Not as many issues as you might think. Of course, I have a smaller foot surface area to work with so not as steady on my toes but I have strong foot and calf muscles to compensate I think and keep me relatively stable. I can run fine but kid's shoes are not designed for a 6'1" 170 lb man to be running in them so I go through shoes like crazy. Mostly it's just social issues - my feet and hands are quite noticeably small so I get comments from strangers a lot. But I just try to laugh it off and be good humored about it.