Why barefoot is (probably) best for a child with Down syndrome.
When Beth was two years old, her early intervention physio recommended that I look into getting my daughter some orthotics. I was a bit uncertain about this approach so I sought a second opinion from her private physio and I was told that Beth should not be looking at orthotics until at least the age of 6. Instead we should try to keep her barefoot as much as possible. We decided to accept the advice of her private physio. This decision was not made without a great deal of thought, I am well aware there are many who believe early intervention is a good thing for a child with Down syndrome. But I do believe that when intervention is suggested, it might be worth seeking a second opinion.
Every child is different and what is right for my child may not be right for yours. However it is worth keeping an open mind and doing some reading.
This article provides some balance to the discussion - Orthosis use in children with Down syndrome Julia Looper, PT, PhD
"As children learn to walk, they are building strength and also learning to balance and interpret feedback coming from the foot and ankle. The neural connections that help toddlers maintain an upright posture are forming in real time as the nervous system receives input. If there is a disruption in this feedback while a child is learning the skill, the skill may not be as adaptable in the future. Using a treatment that provides stability by limiting motion may interrupt the process of motor development by limiting the amount of feedback the nervous system receives".
This article Arch Development in Children: When Are Orthotics Necessary? by Robert S. Striker, DC, MBA explains this further - a summary is below:
"Normal development of the longitudinal foot arch in children is now much better understood. We are not born with arches, but most children begin to show evidence of their eventual adult foot alignment soon after they start walking. The use of corrective shoes and inserts before the age of six is controversial, and has little scientific support. In those children who do not demonstrate normal foot alignment by age six, support for the medial longitudinal arch, including custom-made stabilizing orthotics should be considered."
There was a great article in the Washington Post in February 2016 entitled Why kids should go barefoot more (and probably adults, too) in it the following was mentioned:
"One major benefit of allowing a child to go barefoot is that it strengthens the feet and lower legs, making the body more agile and less prone to injury. It also enhances proprioception, the sense of the relative position of neighboring parts of the body and strength of effort being employed in movement. In other words, going barefoot helps a child develop body awareness. Geary explains that the nerves in our feet are sensitive (the sole of your foot has over 200,000 nerve endings– one of the highest concentrations in the entire body) for this very reason; they make us safer, more careful, and better able to adapt to the ground beneath us. When barefoot, we are better able to climb, cut, pivot, balance, and adjust rapidly when the ground shifts beneath us, as it does when we walk on uneven terrain, or anything besides concrete and pavement.
Dr. Kacie Flegal, who specializes in pediatrics, wrote about optimal brain and nervous system development of babies and toddlers, stating that being barefoot benefits a young child tremendously. “One of the simplest ways to motivate proprioceptive and vestibular development is to let our babies be barefoot as much as possible.” She goes on to say, “Another benefit to keeping babies barefoot is the encouragement of presence of mind and conscious awareness. As the little pads of babies’ feet feel, move, and balance on the surface that they are exploring, the information sent to the brain from tactile, proprioceptive, and vestibular pathways quiet, or inhibit, other extraneous sensory input. This creates focus and awareness of walking and moving through space; babies get more tuned in to their surroundings.”
Another benefit of going barefoot is that it encourages a natural, healthy gait. Adam Sternberg wrote about the topic for New York Magazine in 2008 and cited studies that reveal the damage shoes are doing to our feet; in particular, that we humans had far healthier feet prior to the advent of shoes. Sternberg further reported that despite these findings, people are still not actively encouraged to go barefoot outdoors. Podiatrist Dr. William A. Rossi said it all when he wrote, “It took 4 million years to develop our unique human foot and our consequent distinctive form of gait… in only a few thousand years, and with one carelessly designed instrument, our shoes, we have warped the pure anatomical form of human gait, obstructing its engineering efficiency, afflicting it with strains and stresses and denying it its natural grace of form and ease of movement head to foot.”
And finally, going barefoot is a joy to the senses, especially to young children who experience all the newness of the tactile world around them."
Unfortunately we don't all live in a climate where barefoot at all times is entirely practical. However there are many wonderful brands of barefoot shoes, such as Seekairun, Vivobarefoot, Plae, Bobux and Pediped, amongst many others.
Further reading that you might find useful:
Happy Little Soles - children's foot health.
Why barefoot is best for children - Guardian Article
Pathways to Family Wellness - Barefootin - How keeping little feet in the buff helps babies’ brains and nervous systems develop.
Down Syndrome - A Day to Day Guide - First Shoes - what's best.