Thursday, May 28, 2009

These Shoes Are Made For Walkin'

The first pair of shoes Matthew ever owned were a size 4 brown pair sneakers from Target after his first birthday. I spent around $15, not wanting to spend much more on a pair of shoes that he would wear for conceivably just a few months, especially since he wasn't walking yet. I quickly learned it was a mistake. He only wore the shoes a couple of times. The shoes were too narrow.

In January, I took him to get his foot measured at the local Brown's Shoe Center. $32 and priceless comfort later, he's in a pair of navy blue New Balance toddler shoes, size 5, extra wide. I should've known better. Wide AND thick feet run in the family, i.e. Bill.
new shoes in January
Flat Foot & Weak Ankle
Any child can have a flat foot but it is more common for kids with Down syndrome due to loose ligaments at the ankle (ligament laxity) and low muscle tone (hypotonia). Ligament laxity causes joint instability. I can imagine that gravity compounds this problem by allowing the ankle to roll inward once a child starts walking. My understanding of flatfeet is that it is only a problem if the condition is severe, where one is walking on the inside of the heel, and it causes foot or leg pain. The feet may be turned outward when walking instead of straight ahead.

At Matthew's physical therapy (PT) session this week, I learned that he is flat-footed. Isn't it too young to say for sure though? I thought the arch of the foot doesn't generally appear until the age of 2 or 3 (or 4?). Apparently, his therapist could already tell. I don't have her experience and trained eye so I trust her observations. 70%-80% of the kids who have Down syndrome that she has worked with required ankle braces (in severe cases) or physician-prescribed plastic foot supports called orthotics. Matthew's ankles weren't rolling inward excessively enough to need orthotics.

There are several ways to test whether an arch is being developed. One that I know of is by creating a footprint of your child’s damp foot on colored paper. Another is to walk (barefoot of course) on sand. Then check whether the foot arch leaves a noticeable gap. We'll do this when Matthew is walking independently. He still walks with two-hand support these days and sometimes with one-hand support very gingerly.

Ways To Strengthen The Ankles & Develop The Arch
Matthew's PT suggested a few exercises/ activities to help develop tendons, muscles, and ligaments. Of course, I don't think these exercises are a guarantee that an arch will develop, but if it will improve muscle tone in the legs and feet, I'm all for it.

  • Walk barefoot on soft uneven surfaces - Sand on the beach is a good example but since we don't live anywhere near a beach, we can create soft uneven surfaces indoors using blankets and pillows or a bed mattress on the floor. Walking barefoot on the grass is also an option for us.
  • Walk with shoes on both level and uneven hard terrains, such as the driveway, gravel road, or rocks.
  • Pushing a weighted toy/ object - This requires him to push off more with his feet to move forward. A laundry basket half filled with clothes is perfect! Matthew enjoys pushing our laundry basket and fusses when I say it's time to stop.
  • Activities where he needs to tiptoe and maintain the position for a few seconds at a time. He's getting tall enough to hold on to the top of our sturdy dining table. Perhaps a good motivator is having a toy on the edge of the table, just slightly out of reach so he has to tiptoe to get it.

Special Shoes?
Custom shoes, arch supports, or braces prevent flat feet from worsening and alleviate pain (only in cases of severe flatfeet) but they don't help develop an arch or correct a problem. Whether Matthew may need orthotics or not remains to be seen. He'll probably need arch supports and hopefully, the off-the-shelf kinds will work just fine. Orthotics aren't as affordable but we won't hesitate to get them if that's what Matthew will need in the future.

New Balance Size 5 extra wideShoes with a flexible sole are recommended for kids learning to walk. And in Matthew's case, we're going to need extra wide shoes as well. I know of two brands that have extra wide sizes: New Balance and Stride Rite. Recently, I stumbled upon Piedro Boots and Ricosta(German brand) in Foot Problems in Children with Down Syndrome at the Down Syndrome Centre website. There are probably other good shoes out there that are available in extra wide with flexible soles but I haven't come across them yet. Has anyone had any luck with other brands and/or styles?

Size 5 Circo sandals and slippersIn the meantime, his New Balance shoes are just fine. Target, my favorite store, hasn't failed me completely. I recently found a pair of Circo brand sandals ($13) with adjustable velcro straps near the toes and the ankle. This helps compensate for his wide, thick feet. I also found a pair of slippers ($7), which are great for when he's playing at his water table.
Circo sandals


Far Above Rubies said...

Ria, Stride rite is also a good shoe store. Thanks for all the tips. Good info. I'm going to ask my therapist about some of the things you mentioned. I know right now Gaby wears a special bandage type material to support her ankles from turning inward and this has helps. I also purchased her shoes from stride rite which give her a lot of support.

Kim Ayres said...

Meg had some special arch supports created for her which she would slip into whichever shoes she was wearing. This was reckoned to help her develop her arch and certainly for 3 years now she's not needed them

Ria said...

Jasmine, how does Gaby do with the ankle supports? I'll ask my PT about that for Matthew too. Thanks for mentioning it. Does she have to wear them even without shoes?

Kim, That's great that Meg doesn't need special arch supports anymore. When did Meg need to start wearing them?

Monica Crumley said...

Cute pic of his feet. I can tell John Michael has weak ankles, which may make walking more difficult. I won't be surprised if he has flat feet either. My 11 yr old son has flat feet and they are literally a pain for him. He has to wear orthotics to play sports. He was never told he could develop an arch, but that the muscles could get stronger.

Michelle said...

He is absolutely adorable!!

Hi, I'm Alysha -But you can call me Lysh said...

Hi Ria, I found your blog while searching the internet on info. for flat feet in children w/ DS. I just wanted to tell you how wonderfully helpful I've found it! We have 2 boys w/ DS. Our bio. son is about to turn 3 and we've just brought home our Ukrainian blessing whose 4...his feet are soooo flat! :)Anyway..thanks for your super blog, for all the time you've put into it and I just wanted to let you know it's well worth it :) You've helped this family out! :) Blessings to you all! Alysha~one blessed mama

Gail said...

Your son is one of the cutest kids I have ever seen. - He could be in commercials! He is absolutely adorable.- My son has flat fat feet and its been difficult finding shoes for him. NB are the way to go.- Your son should be on TV- he is soo soo cute!

Ria said...

Thanks Gail. :-)
And thank you everyone for the comments. :-)