Diseases That Can Be Prevented in Children by Wearing Footwear: What Parents Need to Know
As a pediatrician, I have seen many cases where simple preventive measures could have protected children from painful and sometimes debilitating infections. One of the most effective yet often overlooked prevention strategies is ensuring children wear proper footwear. This comprehensive guide will help you understand which diseases can be prevented by this simple practice and how you can protect your child.
Why Footwear Matters for Children's Health
Many parents may not realize that bare feet expose children to various parasites, bacteria, and fungi living in soil. Children are particularly vulnerable because they play outdoors frequently, have developing immune systems, and their natural curiosity leads them to explore environments where these organisms thrive.
According to research published in the National Center for Biotechnology Information, wearing shoes provides a physical barrier that prevents disease-causing organisms from entering the body through the feet. This simple protective measure can prevent millions of infections worldwide, especially in areas with warm climates and poor sanitation.
Major Diseases Prevented by Wearing Shoes
1. Soil-Transmitted Helminths (Intestinal Worms)
What is it? Soil-transmitted helminths include roundworms (Ascaris), whipworms (Trichuris), and hookworms that live in contaminated soil. These parasites can enter the body through bare feet or contaminated hands and establish infections in the intestines.
- Abdominal pain and bloating
- Diarrhea or constipation
- Loss of appetite and weight loss
- Fatigue and weakness
- Visible worms in stool (in some cases)
- Impaired growth and development
- Malnutrition and vitamin deficiencies
How common is it? The World Health Organization estimates that over 1.5 billion people worldwide are infected with soil-transmitted helminths, with children bearing the highest burden of disease.
- Those living in tropical and subtropical climates
- Children in areas with inadequate sanitation
- Kids who play in soil contaminated with human waste
- Those walking barefoot in endemic areas
- Children with poor hand hygiene practices
2. Hookworm Infection
What is it? Hookworm infection is caused by parasitic worms (Ancylostoma duodenale and Necator americanus) that live in contaminated soil. When children walk barefoot, these tiny larvae penetrate through the skin of their feet and travel through the body to reach the intestines, where they attach and feed on blood.
- Itchy rash on feet where larvae entered (ground itch)
- Coughing and wheezing as larvae move through lungs
- Abdominal pain and loss of appetite
- Diarrhea and weight loss
- Fatigue and weakness due to anemia
- Pale skin and gums
- In severe cases: delayed physical and mental development
- Difficulty concentrating in school
How common is it? According to the Centers for Disease Control and Prevention, hundreds of millions of people worldwide are infected with hookworm, with children being particularly susceptible due to their play habits and developing immune systems.
- Those living in tropical and subtropical regions
- Children in areas with poor sanitation
- Kids who play in soil where human or animal waste may be present
- Those walking barefoot in contaminated areas
- Children in agricultural communities
3. Tetanus (Lockjaw)
What is it? Tetanus is a serious bacterial infection caused by Clostridium tetani, which lives in soil, dust, and animal waste. The bacteria enter the body through cuts, puncture wounds, or breaks in the skin—all common when children walk barefoot. Tetanus affects the nervous system and causes painful muscle contractions.
- Jaw cramping or difficulty opening mouth (lockjaw)
- Painful muscle stiffness throughout the body
- Difficulty swallowing
- Painful muscle spasms, often triggered by light, sound, or touch
- Fever and sweating
- High blood pressure and rapid heart rate
- In severe cases: breathing difficulties and life-threatening complications
Why it's serious: Tetanus can be fatal even with treatment. The mortality rate is 10-20% overall and higher in young children and the elderly. However, it is entirely preventable through vaccination and proper wound care, including wearing protective footwear.
- Those with incomplete tetanus vaccination
- Children who frequently get cuts and scrapes outdoors
- Kids playing in areas with animal waste
- Those in rural or agricultural settings
- Children with deep puncture wounds from stepping on nails or sharp objects
4. Foot Injuries and Secondary Infections
What is it? Bare feet are vulnerable to cuts from glass, sharp stones, thorns, nails, and other debris. These wounds can become infected with various bacteria including Staphylococcus, Streptococcus, and other organisms, leading to serious complications like cellulitis, abscesses, or even sepsis.
- Cuts, lacerations, or puncture wounds on feet
- Redness, warmth, and swelling around wounds
- Pus or discharge from injured areas
- Increasing pain rather than improvement
- Red streaks extending from the wound
- Fever and chills
- Difficulty walking or bearing weight
- Swollen lymph nodes in the groin
Common causes: Sharp objects hidden in grass, broken glass on sidewalks, thorns and splinters, rusty nails in wooden structures, sharp rocks and shells on beaches, and hot surfaces that can cause burns.
