Children's feet and footwear

"The foot is the foundation, and if that isn't working correctly, nothing will"


We all know children grow, most of the time, too quickly. Especially their feet.
So how do we target this, and what is the impact if we don't? This blog post is to discuss the impact of rock climbing footwear on children's feet, especially due to the growing market of climbing shoes available for the younger climber.


The first thing to note is the rate of growth in children's feet.


In girls, the foot grows linearly fashion in both width and length from 3 to around 12 years old, and stop growing completely around 14 years old.
In boys, the foot grows in a linear fashion in both width and length from 3 to around 15 years old, and stop growing around 16 years old. 

A child's foot can grow 3 sizes in a year, so it is really important to monitor growth closely.
Children's feet also sweat more, so need more ventilation from their chosen footwear to prevent poor foot hygiene.


A study done into the German Junior National Team found a higher incident of hallux valgus in those members who had spent a relatively longer time active in indoor competition climbing, as well as 74% of the team having feet pressure marks compared to 28% recreational climbers, indicating tight fitting shoes (even though the importance of tight fitting shoes in indoor walls is less important due holds being relatively larger than outdoors, enabling children to wear shoes too long if required).


Another problem with the climbing shoes is the supinated foot position as mentioned in the previous foot and ankle post, which can put a child more at risk of ankle injuries. With children, this puts them more at risk of ankle growth plate, as their growth plates are not fully formed until the age of 17 years old.

Rigid shoes or too much cushioning can limit the development of the connective tissue, muscles and bones, due to these structures requiring the mechanical stimuli to aid the growth. This is especially important as the connective tissue strength and foot flexibility does not stop forming until the age of 15.


Finally, shoes that do not cut into Achilles tendon are recommended, as this can cause shortening of the tendon when the calf is flexed, causing torsion in the plantar fascia leading to a higher arch causing a change in the biomechanics of the foot.


Any children's shoes that are too tight or too small will limit the growth of a child's foot at the key stages of their development. A poorly developed foot will impact a child for the rest of their life.

In summary, a child's climbing shoe needs to be:

• flexible
  
• not cutting into the Achilles tendon
  
• not too much cushioning
  
• not restrictive
  
• needs ventilation
  
• review the sizing often

Coming next, will be the impact of climbing on children's fingers. 

References

Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn). Lochner Verlag: Ebenhausen.

Morrison A 2009 Climbing shoes: is pain insane? BMC

https://www.thebmc.co.uk/climbing-shoes-is-pain-insane


Morrison AB, Schoffl VR 2007. Physiological responses to rock climbing in young climbers. Br J Sports Med 41;852-861.


Walther M, Herold D, Sinderhauf A, Morrison R 2008 Children sport shoes—A systematic review of current literature. Foot and Ankle Surgery 14(4): 180-189

Feet and rock climbing

So you're out climbing, and you pull your climbing shoes out the bag. What size are they? One size smaller than your normal shoes? Maybe two? Well, this post is to discuss the links between feet, footwear and climbing, and other foot injuries/problems.

Do remember, however, that we aren't the only sport or hobby to do this to our feet.....

In a study of 104 rock climbers, Killian et al (1998) found that 81% suffered from an acute or chronic pain or pathology in the foot and/or ankle during or after rock climbing. They suggest that this is in relation to the biomechanics of wearing small rock shoes.

First, as always, I will discuss the anatomy of the foot.

Ligaments

Muscles

Tibialis anterior is also the main dorsiflexor of the ankle.
The gastrocnemius, soleus and plantaris are the plantarflexors of the ankle (there are more muscles involved with platarflexion due to needing to lift the entire body weight, whereas dorsiflexion only consists of lifting the foot.)

Movements of the foot

Feet position within climbing shoes

Arches of the foot

Forces through feet when climbing

Robert Bradshaw-Hilditch and Gary Gibson (yes, THAT Gary Gibson) are both podiatrists who have been conducting some brilliant studies in collaboration with Staffordshire University regarding the forces that are exerted through climbing shoes, and where. 

Their research has found that the forces when front pointing on the hallux (big toe) during climbing causes more force through the metatarsal head, and puts the plantar fascia under tension.

During edging, the forces through the hallux again puts most of the force through the hallux metatarsal head, and stresses the plantar fascia, but also places the foot in a supinated position.

This is just the tip of the iceberg for this research, and Rob and Gary are looking at expanding this much further, as this was only looking at the plantar aspect of the foot in an indoor climbing situation.

But what does it mean?

This means that the feet are more prone to ankle injuries due to the supinated position (see below), and this increase in pressure on the plantar fascia could cause plantar fasciitis (see below as well). The forces being placed through the metatarsal head will change the biomechanics of the foot through the strength of certain muscles, and could cause problems with the arch of the foot (see below) and these problems will surpass what happens on the rock alone. 

So what can be done? 

Read on...

Problems with the feet

Hallux-Abducto Valgus (commonly known as bunions)

Hallux valgus is defined as a 20 degree difference between the axis of the first metatarsal and the axis of the proximal phalanx of the toe, and was noted in both feet in 53% and in one foot in 20% of climbers participating in the sport for more than 5 years and climbing UIAA degree IX. (Peters 2001)

Bunions are not actually caused by wearing tight shoes, but climbing shoes can worsen the deformity. Bunions are most often caused by an inherited faulty mechanical structure of the foot. 

Treatments include wearing bunion pads, orthotics or different footwear and pain killers, or there is the surgical route if the pain is severe. There is no physiotherapy intervention that can help here, therefore prevention is the best cure, by avoiding wearing tight shoes and decreasing the effect of escalating the problem. 

