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Accidental Falls* / prevention & control

Footwear Characteristics and Their Impact on Gait and Balance in Older Adults: A Systematic Review of Recent Evidence

Author/s: 
Chi-Hsien Chen, Jinfeng Li, Yoshiro Okubo

Background
Improper footwear has been identified as a modifiable risk factor for falls in older adults. Studies suggest that certain footwear characteristics can impair gait and balance, thereby increasing the risk of falls. However, the impact of footwear on gait and balance control may vary across research protocols. A systematic review focusing on these relationships is currently unavailable to date. This study aims to investigate the impact of footwear on gait and balance control in older adults, as well as the research protocols employed and the study outcomes.

Method
A systematic review was conducted using PubMed, IEEE Xplore, Scopus, Web of Science, and Clinical Trials to identify relevant studies published between 2017 and 2024. Keywords were systematically searched, and data were manually extracted. Thirteen studies were included. The review synthesized findings on the influence of various footwear designs on gait and balance control in older adults.

Result
Footwear featuring a minimal outsole, a textured insole design, and a high collar design was generally associated with improved balance outcomes. The evidence for toe-beveled footwear designs was mixed. Studies incorporated both walking and balance assessments, with some including perception-based questionnaires. A combination of walking, balance, and perceptual assessments provides a more comprehensive understanding of how footwear affects balance in older adults.

Conclusion
Among the included studies, featuring a minimal outsole, a textured insole design, and a high collar design showed consistency to benefit older adults that provides textured feedback while offering foot protection, which may enhance balance control. However, some studies also implied that certain designs may have potential negative effects, including toe-beveled, minimal outsole, less-fixation, and barefoot condition. The lack of comprehensive descriptions of experimental footwear affects scientific transparency and reproducibility.

Keywords 
older adults Footwear Balance and Gait

Evidence-Based Footwear Recommendations for Older Adults: Enhancing Mobility, Comfort, and Fall Prevention

Author/s: 
C Ray Cheever, Hyoungjun Sim, Mohamed Y. Ahmidouch, Jaewon Moon, Anissa Powell, Rayad B. Shams, Matthew Wang, Madison Hunter, Samantha Kodikara, Lindsay A. Wilson, Michael T. Gross

Background: Older adults often struggle to find footwear suitable for their clinical needs, thus affecting mobility, safety, and quality of life. Proper footwear is important due to fall risk, balance impairments, knee osteoarthritis (OA), hallux rigidus, plantar fasciitis, diabetic neuropathy, and limb length discrepancies (LLDs). Barriers such as inadequate clinical guidance and limited patient understanding persist. This paper provides updated, evidence-based recommendations for these challenges.

Methods: A topic review was conducted to evaluate shoe wear characteristics that address geriatric needs. Recommendations were synthesized from more than 45 years of clinical experience in physical therapy and categorized by clinical conditions. Evidence identified effective shoe features, including sole stiffness, tread patterns, heel elevation, and orthotic modifications to improve function, reduce pain, and reduce fall risk.

Results: Balance and fall risk: Shoes with wide soles, medium-firm materials, low heels, and high collars improved stability and reduced postural sway. Cupped, rigid insoles enhanced dynamic control, while treaded rubber outsoles minimized slipping. Knee OA: Flexible shoes with laterally wedged insoles and minimal heel lift reduced medial knee loads and pain. Supportive shoes and medially wedged insoles decreased lateral knee loads and pain. Hallux rigidus/bunions: Rocker-bottom shoes and stiffer soles accommodate deformities, improving function and comfort. Plantar fasciitis: Orthoses, supportive therapies, and stretching regimens were efficacious. Diabetic neuropathy: Rigid rocker soles and custom insoles reduced plantar pressure and ulcer recurrence. LLDs: Gradual shoe lift introduction alleviated low back pain. General recommendations: Properly fitted, comfortable shoes with moderately firm insoles, slip-resistant outsoles, and secure fastening mechanisms improve safety and function.

Conclusions: Footwear significantly impacts the mobility, safety, and well-being of older adults. Tailored recommendations enhance pain management, independence, and fall prevention. Providers should involve patients in decisions and counsel against the use of slippers or excessively elevated heels.

Keywords: fall prevention; older adults; orthoses; pain; shoes.

Keywords 
Fall prevention older adults Orthoses Pain Shoes Foot Orthoses
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