- Those playing in construction areas or vacant lots
- Children with diabetes (slower wound healing)
- Kids with compromised immune systems
- Those playing on beaches or in parks without inspection
- Children in urban areas with broken glass and debris
5. Fungal Infections (Athlete's Foot and Others)
What is it? Athlete's foot (tinea pedis) and other fungal infections occur when fungi grow on the skin of the feet. Walking barefoot in contaminated areas like locker rooms, public showers, pools, and damp soil increases exposure. These infections are highly contagious and uncomfortable.
- Itching, stinging, and burning between toes or on soles
- Cracked, peeling, or scaling skin
- Redness and inflammation
- Blisters or ulcers in severe cases
- Dry, scaly skin on the sides or bottom of feet
- Foul odor from feet
- Thick, discolored, or crumbling toenails (if infection spreads)
- Pain when walking or wearing shoes
Why prevention matters: Fungal infections can spread to other parts of the body (like hands or groin) and to other people. They often recur and can become chronic if not properly treated. Children may spread infections to family members through shared floors and bathing areas.
- Those walking barefoot in public showers or pools
- Children with sweaty feet
- Kids who share shoes or socks with others
- Those in humid, warm climates
- Children with weakened immune systems
- Athletes and active children with constant foot moisture
6. Snake and Insect Bites
What is it? Bare feet are vulnerable to bites and stings from snakes, spiders, scorpions, bees, wasps, and other venomous creatures. Footwear provides a crucial barrier between feet and these potentially dangerous animals that may be hiding in grass, under rocks, or in soil.
- Puncture marks or visible bite/sting site
- Immediate sharp pain or burning sensation
- Swelling, redness, and warmth at the site
- Bleeding or oozing from the wound
- Nausea, vomiting, or dizziness
- Difficulty breathing or swallowing (in severe reactions)
- Muscle cramps or weakness
- Changes in heart rate or blood pressure
- Allergic reactions including hives or facial swelling
Emergency situations: Snake bites, particularly from venomous species, require immediate medical attention. Even non-venomous bites can cause serious infections. Allergic reactions to insect stings can cause life-threatening anaphylaxis.
- Those playing in tall grass, brush, or wooded areas
- Children in regions with venomous snakes or spiders
- Kids hiking or camping without proper footwear
- Those playing near rock piles, woodpiles, or debris
- Children with known allergies to insect stings
- Those in agricultural or rural settings
7. Tungiasis (Sand Flea Disease)
What is it? Tungiasis occurs when female sand fleas (Tunga penetrans) burrow into the skin to lay eggs. These tiny parasites are found in sandy, dusty environments and are too small to see easily. Boys aged 5 to 14 are at particularly high risk.
- White circular lesions with a black dot in the center (usually on feet)
- Intense itching that disturbs sleep and concentration
- Pain when walking or pressure on affected area
- Swelling and inflammation around the lesion
- Difficulty attending school due to discomfort
- Secondary bacterial infections
- Multiple lesions in severe infestations
- In severe cases: nail deformities, open sores, and tissue damage
The impact on children: Research from the World Health Organization shows that tungiasis significantly affects children's education and quality of life. Children with this condition often have impaired concentration, lower school exam scores, and social stigma.
- Tropical and subtropical regions of Africa, Caribbean, and South America
- Sandy beaches and dry soil areas
- Communities with poor housing conditions
- Areas where domestic animals (pigs, dogs) roam freely
- Rural villages and urban informal settlements
- Beaches frequented by stray animals
8. Podoconiosis (Non-Filarial Elephantiasis)
What is it? Podoconiosis is a disease that causes severe swelling of the lower legs and feet. It develops when genetically susceptible children are exposed to irritant mineral particles found in red clay soils from volcanic areas. The World Health Organization recognizes this as a neglected tropical disease that affects millions worldwide.
- Itching and tingling sensation in the forefoot
- Burning sensation in feet and lower legs
- Widening of the forefoot
- Soft swelling that progresses over time
- Formation of hard skin nodules (mossy appearance)
- Painful acute episodes with fever
- Progressive leg swelling that can lead to disability
- Skin changes including thickening and warty growths
Why it matters: Podoconiosis typically begins in childhood with first symptoms appearing in the first or second decade of life. Once established, it causes lifelong disability and social stigma. However, it is completely preventable through consistent shoe wearing from early childhood.
