Are You Wearing The Right Shoe? Spotting Fall Hazards

Footwear helps support a person's balance, which reduces the chances of slipping, tripping, and falling.

According to a new study, up to 83% of older people wear the wrong type of shoes, including not using the correct size. This results in foot disorders, pain, and increased risk of falling.

The Wrong Shoes

To reduce the risk of a falling, elders are often advised to wear sturdy shoes. Up to 70% of elders who fall are wearing athletic shoes, oxfords or loafers, the kinds of shoes that are commonly considered sturdy and thus safe. But in some cases, these shoes are the cause of the fall.

For example, the shoes elders select for safety can sometimes place them at greater risk of:

• Slips and trips
• Poor balance
• Unsafe walking patterns
• Difficulty in judging whether walking surfaces are slippery.

So, which types of shoes increase fall risk?

Examples of inappropriate footwear include:

• Loose, worn or backless slippers. These are one of the most common causes of falling.
• Slip-on shoes, such as sling backs or flip flops which can result in slipping and tripping.
• Shoes with slippery or worn soles, can cause slips, especially in wet weather.
• Shoes with a heel (higher than 1”), or with a narrow heel. High heel shoes lead to the risk of ankle turns, unstable balance, and falling.
• Wearing sneakers (with bulky rubber soles) that easily get caught or drag on the floor.
• Athletic shoes with flat or worn soles that are slippery on wet surfaces.
• Lastly, walking barefoot or in socks indoors also increases fall risk.

Why do some elders wear the wrong shoe?

• As people get older, the shape of their feet change; they become longer and wider. Also, the feet lose muscle and fatty tissue, becoming bonier.
• Chronic diseases such as obesity, vascular diseases, diabetes or rheumatoid arthritis, cause increased foot problems.

If elders don't modify their shoe size because of these aging and health changes, they are likely to be wearing shoes that are harmful to their health.

The Right Footwear

Elders should be advised about the importance of wearing the right (or correct) shoes, which helps improve one's walking and balance. There are numerous things to consider when selecting shoes for elders. Here's a list of what to look for:

• Footwear should have a hard, slip resistant sole, which provides traction on both dry and wet surfaces. Look for shoes with midsoles that are sturdier and not too flexible to ensure better stability. Lightweight shoes are okay because they're easier to walk in, but make sure they're not too flimsy or have too much flexibility at the midsole.
• Avoid shoes with smooth leather or plastic soles, which can be slippery on carpets, wood and tile floors, and wet surfaces. Some athletic shoes made with synthetic soles, which are good for exercising in the gym, can be very slippery on a damp or wet surface.
• Avoid wearing shoes with heavy rubber soles that can catch on carpets, especially when they are worn by people who barely pick up their feet when they walk. Also, stay away from shoes with a lot of cushioning; they can lead to instability and balance loss.
• Select shoes with laces that tie. These are safer than shoes that slip on the feet. Also, laced shoes can be adjusted to accommodate orthotics, swelling of the feet, etc. Lace closures are also good if they're tied securely to provide a comfortable, secure fit. For those individuals who lack dexterity, consider replacing cloth laces with elastic ones that hold the shoe firmly on the foot, but stretch enough to allow shoes to be slipped on and off without tying or untying the laces. Also, Velcro fasteners ensure that shoes won't slip off.
• Avoid wearing shoes and slippers that are loose or ill-fitting. If shoes are too big they can be difficult to walk in safely; if they're too small (or tight) they can cause foot disorders (such as calluses and corns).
• Up to 70% of elders have foot problems (such as bone deformities, bunions, toenail malformations, calluses, corns, flat feet, etc.). This often leads to chronic pain and unsafe mobility when walking. In general, these individuals should wear wide-fitting shoes, which helps reduce the impact on joints when walking. Also, a wide opening makes it easier to get one's foot in and out of the shoe.
• Avoid walking in socks, stockings or barefoot; all are associated with increased risk of falling. Rather wear well-fitted, slip-resistant slippers or house shoes indoors.

In closing, falls can be due to many health and environmental problems. But, in many cases preventing falls can be as simple as realizing that one is wearing the wrong shoes, and taking corrective action.

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (healthcare professional who specializes in working with elderly patients) and a geriatric physician's assistant.