The Importance of Biomechanically Appropriate Pediatric Footwear in Children

Background: The selection of appropriate footwear during childhood is crucial for healthy foot development, gait acquisition, and long-term musculoskeletal health. Despite the wide variety of children’s footwear available, there is no clear consensus on the optimal characteristics of footwear that supports healthy foot biomechanics during development. Biomechanically appropriate pediatric footwear (PF) is defined as footwear designed to accommodate the child’s foot morphology during growth, allow natural movement, and provide appropriate support and stability without altering physiological gait patterns. Methods: A systematic review was conducted and reported in accordance with the PRISMA 2020 Statement and registered in PROSPERO (CRD42022337587). The search included studies published between 2010 and 2025 in MEDLINE (via PubMed), Scopus, Cochrane Library, and Dialnet, focusing on preschool (2–6 years) and school-age (6–12 years) children. Younger children (<2 years) and adolescents (>12 years) were excluded due to gait and footwear data and developmental differences that could confound comparisons. Studies evaluating the effects of footwear on foot health, gait mechanics, balance, and functional outcomes were included. Results: A total of 1276 studies were identified, with 25 meeting the inclusion criteria. Findings indicate that certain footwear characteristics have been associated with foot discomfort, altered gait patterns, and variations in foot posture. While some studies suggest that barefoot walking or minimalist footwear improves postural control and reduces lower-limb impact forces during gait, others report that footwear does not significantly alter gait mechanics in young children. Variability in study designs and methodologies limits the ability to establish definitive recommendations. Conclusions: Although current evidence remains inconclusive due to methodological heterogeneity, variations in study populations, and inconsistent footwear classifications, biomechanically appropriate pediatric footwear and moderately minimalist footwear appear to be associated with more favorable functional outcomes in several studies. Further standardized longitudinal and age-specific studies with clearly defined footwear characteristics are needed to determine the long-term effects of pediatric footwear on foot biomechanics and musculoskeletal development.