Babies with Epidermolysis Bullosa (EB) require soft, lightweight, and breathable shoes with seamless interiors to minimize friction and prevent blistering. Ideal shoes should be flexible, well-ventilated (leather or mesh), have wide openings for bandaged feet, and feature soft Velcro or adjustable straps.Top Recommended Shoe Features & Types:Seamless/Soft Interior: Crucial to prevent skin damage.Wide/Adjustable: Shoes like Billy Footwear (zip-on) or Wide New Balance sneakers accommodate bandages easily.Soft Soles/Lightweight: Robeez are popular for encouraging natural foot movement, while Crocs are often used for their lightweight, roomy design.Breathability: Leather or mesh materials prevent excessive sweating, which increases blistering risk.Arch Support & Cushioning: Adidas Climacool or Nike shoes with cushioning help absorb impact.Key Considerations for EB Footwear:Bandage Room: Shoes often need to be a size or two larger to fit comfortably over dressings.Fasteners: Use Velcro or soft laces rather than buckles or stiff fasteners.Maintenance: Use Vaseline or specialized oil on the inside of leather shoes to reduce friction.For babies with EB, it is essential to check for pressure points regularly, as they may not be able to feel if a shoe is uncomfortable.

Footwear advice for parents caring for a child living
with epidermolysis bullosa (EB)

B is a group of rare genetic disorders characterised by fragility of the skin and
mucous membranes and mechanically induced blistering. EB comprises four
main types - EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and
Kindler EB (KEB), with more than 30 subtypes. EB is clinically heterogeneous
including a broad spectrum of severity.

PRE-WALKING STAGE OF YOUR BABY
When your child is learning to walk, it is advisable to allow your child to walk barefoot as much as
possible. This encourages natural development of the foot and aids the development of walking by
amplifying the feeling of different sensations and textures through the soles of the feet; often this is
referred to as the motor skills development stage.
These different sensations and textures through the soles of the feet can be reduced if
footwear is worn too early.
The benefit of barefoot walking does need to be considered alongside blister development. During
this development time minor or even major accidents can occur. With an EB child, an accident often
involves the development of blisters followed by pain (we will cover this later in the booklet). As
parents, understandably you want to protect your children against all accidents and pain, as you do
not want to see them suffer. However, it is also important for your child to find out for him or herself
what their physical abilities are and learn his or her own boundaries.
࢝ Allow your child to walk barefoot.
࢝ Your child can wear just socks indoors.
࢝ Shoes are not always necessary indoors.
࢝ Use thick dressings on top of the usual layer to create extra padding for the knees and feet to
minimise blistering when your child starts crawling/walking.
Special considerations for a child with severe EB would be to not walk barefoot but have layers of
protective dressings.

WHY IS FOOTWEAR IMPORTANT FOR EB?
EB is a genetic skin blistering condition. Depending on the EB type and severity, it can affect any
area of skin. Typically, it is prone to blistering and scarring in areas exposed to repeated application
of pressure or friction. It is therefore not surprising to find that EB typically affects the feet. Although,
due to the nature of EB, blistering in the feet is often inevitable, there are certain methods that can
limit their creation, and the pain and discomfort that they bring.
EB feet are typically affected by the footwear your child wears.

FOOTWEAR ADVICE
For your child to enjoy a healthy active life, taking good care of their feet is vital. Footwear can
have a significant effect on the foot health and well-being of your child. Choosing suitable shoes is
essential.
Feet are vulnerable areas of the body where footwear aims to protect, secure, and offer comfort
through the changes of the day. Footwear is very specific to each child with EB. What works for one
child may not work for another. However, symptoms in a fully developed foot are often improved if
your child is able to support their feet with a stiff soled shoe or trainer.
࢝ Make sure you are aware of your child’s correct foot size (this can vary over time and
between shoe brands or manufacturers).
࢝ Footwear with fastenings provides the greatest support.
࢝ Check there is enough room in the shoe for your child to wiggle their toes (6 mm
between the tip of their longest toe and the end of the shoe).
࢝ There should be enough width in the shoe to accommodate the whole foot; there
should be no pressure points.
࢝ Shoes should not slip at the back (if they slip whilst walking, slide your child’s foot
to the back of the shoe and readjust the laces/straps).
Tips
A supportive shoe can reduce the range of movement within the foot that results in blisters from
friction. It is typically along the pivot point of the balls of the feet/metatarsal heads where blistering
tends to be most prevalent

