Growing up can be tough enough without having to trip over your own shoes. But an increase in concern over seemingly clumsy children has led the Department of Health to produce Fit To Be Tied, a brochure on the importance of properly fitting a child's shoes.

"Teachers will call us because they are concerned that a child is stumbling or tripping over more than what would be considered normal," explains Kathie Knox, a physiotherapist with the Department of Health. "So we will be called in to have an look and we are often finding that it is simply a matter of children wearing shoes that are far too big for them."

Shoes that are too large not only prohibit proper movement, they can lead to children performing poorly in Physical Education classes, losing their confidence and, of course, there is the obvious risk of injury.

Buying shoes that don't fit is often a case of parents budgeting against constantly growing feet by purchasing shoes that their children can "grow into". Ms Knox recommends having fewer pairs of shoes that fit properly rather than a closet full of misfits.

"Children go through them so quickly that they really don't need the whole gamut of shoes," she advises.

When buying new shoes Fit To Be Tied has several recommendations that will ensure proper support for young feet:

* The correct shoe length should be ? inch to ½ inch from the end of the longest toe.

* Buy shoes at the end of the day because that's when feet are biggest.

* Measure both feet as most people's feet are different. Buy shoes that fit the larger foot and if necessary add an insole or heel grip for the smaller foot.

* Wear socks that are similar to those that will be worn with the shoes.

* Have the child stand up straight with the shoes on and then take the measurement.

The brochure goes on to explain that after a summer in sandals or bare feet school shoes will often feel uncomfortable on children, so they should be given a chance to wear them around the house for a few hours before the school term starts.

However Ms Knox says a good pair of shoes should not need "breaking in". They should fit properly when they are purchased and will not stretch to better fit a child's foot.

Fit To Be Tied also addresses another area where budgeting on shoes can have a detrimental impact on growing young feet — second hand or hand-me-down shoes.

The brochure states that "ideally a shoe should only ever have one owner."

"Every foot is different," explains Ms Knox pointing out that feet vary in length, width and shape. "A shoe conforms to a foot and someone else wearing that shoe will not get the proper support."

This can even lead to structural or alignment problems because of how people move and carry their weight.

Fit To Be Tied, and indeed Ms Knox, emphasise that the impact of ill-fitting shoes cannot be overstated and can have serious implications on a child's development.

Ms Knox says the brochure can be found at Health Department Clinics and that they are planning for further distribution to reach as many parents as possible.

"We hope that the brochures will be distributed and displayed in paediatrician's offices and the Island's shoe stores. We also plan to make them available to school PTA's."

If parents or teachers have concerns they can contact the Department of Health at 278-6427 or 278-6428.

Other tips for healthy young feet:

Lace 'em up: Shoe laces are still the best way to secure a shoe on a foot. They provide the best possible fit, but only when they are tied snugly. Tying shoelaces is also an important developmental milestone for children. If Velcro must be used then be sure that it is also pulled snugly across the foot.

Set them free: Going barefoot whenever possible allows the small muscles of the feet to develop properly and provide the best long-term support. Of course shoes provide important protection so caution should be taken when going barefoot. Shoes can also be instrumental in providing extra or even corrective support where this is deemed necessary.