Notes from the POLOLO retailer lecture with Nina Holtkamp
The Digital POLOLO Retailer Lecture on July 19th, 2022 was once again dedicated to the fundamental question of how children can be “well on their way” to healthy feet as the basis for foot health in adulthood. The impulse this time was given by the children’s physiotherapist Nina Holtkamp, herself mother of a 2-year-old daughter.
Children’s feet – a sensitive marvel of anatomy
Nina Holtmann began by explaining that a healthy adult foot has 26 bones, but children’s feet still have 33 bones and some of them are only growing together in the course of ossification. It is important to understand that the child’s foot is therefore still extremely deformable. The forefeet bear about half of the body weight at the beginning of learning to walk – they should be able to develop as freely as possible.
In this context, she pointed out that even socks that are too small can be constricting. If socks are worn, they should not be pointed, but rather semi-circular (she also recommended stretching socks by hand after washing before putting them on). She mentioned arm and leg warmers as a good option to keep the ankles and thus also the feet warm.
(Fig. 1: Arm and leg warmers should be preferred, especially for babies)
Barefoot walking recommended – at temperatures between 15 and 25°C
To allay parents’ fears of catching a cold, she emphasised that walking barefoot and getting sick are only connected to a limited extent: According to this, cold feet are in principle “normal”, because the body specifically keeps the internal organs warm, precisely so that the child remains healthy.
Walking barefoot is recommended if the surface is suitable (such as on meadows or in sand) – according to her, the tolerable temperature range is between 15 and 25°C (at higher temperatures, the ground threatens to become too hot, which is why the child should then seek the shade). To keep the child healthy, the torso should be dressed warmer if necessary. Care should be taken to ensure that nappies, trousers and socks are loose-fitting so as not to impair blood circulation.
The longitudinal and transverse arches of the feet develop when the child stands upright
The longitudinal and transverse arches of the feet only develop when the child is moving upright and the pelvis is in the correct position: So-called “bent and fallen feet” are normal for children learning to walk. She describes heel, club and sickle feet, on the other hand, as congenital deformities.
First walkers have bow legs in the first year of running, then knock-knees until the normal posture and arch are formed in the 5th or 6th year of life.
“First walkers’ shoes” – a possibly misleading term
She addressed the question of when it is recommended to start wearing shoes: “Decorative shoes look cute,” said Nina Holtkamp, but before real shoes are put on, the child should be able to walk freely on its own – without having to hold on – for around four weeks.
The German term for “first walkers’ shoes” („Lauflernsschuhe“) could be misleading and wrongly interpreted as “training shoes”, because you don’t need shoes to support learning to walk – the term should rather be used for little shoes for the age e.g. up to three years (like POLOLO does). She recommended shoes without a firm sole: in the right size and made of good material, with clean workmanship, especially the seams. Strappy shoes are also suitable, as barefoot shoes with a wide toe box for unfolding.
(Fig. 2: Wide cut in the forefoot area (broad toe box)
“Barefoot shoes”
Barefoot shoes are characterised by a flexible, thin sole, wide cut in the forefoot area, zero heel or heel drop. They are also very light and made of flexible, elastic upper material.
Nina Holtkamp made it clear: Heel pads, arch supports and footbeds are unnecessary for a healthy foot, because the foot muscles have to be trained without interference. The body naturally strives to stand up straight – a high heel could therefore influence the posture and also the pelvic floor.
Correct shoe size a decisive criterion for foot health
On the subject of foot measurement, she advised measuring both the length and the breadth of the feet. She considers the so-called Thumb Pressure Method with a margin of about 1.2 cm to be safe only for children aged ten to twelve years – younger children still tend to claw with their toes.
To date, there is no measurement method for determining the instep – it should also be noted that “breadth” is not the same as “width”. It is always important to check whether the length of the inner shoe is really the same as the length of the insole (Franziska Kuntze noted that POLOLO shoes have the right insole for every size). Nina Holtkamp warned that shoes that are too small also cause the toes to claw – there is then a risk of permanent malpositioning (see hallux valgus), but nail bed inflammation is also possible. On the other hand, shoes that are too big cause the toes to slip back and forth because no support is found – when rolling, the toes are compressed by the “twisting” shoes.
(Fig. 3: First Walkers: 12mm margin, 2-3mm gain, measurement every 4 weeks / Stable Walkers: 12mm margin, 4-5mm gain, measurement every 6 weeks)
Handing down of children’s shoes is possible
Finally, Nina Holtkamp discussed the often asked question – in view of the rapid growth of children’s feet – whether children’s shoes can be passed on and used once more without hesitation.
The prerequisites for this are: good condition, no pronounced footbed and removable insole. She even recommended the shoe trade to include second-hand children’s shoes in their sales programme if these conditions are met.
Picture credits: all fig. © Nina Holtmann
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