt the work of the foot muscles, the sole must have an elastic, elastic structure that is sufficiently flexible in the toe part, this ensures the shock-absorbing function of the child while walking. Non-slip, with a textured surface for greater stability and safety. Thanks to the roll in the toe part, the gait will be formed correctly.

Heel

A small heel is required for children's shoes. In preventive shoes, you can most often see the Thomas orthopedic heel, which is elongated on the inside to support the middle part of the foot to prevent the foot from falling inward.

The Thomas Orthopedic Heel provides:

1. Correct position of the leg.
2. Participates in the formation of gait.
3. Comfort when walking.
4. Correct distribution of the load on the feet.

According to GOST, the heel height in children's shoes should be:

• 5 mm – for toddlers.
• No more than 10 mm – for small children and preschool groups.
• No more than 20 mm – for schoolchildren, boys and girls.
• No more than 30 mm – for a girl’s group.

Sock

The toe part of children's shoes should be wide so that the toes feel free, without squeezing. The compression of your toes by tight shoes causes your arch muscles to weaken. A small child who wears narrow-toed models will have a foot with a flat transverse arch, and at an older age “bumps” or so-called bones will appear at the base of the big toes.

Clasps

Shoes should not dangle on the baby’s feet, so the fasteners should be adjustable (“Velcro” or straps):

• reliably fix the baby’s foot in the correct position and avoid foot deformities;
• easy to adjust precisely to the child’s leg;
• do not allow the foot to move forward in the shoe;
• Velcro can be easily handled by the child himself.

Design features of rehabilitation shoes

Despite the large number of different models of postoperative shoes, they all have common design and tailoring features. When choosing the optimal shoe model, the specialist pays attention to the following elements and characteristics:

• Back - the presence of a hard back helps to securely fix the joints and prevents re-deformation. The height is calculated individually according to the size of the foot. Most often, experts recommend choosing shoes with a heel that is at least 3 cm higher than the heel.
• Anatomical instep support - the task of this shoe element is to fix the arch of the foot and evenly distribute the load. This allows you to avoid injuries and pathological changes in joint structures.
• Laces or Velcro – after surgery, it is advisable to wear shoes that secure the foot tightly. To do this, you should give preference to models that have lacing or Velcro, allowing you to adjust the tightness of the shoe to your foot.
• Metatarsal pads are special silicone pads located in the toe part of the shoe that reduce friction between the toes, protect the toes from deformation and calluses, and prevent the foot from slipping in the shoe.
• Hammer-shaped correctors are special devices that fit onto the fingers and separate them. This reduces the pressure of the crooked toe on the rest of the toes.
• Soft toe - the toe of a rehabilitation shoe should not be narrow, should not squeeze or bind the toes, and the sole in the toe should be relatively soft and flexible.
• Sole and heel - the sole of orthopedic shoes must have a special shape and design, which allows you to properly distribute and reduce the load when walking and running. Heel: people who have undergone surgery to remove a bunion can wear shoes and sandals that have a stable, wide heel, no more than 4 cm in height.
• Material – safety shoes must provide good air permeability. This eliminates the accumulation of moisture in closed shoes and prevents fungal infections of the foot, which are unacceptable in the postoperative period. To do this, rehabilitation shoes must be made from high-quality, preferably natural materials - leather, suede, soft textiles, etc.

The best option for choosing postoperative orthopedic shoes is to have a suitable model made to order. This will allow taking into account the individual characteristics of the anatomy of the foot and its condition after the intervention.