Connected Paediatrics Newsletter: What If We’ve Got It Backwards?


Hi Reader

Dad Joke: I always knock on the refrigerator door before opening. Just in case there is salad dressing

For the past weeks I have been down the barefoot shoe rabbit hole gearing up for our masterclass coming up this Wednesday. If minimalist footwear something you speak about in clinic, I urge you to hop onto the call. I have some amazing resources for you and the research is just incredible.

But the point of this newsletter is to share my biggest AHA! moment of the process…and like so many of these moments it wasn’t “EUREKA, I’ve got it!”

It was more “you’ve got to be kidding me…how did I not see that”

The moment came from a conversation I had with a parent. But for context, I need to explain that when I am down one of these rabbit holes, it becomes the thing I tend to talk about all the time in clinic…and this is exactly what was happening.

I was in full swing, chatting to a mum about her kid’s footwear, what barefoot shoes are and what brands are out there. When she looked at me and said “But why would I add barefoot shoes”. And that was the moment…her word “add”, stopped me in my tracks.

She saw barefoot shoes as the intervention!

For almost all human evolutionary history, the human foot has interacted with the ground barefoot or through very minimal protection. The thick cushioning, rigid soles, elevated heels, narrow toe boxes and structural support found in many modern shoes are extraordinarily recent additions. Like the last 50-60 years!

Turns out…The conventional shoe is the intervention.

Shoes protect us from temperature, sharp surfaces and the environments we now live in. And, of course, some children may genuinely benefit from additional structure. But this shift in thinking fundamentally changes our starting point

Instead of asking: “Why would we add barefoot shoes?”

Perhaps we need ask: “What are we adding when we put a structured shoe around a developing foot?”

Daniel Lieberman describes this broader idea as an evolutionary mismatch: our bodies evolved under environmental conditions that can be very different from those we now create around them. And the foot is a great example. The medial arch isn't designed to sit at one height like a fixed bridge. During gait it behaves more like a spring.

As the child loads the foot, the foot pronates, the arch lowers and the foot adapts to the ground. Then later in the step the heel rises, the great toe extends, the arch rises and stiffens as the foot becomes a lever for propulsion.

And that’s the point, the foot needs to be able to do both.

This is where barefoot-style shoes become interesting. A wide toe box, thin flexible sole, low heel-to-toe drop and minimal structural support aim to get out of the way enough for the foot to do more of its own work. They are an attempt to provide protection while restoring more of the mechanical environment in which the human foot evolved to function.

Perhaps the question isn't: “Does this child need barefoot shoes?”

Perhaps it is: “How much shoe does this child's foot actually need?”

Chat Soon

Mike

*Reference: Lieberman DE. The Story of the Human Body: Evolution, Health, and Disease. 2013.

Connected Paediatrics

This newsletter is for you if you are a chiropractor who enjoys treating paediatric patients.

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