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Designing a shoes to reduce falls in the elderly

Discussion in 'Biomechanics, Sports and Foot orthoses' started by scotfoot, Jul 22, 2023.

  1. scotfoot

    scotfoot Well-Known Member

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    What are the features a shoes should have if its purpose is to reduce falls in the elderly when compared to other shoe designs?

    Well ,IMO-

    1 It must be perceived as comfortable or it won't be used.

    2 It must look OK or again it won't be worn esp by the fashion conscious.

    3 It must allow the bodies balance mechanisms to function properly esp with regard to control during weight shifting, the most common time for a fall to occur.

    4 It shouldn't cost too much.

    Those are the main factors esp 1,2,3.

    When designing this shoe the clinician doing the work should abandon all bias towards minimal or maximalist shoes since the result can be anywhere in between and feature design elements of either. A blank page and an open mind are required .
  2. scotfoot

    scotfoot Well-Known Member

    The 1st thing I would do if designing a shoe to prevent falls in the elderly is find out what makes a shoe comfortable .

    Generally this seems to involve some form of cushioning and often support in the form of medial arch support and ,since I don't see why not ,in these would go to the design .

    If people have been used to wearing shoes with some form of heel raise most of their life , a heel of about and inch or a bit less seems appropriate .

    Ankle support ? No, since IMO this may negate one of a number of balance mechanisms. ( more of this later)

    Sole of the shoe ; This should be made of a soft flexible material which does not spring back into shape after bending /flexing . Soles with a high degree of spring/recoil take work away from the toes causing more rapid weakening of the intrinsic foot muscles .

    Lastly ,unless clinically indicated, there should be no or very little toe spring. This is probably one of the most important aspects of building a shoe to prevent falls in the elderly since most falls occur during weight shifting not walking . If you build a shoe for walking but not weight shifting how can you come up with the optimal design?
  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Some years ago, I had a meeting with the president of one of the largest shoe manufacturers in the United States. At that time, I was trying to change the design of shoes to make them more biomechanically efficient. Succinctly, this is the encapsulation of what I was told:

    "We are in the business to sell shoes. How they function is of no concern."

    I found this incredulous, but nevertheless, factual as I talked to almost all the shoe manufacturers in the U.S.
  4. scotfoot

    scotfoot Well-Known Member

    There is now a lot of research which indicates that the intrinsic foot muscles are important for balance and a recent paper underlines this .

    What appears to confuse some is the anatomy/physiology of muscles like the flexor digitorum brevis and abductor hallucis. These muscles have distal origins at or around the heel and insertion points on the toes or in structures that have a role in toe flexion like the sesamoid bones . The abductor hallucis, flexor digitorum brevis and flexor hallucis brevis do not insert into the heads of the metatarsals .

    For the intrinsics to have a meaningful role in balance , toe plantarflexion must meet with some sort of resistance from the shoe/ground. Toe springs hinder this since the distal part of the shoe will simply bend downwards under pressure.

    Toe springs may help with walking but, IMO, they likely hinder balance during weight shifting.

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