The APMA are taking some heat for this advice on childrens shoes and its hard to defend

On the website of the American Podiatric Medical Association, is this advice regarding children’s footwear with this graphic provided by the children’s shoe manufacturer, StrideRite.
children's shoes
It is not too dissimilar to the advice that I have seen being widely given for the use of children’s shoes. Where a problem arises is that I periodically come across comments in social media calling out the APMA on what they are advising, asking how robust the advice is and what is the evidence supporting the advice that they are given. I have yet to ever see the APMA respond. Here the most recent couple that I have seen:


The onus on any professional body giving advice or guideline is to ensure that that advice and guidelines are consistent with the latest preponderance of evidence and not underpinned by any commercial bias. What evidence is underpinning the above recommendations? There is none. There is no evidence that a children’s shoe should have a stiff heel. There is no evidence that a children’s shoe should only bend at the toes. There is no evidence that the midsole should be rigid. It is on that basis that the APMA is being called out in social media for this advice.

The cynic could simply respond superficially by saying, do those who are criticizing the APMA have any evidence that the claims are wrong? They don’t. However, the ‘burden of proof’ fallacy is that the burden is on those making claims to support and defend them. So you can’t just twist it around to get the critics to provide evidence of the opposite by deflecting the burden of proof to the negative.

What sort of issues does this raise?

  • What are the responsibility of professional representative organizations to issue advice and guidelines that are evidence-based? (surely the answer to that is obvious!)
  • If you follow some comments in social media, the commercial bias and imperative is often raised. In this case, the graphic on that APMA page that is posted above is provided by a commercial manufacturer. I do not have a problem with commercial sponsorship and support for professional organizations as the money is typically used to fund the goals of the organization, but they should not dictate or influence any policies or guidelines of the organization. In this case, StrideRite has a ‘seal of approval‘ from the APMA which they would have had to pay for. This certainly opens the APMA to criticism in giving non-evidence-based advice on a product that is giving them money. As money is involved, this increases the scrutiny as to the quality and robustness of the advice being given
  • Why is the APMA not responding to the call outs in social media to defend what they are advising?

So what advice should be given for children’s shoes?
I would have thought that the most appropriate logical and intuitive advice on shoes for kids, in the absence of any evidence to intervene, would be to use shoes that have design features that do not interfere with the developing foot. That contradicts with some of the advice being given by the APMA.

This is, of course, assuming that there are no problems present that need intervention. We can have a debate on the evidence for that another day.

Postscript:

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2 thoughts on “The APMA are taking some heat for this advice on childrens shoes and its hard to defend

  1. Howard J Hillstrom, PhD

    From a historical perspective our team looked at several shoe designs ranging from very flexible to very stiff [1,2]. Our measurements of shoe torsional and toe break flexibility were made in a custom jig using an Instron materials testing machine. We also measured children in the learning to walk age group (9 to 24 months) with in-shoe plantar pressures and temporal-distance gait pattern parameters. As a matter of full disclosure this study was sponsored by Stride Rite. We concluded that the child learning to walk was better served with flexible as opposed to stiff walking shoes. We can not comment on children older than 24 months. Of course more research is needed. We did not evaluate the manual approach to testing the shoe with a ‘pinch, bend, and a twist’ but the underlying concept is familiar. Given the nonlinearity, viscoelasticity, and different geometries of insoles, midsoles, and outsoles it is not likely that such tests could be ‘component specific’ within a shoe.

    Best wishes,

    Howard J Hillstrom, PhD

    1. Hillstrom HJ, Buckland MA, Slevin CM, Hafer JF, Root LM, Backus SI,
    Kraszewski AP, Whitney KA, Scher DM, Song J, Furmato J, Choate CS, Scherer PR.
    Effect of shoe flexibility on plantar loading in children learning to walk. J Am
    Podiatr Med Assoc. 2013 Jul-Aug;103(4):297-305. PubMed PMID: 23878382.
    2. Buckland MA, Slevin CM, Hafer JF, Choate C, Kraszewski AP; Hospital for
    Special Surgery Pediatric Research Team. The effect of torsional shoe
    flexibility on gait and stability in children learning to walk. Pediatr Phys
    Ther. 2014 Winter;26(4):411-7. doi: 10.1097/PEP.0000000000000084. PubMed PMID:
    25251796.

    Reply

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