Every September our Belfast clinics see the same two things: children whose new school shoes are the wrong size or the wrong shape, and teenagers with a red, swollen big toe that started as a slightly tight trainer in August. Both are avoidable. This is the checklist our podiatrists give parents, and it takes about ten minutes in the shop to get right.
Why it matters more for children than for adults
A child's foot is still mostly cartilage and is growing quickly. Under about age four, feet can go up two sizes in a year; from then until the teenage growth spurt, roughly a size a year is typical, in bursts rather than evenly. A shoe that was right in August can be tight by October. Bones that are still forming will adapt to a shoe that squeezes them, which is why the Royal College of Podiatry's footwear advice for children is stricter than for adults: fit first, style second.
The ten-minute shop checklist
- Measure both feet, standing, in school socks. Fit to the larger foot. Most children have one foot slightly bigger than the other.
- Growing room: about a thumb's width (roughly 1 cm) at the toe. Less and the toes hit the end; much more and the foot slides, which is when blisters, clawing toes and pressure on the big toenail begin.
- Width and depth matter as much as length. The widest part of the foot should sit in the widest part of the shoe, and the toes should be able to wiggle freely. Look for a rounded or square toe box, not a pointed one.
- A proper fastening. Laces, straps or buckles that hold the heel back into the shoe. Slip-ons, backless shoes and thin ballet pumps make the toes grip to keep the shoe on, which tires the foot and pushes the nails into the shoe.
- A firm heel counter. Squeeze the back of the shoe: it should not collapse. The heel should not lift or slip when your child walks.
- A sole that bends where the foot bends. Flex the shoe: it should bend at the ball of the foot, not in the middle. Stiff, flat fashion soles are hard on growing feet.
- Breathable uppers. Leather or a good textile. Sweaty, sealed shoes are the friend of athlete's foot and softened nails.
- Shop in the afternoon. Feet swell through the day. A shoe that fits at 9am can pinch by 3pm.
- Buy to fit now, not to "grow into". Beyond that thumb's width of room, an oversized shoe is as much of a problem as a small one.
- Hand-me-downs: think twice. A worn shoe has moulded to the previous owner's foot. Fine for a spare, poor as the everyday pair.
PE trainers and sport
PE kit is where the trouble usually starts. Trainers get bought a size up "to last", worn without socks, or kept long past the point where the sole has gone. Give sport its own pair, with a fastening, and check them as often as the school shoes. Football and GAA boots deserve the same rules: a narrow, tapered boot on a wide teenage foot is a classic route to an ingrown toenail. If your child has heel pain during or after sport, read our guide to Sever's disease, the most common cause in 8 to 14 year olds.
Socks: the overlooked culprit
Tight or too-small socks press the toes together for the whole school day, and children rarely mention it. Buy socks by shoe size, not age, and retire the pairs that have shrunk. Seam-free or flat-toe socks are worth it for children who complain of rubbing.
The signs a shoe is wrong (in a child who won't tell you)
- Red marks or dents on the toes or heel when the shoes come off
- Toes that look curled or bunched, or a big toenail that is thickened, bruised or lifting
- Blisters, hard skin or a corn on a child's foot (children should not need corns treated)
- Complaints of tired legs, tripping more than usual, or reluctance to walk to school
Check the fit every two to three months for primary-age children and at least once a term for older ones. Growth happens in bursts, so a quick look at the toe room during a growth spurt saves a lot of trouble.
The one habit that prevents ingrown toenails: cut nails straight across
Tight shoes, sport and a growth spurt are three of the four ingredients for an ingrown toenail. The fourth is nail cutting. Cut toenails straight across, not too short, and never dig down the sides or round the corners. Use a file to soften a sharp corner rather than cutting into it. Teenagers who pick or tear their nails, or who cut them very short before sport, are the group we see most often.
Early signs of an ingrown toenail are pain along one edge of the nail, redness and swelling of the skin beside it, and sometimes weeping or pus. At that stage please do not soak-and-cut at home; when the skin is infected, home cutting usually makes it worse. A podiatrist can trim and pack the nail edge in one visit, and that is often all a first episode needs.
If the nail keeps coming back, or the toe is infected, the reliable fix is nail surgery: the offending edge is removed under local anaesthetic and phenol is applied so that edge is designed not to grow back, with a 95%+ success rate. It is a 30 to 45 minute walk in, walk out procedure, and we do it for children and teenagers with a parent in the room. Full details, prices and what happens on the day are on our ingrown toenail removal in Belfast page: £365 all-inclusive, or a £58 assessment first which comes off the surgery price if you go ahead. Same-week appointments at Lisburn Road and Ormeau Road, no GP referral needed.
Worried about your child's feet or a sore toenail?
Book a £58 assessment (30 minutes) or, for foot, heel or knee pain in an active child, a Children's Foot Injury Assessment. Call 028 9013 9185. Two Belfast clinics, 700+ five-star reviews.
A quick word on flat feet
Most young children have flat-looking feet and grow out of it; an arch usually appears between about 4 and 8. Flat feet on their own are not a reason to buy special shoes or insoles. Pain, one foot noticeably different from the other, frequent tripping, or a child who avoids activity are the reasons to have them looked at. Our guide to children's foot problems covers the common ones.
