2025 review finds children's footwear guidelines remain inconsistent

Key facts

A rapid scoping review published in Healthcare (Basel) in July 2025 by researchers from Southeast Technological University in Ireland and Leeds Beckett University examined clinical guidelines for children's footwear across governmental, professional, and clinical sources worldwide. The study found that existing guidance varies substantially and that most current recommendations rest on expert opinion rather than high-quality empirical data. The American Academy of Pediatrics (AAP), through its HealthyChildren.org patient-education platform, provides some of the most widely referenced English-language guidance on the subject for North American families.

• Children between ages 1 and 2.5 years typically outgrow a shoe size every two to three months; after age 3, growth slows to roughly one size change every four to six months.
• Flat feet are normal and expected in toddlers; the plantar arch does not typically become fully visible until around age 6 to 8.
• The 2025 review recommends a toe allowance of 10 to 15 mm beyond the longest toe and sufficient width to allow natural toe splay, with flexible, low-cushion designs favored for children under four.

What it means for parents

The AAP's guidance is direct: in the early months, babies' feet develop best without shoes. Socks are sufficient to keep feet warm indoors. Once children begin walking outdoors, shoes serve a protective purpose, but fit matters more than price or style. The AAP advises checking fit roughly once a month; the top of the child's big toe should sit about one finger-width from the inside edge of the shoe. The AAP also cautions that no shoes at all is preferable to shoes that are too tight.

Measuring the child's foot directly is more reliable than consulting age-based size charts, because brand-to-brand sizing inconsistency is a documented problem in the research literature. A shoe that fit correctly at purchase may be outgrown within weeks during the first three years. The 2025 review advises parents to avoid excessively rigid or heavily cushioned footwear for early walkers, as that construction can limit the natural range of motion the foot needs to develop strength and sensory feedback.

Background and context

Children's feet are composed largely of cartilage in the earliest years, with bones gradually hardening throughout childhood and into the teenage years. This makes the developing foot particularly susceptible to deformation from ill-fitting footwear, and it is the biological basis for why pediatric guidance consistently emphasizes flexibility and room to move over rigid structural support. The AAP has long recommended minimal or no footwear for pre-walking infants, reserving sturdier shoes for outdoor protection once a child is walking independently.

The 2025 scoping review covered guidance from multiple countries and found both areas of consensus and persistent disagreement among clinical bodies. There is broad agreement that shoes should allow 10 to 15 mm of toe room, that overly rigid or heavily cushioned designs are inappropriate for toddlers, and that minimalist or flexible footwear features are preferable for children under four. What differs across sources is specifics: heel-height tolerances, arch-support recommendations, and the criteria used to judge fit. The review's authors concluded that validated, age-specific assessment tools and longer-term outcome studies are needed before truly standardized, evidence-based guidance can be established across clinical settings.

Takeaway

Current pediatric guidance converges on a few practical rules: keep footwear light and flexible, leave room for toes to spread, check fit frequently, and allow barefoot time indoors when the surface is safe. When shoes are worn, socks that fit without bunching or compressing the toe area reduce friction and help maintain correct shoe fit across a full day of activity. For parents monitoring fit carefully through the rapid-growth toddler years, SUNBVE's seamless toe construction removes one common source of toe-area pressure and constriction.