- Highland areas above 1,000-1,500 meters elevation
- Regions with red volcanic clay soil (particularly in Ethiopia, Cameroon, Tanzania, Uganda)
- Parts of Central and South America and South East Asia
- Children with family history of the condition (genetic susceptibility)
- Rural farming communities with prolonged soil exposure
- Areas where barefoot farming is common
9. Cutaneous Larva Migrans (Creeping Eruption)
What is it? This skin condition is caused by hookworm larvae from dogs and cats (Ancylostoma braziliense and Ancylostoma caninum). When children walk barefoot on contaminated soil or sand, these larvae penetrate the skin and create visible, winding tracks as they migrate underneath the skin surface.
- Raised, red, winding tracks on the skin (often on feet)
- Intense itching that can be unbearable, especially at night
- Tracks advance a few millimeters to centimeters each day
- Most commonly affects feet, but can occur on hands, buttocks, or any skin touching contaminated surfaces
- Tracks may look like red, serpentine lines or trails under the skin
- Scratching can lead to secondary bacterial infections
- Blisters may form along the tracks
Common scenarios: Children often get this infection while playing in sandboxes used by cats or dogs, on beaches where pets defecate, or in backyards where pets roam. While the infection typically resolves on its own after several weeks to months, the intense itching causes significant discomfort and can interfere with sleep and daily activities.
- Playing in sandboxes frequented by cats or dogs
- Walking barefoot on beaches where animals defecate
- Contact with soil in areas where pets have access
- Tropical vacations where children play on contaminated beaches
- Playing in yards or parks without shoes
- Areas with large populations of stray dogs and cats
10. Hand-Foot-Mouth Disease Transmission
What is it? While hand-foot-mouth disease (HFMD) is primarily spread through direct contact, walking barefoot on contaminated surfaces can increase exposure risk. The viruses (usually coxsackievirus or enterovirus) can survive on floors and ground surfaces, particularly in areas where infected individuals have been, such as playgrounds, daycare centers, and public spaces.
- Fever, often the first symptom
- Painful sores in the mouth, throat, tongue, and gums
- Red spots or small blisters on palms of hands
- Red spots or small blisters on soles of feet
- Rash on buttocks or genital area in some cases
- Loss of appetite
- Sore throat and difficulty swallowing
- Irritability in young children
- General feeling of being unwell
Prevention connection: While footwear alone doesn't prevent HFMD (since it's primarily transmitted through respiratory droplets and direct contact), wearing shoes reduces one potential exposure route by preventing direct skin contact with contaminated surfaces where viral particles may be present.
- Children under 5 years of age (most common)
- Those in daycare or preschool settings
- Children with siblings who have the infection
- Kids in crowded public spaces during outbreaks
- Those with weakened immune systems
- Children in areas with poor hygiene practices
11. Other Skin Infections and Conditions
What are they? Numerous other conditions can affect children's feet when exposed to contaminated environments without protective footwear. These include bacterial skin infections (impetigo, erysipelas), plantar warts caused by human papillomavirus (HPV), contact dermatitis from irritants or allergens in soil, and thermal injuries from hot surfaces.
- Impetigo: Honey-colored crusted sores, usually around mouth, nose, or on exposed skin
- Plantar warts: Small, grainy growths on soles of feet, often painful when walking
- Contact dermatitis: Red, itchy rash from contact with irritants or allergens
- Thermal burns: Red, painful skin from hot pavement, sand, or metal surfaces
- Cellulitis: Red, swollen, warm, tender skin that spreads rapidly
- Myiasis: Infestation by fly larvae in open wounds
The cumulative effect: While any single condition may seem minor, the cumulative risk of multiple infections and injuries from barefoot exposure creates a significant health burden. Children with repeated infections may face complications, scarring, and chronic health issues.
- Walking on hot surfaces (pavement, sand, metal) during summer
- Contact with contaminated public surfaces (pools, gyms, bathrooms)
- Exposure to allergens and irritants in soil and vegetation
- Pre-existing skin conditions (eczema, psoriasis)
- Poor overall hygiene or sanitation
- Compromised immune function
Practical Prevention Tips for Parents
1. Make Footwear a Habit: Encourage children to wear closed shoes whenever they go outside. Make it a non-negotiable rule, just like wearing a seatbelt in the car.
2. Choose the Right Footwear: Select well-fitting, closed-toe shoes that cover the entire foot. Sandals and flip-flops do not provide adequate protection against soil-transmitted infections.
3. Daily Foot Hygiene: Establish a routine of washing your child's feet with soap and water every evening. Inspect their feet for any cuts, rashes, or unusual marks.
