hi all,
i think slippers is one big factor causing older adults to fall at home. The poor fixation mechanism of slippers would increase risk of falling because older adults need to spend extra energy and concentration to hold the shoes within the foot. This could be considered an secondary task. When older adults performing two or more tasks concurrently, the total capacity is required and therefore one of the tasks will be compromised (Shumway-Cook, 2002). Older adults tend to forcus on postural control as their primary task.

A high heel could increase loading of the forefoot, increased arch height and lead to increased risk of lateral ankle sprain. A high-heel shoes would also increase energy consumption which could be another contributing factor for falling. Many studies found high-heeled footwears are responsible for instability and falling ( Snow and Williams, 1994). Robbin et al 1991 also suggests a thin and hard midsole is the best for older adults in terms of preventing falls because soft materials cause instability due to sensory reduction-less perception.

The think the footwear assessment form by Sherrington and Menz, 1999 which looks at the types footwear, fixation, heel hight, midsole, heel counter stiffness, sole flexion point, sole hardness etc, is a great reliable clinical tool to assess patients' footwear

Jessup 2004 is another good reference to look at the poor mechanisms of footwear that would increase risk of falling, such as


P.S Romberg's test, timed get up and go test are good guideline to check patient's stability


hope all make sense

regards,
Mark

 

It with interest that i have read your thread, as i have noted that in some rest home situations,residents are often encouraged to wear slippers as it is an'easy'footwear to put on and often does not require caregivers to assist.i recommended that this option was discouraged and replaced with a sports shoe type alternative, often replacing laces with an elastic lace alternative so that footwear could still be slipped on easily by most residents.in some cases i also added a simple arch support to stabilise the foot.falls have slowly decreased and the gait patterns of several residents who used to shuffle in slippers now walk more confidently in their shoes.Regards melpod.

 

Two thoughts for you

Heel "height" is not the real issue, heel "pitch" is the real issue.

Slippers, your right they are poorly fixed to the foot, but have you ever seen a pair of slippers that actually fit the clients foot correctly? most are too big as one of the ever helpful children have bought them without the parent been there, how many times have l heard........."Thats close enough, she does walk much any way":bang:

 

Are non-slip socks really 'non-slip'?

Are non-slip socks really 'non-slip'? An analysis of slip resistance

Satyan Chari, Terrence Haines, Paul Varghese and Alyssia Economidis

BMC Geriatrics 2009, 9:39doi:10.1186/1471-2318-9-39

Abstract (provisional)
Background
Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit.

Methods
Phase one involved slip resistance testing of two commercially available non-slip socks and one compression-stocking sample through an independent blinded materials testing laboratory using a Wet Pendulum Test. Phase two of the study involved in-situ testing among healthy adult subjects (n=3). Subjects stood unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was increased incrementally for each condition until slippage of any magnitude was detected. The platform angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video.

Results
Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not offer better traction than compression stockings. However, in phase two, slippage in compression stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested, barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance.

Conclusions
It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the testing method, participant group and sample size are discussed.

 

Hi Hylton

Just doing some research myself for a talk on falls and rereading the tread. Picked up your comments how I got away with so muc - the reason is simple no one pays any attention to what I write. Just like growing older I can now walk through a group of young ladies and be completely unseen. Time was I could turn some heads but no longer, alas. Same with my writing.

On heel heights generally - I suppose it is very difficult to be precise because of individual anatomical variation. Also the type of fall patterns does vary within the demographic ie from community dwelling elderly to geriatric to psycho-geriatric etc. I can certainly see the association between imbalance and falls and anything that would lead to imbalance would be a critical factor. I do not think heels should be mandatory. :D

I was interested recently to read of the studies from Italy where there seemed to be an arguement that heeled shoes might assist with continuence training in older adults. Have you any comment?

Cheers
toeslayer (the pod formerly known as Cameron)

 

I try to notice foot drop issues when I fit older people. They often report carpet giving them trouble and "catching" on the toes of their shoes.

Many times we have ground off the urethane or rubber distal to the sulcus, and replaced it with smooth soling leather. In cases of foot drop, this helps quite a bit, according to reports from my patients. Esp. on carpet.

Of course a leaf spring AFO would solve the problem better. But, in mild cases or where the elderly patient will not wear a brace, it helps.

