Where should a school shoe provide flexibility and support for the asymptomatic 6-to 10-year-olds and on what information is this based? A Delphi yielded consensus

Background: There is a paucity of evidence regarding the design of children's footwear in relation to musculoskeletal structure. Objectives: The aim was to gain consensus regarding where flexibility and support should be given on a school shoe for the 6- to 10-year-olds. Study design: Delphi Questionnaire. Methods: Recruitment of 10 Allied Health Professionals yielded a consensus group. Those recruited had dedicated experience in paediatrics and foot health. Rounds of questions were delivered to investigate the basis of the opinions made by the group on the location of support and flexibility in a school shoe for the age range identified. Results: Six themes were generated. Four themes gained 100% consensus regarding footwear allowing normal foot movement, footwear allowing normal forefoot function, footwear providing a stable base and the foot being secure in the shoe. Fleiss' kappa calculations revealed poor agreement' for the remaining two themes regarding clinical intervention and the purpose of footwear design in the midfoot in both the upper and sole of the shoe. Conclusion: The qualitative data generated through discussion have highlighted areas where more understanding and research are required, particularly in understanding how, in the long term, shoe design can affect the developing foot. Clinical relevance Children's footwear advice is often delivered from experience and personal belief. This article questions current understanding and opinion from clinical experts in the field of paediatric footwear and highlights that there is a lack of knowledge and confidence into the effects of children's footwear. There is a strong requirement for further empirical research to be completed on children's footwear to allow clinicians to formulate relevant and appropriate footwear advice.