4. Maintain Clean Environments: Keep floors clean and covered, especially in areas with dirt or clay soil. Use mats and coverings indoors.
5. Pet Health Matters: Regularly deworm your family pets and prevent them from defecating in play areas. Clean up animal waste promptly.
6. Educate Your Children: Teach children why wearing shoes is important. Help them understand that tiny organisms in soil can make them sick, even if they cannot see them.
7. Lead by Example: Children learn by watching. Always wear shoes outdoors yourself and make it a family practice.
8. Travel Precautions: When traveling to tropical or rural areas, ensure your children wear proper footwear at all times, especially on beaches and in sandy areas.
When to See a Doctor
Seek medical attention if your child experiences:
- Persistent itching on feet or legs
- Visible tracks or trails on the skin
- Unexplained fatigue or paleness
- Progressive swelling of feet or legs
- White lesions with black dots on feet
- Difficulty walking or playing due to foot discomfort
- Any unusual skin changes after walking barefoot
- Symptoms of anemia (tiredness, pale skin, shortness of breath)
Early diagnosis and treatment can prevent complications and long-term health problems. Do not wait for symptoms to worsen.
Frequently Asked Questions
Q: At what age should children start wearing shoes outdoors?
Children should wear shoes as soon as they begin walking outdoors. While babies who are not yet walking do not need shoes, once a child starts exploring outside, proper footwear becomes essential for protection against soil-transmitted diseases. Starting this habit early makes it easier to maintain throughout childhood.
Q: Are sandals and flip-flops safe enough, or do children need closed shoes?
Closed shoes provide the best protection against soil-transmitted infections. Sandals and flip-flops leave parts of the feet exposed, allowing parasites and larvae to penetrate the skin. For maximum safety, especially in areas with known disease presence, closed-toe shoes that cover the entire foot are recommended.
Q: Can these diseases occur in developed countries?
Yes, while more common in tropical and subtropical regions with poor sanitation, these diseases can occur anywhere. Cutaneous larva migrans has been reported in coastal and southeastern regions of developed countries. Travelers returning from endemic areas may also bring infections back. Proper hygiene and footwear use are important regardless of location.
Q: How often should I check my child's feet?
Make it a daily habit to inspect your child's feet during bath time. Look for any redness, swelling, unusual marks, tracks, or lesions. Early detection of symptoms allows for prompt treatment and prevents complications.
Q: Is it safe for children to play barefoot indoors?
Playing barefoot indoors is generally safe if floors are clean and free from soil or contaminants. However, in areas where soil-transmitted diseases are common, or if your home has dirt or clay floors, it is better to use indoor footwear and floor coverings for added protection.
Q: Can my child get these infections from our backyard?
Yes, your backyard can harbor these organisms if pets defecate there or if the soil conditions are suitable. This is why wearing shoes even in your own yard is important. Regular pet deworming and prompt cleanup of animal waste can reduce risk.
Q: What if my child refuses to wear shoes?
Make wearing shoes fun and comfortable. Let your child choose shoes they like, ensure proper fit to avoid discomfort, and explain in age-appropriate terms why shoes are important. Consistency is key. Establish it as a rule and praise compliance. Most children adapt quickly when the expectation is clear.
Q: Are water shoes adequate protection at the beach?
Water shoes provide better protection than bare feet but may not offer complete coverage. Look for water shoes that fully enclose the foot. Remember that sand fleas and parasites can be present on beaches, so closed footwear is ideal even in wet environments.
The Global Perspective
Research published in medical journals shows that footwear-preventable diseases affect millions of children worldwide, with the highest burden in impoverished communities lacking access to adequate shoes and health services. These conditions trap families in cycles of poverty through lost productivity, medical costs, and educational setbacks.
Organizations worldwide are working to provide shoes to children in endemic areas, recognizing that this simple intervention can transform lives. As parents, whether in endemic regions or not, we have the power to protect our children through this basic preventive measure.
The economic and social impact extends beyond individual health. Children affected by these diseases often miss school, face social stigma, and may experience developmental delays that affect their future opportunities. Prevention through footwear is not just about avoiding infection but about giving children the chance to thrive.
Building Healthy Habits
Teaching children about foot health and disease prevention builds lifelong habits that will protect them into adulthood. Make conversations about hygiene and safety positive rather than fear-based. Help children understand that taking care of their bodies is an important part of growing up.
Create routines around foot care that become second nature, like brushing teeth or washing hands. When prevention becomes habit, protection becomes automatic.