Feet: Best foot forward

Children's growing feet are vulnerable to ill-fitting shoes and infections. Maggie Jones gives tips on taking care of them

At a nursery class in the London borough of Tower Hamlets the teacher was having trouble with one of her pupils. Four-year old Nasreen fidgeted, wouldn't concentrate, burst into tears for what seemed no reason, and was reluctant to move from her desk. Eventually, after several conversations with her mother and other staff, the teacher got to the root of the problem - Nasreen was wearing shoes two sizes too small.

Many foot ailments start in childhood, so good care of the feet is vital.

However, children still come to nursery or school in tight, ill-fitting or inappropriate shoes. Some have trailing laces which they trip over, or shoes that leak or have loose flapping soles - while other pupils, at the opposite end of the scale, have fabulously expensive trainers they show off to all their friends.

Properly fitting shoes are essential for young children because if the foot is cramped or restricted at this age, the soft bones can harden into the wrong shape, causing problems for the rest of the child's life. The 26 tiny bones which make up a child's foot are made of cartilage, and are soft and pliable. It is only as the foot grows that the cartilage turns into bone. Foot growth also tends to be in spurts rather than an even progress.

Babies' feet
Even with a young baby, care of the feet is important. At birth, a paediatrician should check for any obvious deformities such as webbed toes or toes in the wrong position. Overtight babygros can constrict the feet, so dress them in bigger sizes and allow the baby plenty of opportunities to kick and stretch freely.

Most children start walking between the age of one year and 18 months. They should be allowed to take their own time, rather than being hurried. Shoes should not be worn until the child is walking confidently.

When children are at home, parents and carers should let them walk barefoot.

This develops the foot's musculature and strength as well as the grasping movement of the toes. Because socks are slippery, it's best to wear nothing at all on the feet. If floors are cold, there are special slippers or foot coverings which allow children to grip the floor, while at the same time allowing feet the same freedom to move as they would when bare.

Before babies start walking, their feet are flatter than an adult foot, without an arch. The arch develops as the child walks. Most babies are born with feet which point slightly outward. If the feet are turned inward this can cause the child to trip or stumble when learning to walk. However, this condition is often self-correcting.

Common foot problems

Verrucas: A verruca is a wart, caused by a papillovirus, on the sole of the foot. The virus is contagious and seems to thrive in damp conditions, such as swimming pools and bathrooms. It can only be caught by direct contact, by walking on damp surfaces or using infected towels. Cuts and scratches on the foot can increase the risk of infection.

Verrucas start as a tiny pink area speckled with black dots. A child may be completely unaware of them and they usually go away of their own accord, but treatment can be necessary if they become painful when the child walks. They can be treated at home with a gel or ointment which dries out the verruca, and usually has to be applied regularly over several weeks. If this fails, or the verruca is very large or painful, it can be removed under local anaesthetic by freezing or electro-surgery.

Children can still go swimming and take part in other sporting activities where they go barefoot, if they wear verruca socks or other foot coverings to prevent the spread of infection.

Athlete's foot:
Also known as tinea pedis, this is a common fungal infection which is normally found between the toes. It thrives in warm, damp environments, such as sweaty socks and inside trainers. Athlete's foot is itchy and can also cause an unpleasant smell. If untreated, the skin can become red and raw, and flake, peel or crack. The fungus can also infect toenails, making them turn yellowish-brown and become brittle.

Athlete's foot is best prevented by washing feet once a day and drying gently, but thoroughly, between the toes. Socks should be made of natural fibres, preferably cotton, and tights should be changed every day. In the summer, wearing open-toed sandals will help prevent infection; in the winter, choose leather shoes that breathe, and where there is enough room for air to circulate around the toes. Trainers with warm, synthetic linings that make the feet sweat and take a long time to dry out, are unfortunately the best possible environment for the growth of the athlete's foot fungus.

Treatment is by one of the many effective anti-fungal creams and powders on the market, used in conjunction with wearing sensible footwear as above and with keeping the feet clean and dry.

Ingrowing toenails:
This is when the nail grows into the skin, which can cause it to weep or bleed. The most common cause is cutting the nails too short or down at the sides. Toenails should be cut off square and not too short.

Ingrowing toenails can also be caused by too-tight shoes which press down on the nails.

If a foot is inflamed, it helps to bathe it in a warm saline solution of three tablespoonfuls of salt in a basin of warm water. Dry the toes thoroughly and put on a clean plaster. If there is no infection, the edge of the nail can be smoothed down. If the toe becomes infected or the condition persists, the child should see a doctor or a state-registered chiropodist.

Choosing the right shoes

• A child's shoes should always be properly measured and fitted in a shoe shop. For children, the width can be just as important as the length. Remember that shoe sizes can vary between brands. Between the ages of one and three, a child's shoe size should be checked every three months. Between three and six, every four to six months should be enough.
  
  
• Shoes should be fastened with laces, straps and buckles, or Velcro. Velcro is easier for children to use, but at some time children need to learn the all-important skill of tying their shoelaces. Fashion shoes are fine for special occasions but should not be used for everyday wear.

Tips for choosing well-fitting shoes:

• The heel should be flat - no more than 4 cm - and have a broad base.
  
  
• Leather uppers are best because they allow the foot to breathe, avoiding problems of sweaty, smelly feet and fungal infections around the toes.
  
  
• The shoe should fit the natural shape of the wearer's foot, especially around the toes.
  
  
• The toe of the shoe should allow the toes to move freely and not be squashed at the top or sides.
  
  
• There should be 18mm growing room between the end of the longest toe and the end of the shoe.
  
  
• Shoes should fit comfortably around the heel so they do not dig in, slip off or cause blisters by rubbing.
  
  
• Remember that wearing too-small socks and tights can cause similar problems to wearing shoes that are too small.