 

In my own observations the vast amount of them: target fixate within 4 feet of their on footstep and start to create a self fulfillling prophesy, they are pitched foward using a controlled fall as a gait, they are poorly propulsive, they have become physically weaker due to developing a flacid gait rather than being dynamically active, they do not counter rotate to manage lateral sway and centre their mass, they have inadequate counter balance swing of their arms so they get little propulsive assist nor offset-balance, they wear shoes that stiffle muscle action and inhibit proprioreceptive feedback, and they have set beliefs that they are too old to change which is another self fullfilling prophesy. Foot function is probably the least of the problem

 

Hamish you make it sound like its a lost battle and its all their fault.
As for "...they have set beliefs that they are too old to change...."
there is no age limitation on being stubborn.
, l have three children one of which proves that often:bang:

l understand what you are saying but as far as "..foot function been least of their problems..", we need to start somewhere and getting them/ anyone mobile again is a great achievement.
We start by reminding them to swing their arms rather than hold them tight to their body, to fit them with light weight but structural footwear and often modify them as "gaittec" does to compensate for some of those lost functions within their gait.

Most elderly when they come in do have shoes that are 5-6years old that no longer support them and due to the poor fit offer little proprioceptive feedback as they slop about, there is often a lot we can do to improve their gait and balance.

l must say Hylton and Martin must be pulling their hair out with some of the footwear some of their subject turn up in:craig:

 

No not blaming them, just observing an attitude that has developed in many. I agree one has to start somewhere, with luck our profession gives us an in. Other professions will start somewhere else. What I have come across on may ocassions is a lack of regard for the other bits from our profession, who can get hung up on small elements and neglect to observe the other "stuff".

 

Shoe sole tread designs and outcomes of slipping and falling on slippery floor surfaces.
Liu LW, Lee YH, Lin CJ, Li KW, Chen CY.
PLoS One. 2013 Jul 24;8(7):e68989.

 

Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention.
Chari SR, McRae P, Stewart MJ, Webster J, Fenn M, Haines TP.
Aust Health Rev. 2015 Oct 12. doi: 10.1071/AH14168

 

Are there any studies regarding geriatrics and shoes like nike frees?
When I had a footwear meeting with nike they were promotinv their frees as a be all and end all for all people and when I mentiined it wasnt an area I was interested in as I mainly work w geriatrics I got a major speel from them about their use of footwear as a reduce in falls risks.
Personally I would think that they would increase the inherent instability in these pts and have steered thwm away from them. But I continually get shoe stores pushing them onto clients of mine. Generally with negative effects.
Any other point of view would be great for a discussion

 

Firstly no one shoe can be all things to all people.

How do you see a client with PTD walking in the Nike Free? l would imagine they would be doing a lot of regular gravity checks;)

 

Effects of Indoor Footwear on Balance and Gait Patterns in Community-Dwelling Older Women.
Menz HB, Auhl M, Munteanu SE.
Gerontology. 2016 Sep 3

 

Influence of Footwear on Gait Characteristics that are Associated
With Increased Fall Risk in Older Persons
Tischa JM van der Cammen et al
The Ergonomics Open Journal, 2016, 9, 43-49

 

Kinematics and kinetics of the shoe during human slips.
Iraqi A et al
J Biomech. 2018 Apr 25.

 

Foot problems as a risk factor for falls in community-dwelling older people: a systematic review and meta-analysis
Hylton B.Menz, MariaAuhl, Martin J.Spink
Maturitas; 2 October 2018

 

Do footwear styles cause falls or increase falls risk in healthy older adults? A systematic review
Annette Davis, Terry Haines & Cylie Williams
Footwear Science : 04 Feb 2019

 

Gait Kinetics Impact Shoe Tread Wear Rate
Sarah L. HemlerJessica R.SiderMark S.RedfernKurt E.Beschorner
Gait & Posture

 

Effect of tread design and hardness on interfacial fluid force and friction in artificially worn shoes
Paul J. Walter et al
Footwear Science; Volume 13, 2021 - Issue 3: 02 Aug 2021

 

Foot rubbing evaluation of friction between shoe and flooring
Kei Shibata, Akihiro Ohnishi
PLoS One. 2022 Sep 29;17(9)

 

Shoe tread wear occurs primarily during early stance and precedes the peak required coefficient of friction
Rosh Bharthi et al
Footwear Science

 

Enhancing footwear safety for fall prevention in older adults: A comprehensive review of design features
In-Ju Kim, Fatma Hegazy
Ann Geriatr Med Res. 2024 Jan 22