Vessel Compression

65% of sport climbers have found to have tingling and/or pins and needles in their feet, thought to be caused by medial to lateral compression of blood vessels and nerves of foot by smaller climbing shoes. This usually dissapates quite quickly once the shoes are removed. If it doesn't, I'd get it checked out by a professional fairly quickly.

Arch Disorders

Rock climbing has been found to have a beneficial impact on longitudinal arch of the foot (due to strengthening), but does cause an increase in frequency in transverse arch disorders such as tansversal platypodia (flat foot),and an increased frequency of abnormal toe-to-surface adhesion.

Both these problems affect the frontal areas of foot, caused by climbing footwear - changes in the biomechanics of the foot, can cause weakness in muscles controlling 1st metatarsal head extension.

Ankle sprains

Ankle sprains are an injury that don't just affect rock climbers, as you may well realise. They are much more likely to affect other sports persons such as fell runners, however, with climbing, due to the already supinated/inverted (turned inwards) position of the foot means that there is an increased risk of an ankle sprain, normally due to jumping/falling off (this has happened to a few friends, one bouldering in Font, the other trad climbing at Stanage – and both those walks out seemed to take forever!) Hochholzer & Schöffl (2006) found that 24% of climbers have suffered from an ankle sprain.

Ankle sprains are normally caused because the muscles around the ankle don't act quick enough to stop the ankle surpassing it's normal range of movement and the ligaments have to take the brunt of the force.It is normally when the ankle is inverted.

Therefore, the preventative measures you can do to improve the acting of your muscles around the ankle would be to improve the proprioception of the ankle (knowledge of where your body is in space).

To do this, you can use the use of a wobble board or wobble cushion. Stand on the board/cushion on one leg until you can do it for 1 minute. Then close your eyes and try to reach one minute. This can also be used as late stage rehab for an ankle sprain.

 

 Early stage treatment for an ankle sprain would be to follow the management of acute injuries, along with maintaining range of movement in a non-weight bearing manner.

Taping can also be used to support the ankle if injured, such as the technique below, to prevent further inversion:

To read more about ankle sprain and preventative measures, check out Global Therapies recent blog.

Plantar Fasciitis

Plantar fasciitis is heel pain that is caused from an inflammatory process of the connective tissue, the plantar fascia. 
It is commonly caused by long periods of weight bearing and flat feet, as well as poor footwear, poor biomechanics, high arches, and/or running/walking long distance on hard surfaces.
The treatment is normally rest, ice, reduce inflammation and swelling, calf stretches, and finally, correcting what caused the problem in the first place, be that poor footwear, muscular imbalances etc.

Achilles Tendinopathy

This has already been covered by a separate post here.

Ankle fractures

So, an ankle fracture, as you'd have guessed, is when a bone involved in the foot or ankle gets broken. There is no real preventative measure for this, and will normally occur from a fall. Therefore, the approach for a fracture is surgical intervention, or conservative treatment (which normally involves just casting the foot and ankle in plaster and waiting it to heal).
The time frame and approach is entirely dependant on where the fracture etc is, and what other structures are involved.
Post op/plaster, you should be referred to physiotherapy for rehab anyway.
So I'm just going to leave you with a tasty X-ray of an ankle fracture and repair!

Other problems

There are also other non-musculoskeletal problems hat can occur with the foot, such as corns, cuts, toe infections etc which just needs you to look after your feet!

Prevention

Just a few tips to try and prevent foot and ankle problems:

As previously mentioned, use of the wobble board or cushion can help prevent some ankle injuries.

Ensuring you have appropriate sized climbing shoes, or if not possible, remove them at all opportunities, or alternate your shoes for different routes

Parallel training to strengthen the muscles around the foot and ankle

Appropriate sized normal footwear

Foot hygiene

If you are a diabetic, please please please avoid tight shoes!! This is because of change in the sensation in the feet (neuropathy) that can be caused by diabetes, and can cause much more serious foot problems!

To avoid some ankle injuries, have some (decent!) spotters when bouldering, and try to have dynamic belay techniques when roped climbing, to avoid clattering into the rock and giving you time to slow down the motion with your upper legs rather than at the ankle!

However, the main take home message is that with footwear, pain is insane! here possible, make your climbing shoes fit properly, feel comfortable, and look after your feet!

Kids feet and climbing shoes

This will be covered in the next post, just to break up the amount of information I'm giving you! 

References

Peters P 2001 Orthopedic problems in sport climbing. Wilderness and Environmental Medicine, 12; 100-110

Morrison A 2009 Climbing shoes: is pain insane? BMC

Killian RB, Nishimoto GS, Page JC 1998 Foot and ankle injuries related to rock climbing. The role of footwear. J Am Podiatr Med Assoc. 88(8):365-74.

Morrison AB, Schoffl VR 2007. Physiological responses to rock climbing in young climbers. Br J Sports Med 41;852-861.

Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn). Lochner Verlag: Ebenhausen.
Killian RB, et al. 1998. Foot and ankle injuries related to rock climbing. The role of footwear. JAPMA 88(8);265-74.

DrJulian Saunders 2009 Ankles Away

E. Demczuk-Włodarczyk, E. Bieć, T. Sipko, E. Boerner, R. Jasiński 2008
ASSESSMENT OF MORPHOLOGICAL ARCHITECTURE OF FEET IN ROCK-CLIMBERS
Biology of Sport 25(1)