Changes in temperature and weather
Rigid soled, supportive footwear is easier to wear in colder periods; however, it can also cause the
feet to get hot.
Footwear is problematic in hot weather when rigid soled footwear tends to be heavier and provides
less ventilation than softer, more flexible shoes. There are options in the summer that will be
preferable to a standard sandal.
In this case, you need to decide what contributes more to blistering of your child’s feet: heat or
friction, and choose the more appropriate footwear accordingly. In certain cases, we find that
footwear that provides a certain amount of support along with a lightweight/ventilated upper is a
good compromise. One recent example of these are memory foam trainers.
Flexible footwear in warmer weather will often provide the most amount of ventilation as well as
being the most lightweight. Both of these characteristics mean that this type of footwear is most
often used in the hotter times of the year.

Your child’s shoe size does not stay constant throughout life. It is recommended that feet are
measured every 2-4 months during childhood. If you do not have facilities close by, you could
use the easy shoe size guide. Have your child’s foot measured if they are feeling discomfort
with their normal shoe size.
࢝ Make sure shoes are a comfortable fit: appropriate length and width, flexible,
rounded end with plenty of room for the toes.
࢝ A flat heel is better for heel support.
࢝ Laces or straps prevent excessive movement or slipping of the foot inside the shoe.
࢝ Seams should be flat or absent.
࢝ The upper covering of the shoe should be made of leather or fabric mesh to allow
air to circulate, rather than plastic or synthetic.
Tips from EB experts
࢝ Shoes have to fit perfectly before buying them.
࢝ Wear shoes little and often at first around the house and garden.
࢝ Rub oil or Vaseline into leather shoes.

YOUR CHILD’S ENVIRONMENT
Children are also exposed to peer pressure as they want to fit in and make friends even very early
on in life. With a child that lives with EB this can be enhanced due to the visible nature of their EB
if they have recessive dystropic EB or the more invisible nature of their EB if they have EB simplex
for example.
As your child grows older, how they dress themselves is a form of self-expression, which nowadays
may start even before they are a teenager. In the case of children living with EB from birth, they
mature earlier than their peers and may look for this self-expression earlier. This is a part of growing
up, knowing themselves, and becoming aware of their body image. As stated before, your child will
need to explore their boundaries even with footwear including footwear that is for the more fashion
conscious.
If you are a parent currently experiencing these changes with your child, it is important to at
least restrict your child’s activity as much as possible in this type of footwear due to the lack
of support that they provide.

CUSHIONING, INSOLES, AND SOCKS
In conjunction with appropriate footwear, specialised cushioning insoles have proven to help reduce
pressure and friction underneath the foot, which can stop or reduce the development of blisters.
In EB clinical centres with dedicated specialist EB trained podiatrists, they may examine your
child’s feet and walking style using a plantar pressure readout system. If you do not have access to
a specialist EB trained podiatrist then it would be useful to try and find a local, certified podiatrist
who can liaise with your child’s EB team about what type of insole may help your child. In some
cases, you may find that anything that takes up additional room in your child’s footwear (even a
thin insole) may contribute to symptoms getting worse due to an increase in localised heat and/or
a reduction in ventilation. It is always advisable to discuss this with your child’s EB team prior to
using something new.
There are certain accessories available that can help maintain comfortable feet. These include
double layer socks, Coolmesh socks, silver socks, and silk. Silver socks can conduct heat away
from the feet and help reduce friction; they also have antimicrobial properties. Silk, Coolmesh socks,
and double layer socks also help to reduce friction. However, in some cases the extra layer of the
double layer socks can increase heat and is therefore detrimental to some users.
Using dressings or barriers to prevent blisters can also be effective. Materials such as bi-stretch
soft silicon Spycra, Mepitel, fixation bandage Soft-One, or hydrogel sheets Kerralite Cool can help
cool the skin and reduce pain. Access to these materials will vary depending on where in the world
you are. These materials can be easily cut to wrap around toes or cover larger areas where repeated
blistering or scarring is a concern.