Balance & Aging
Why are Seniors at Higher Risk for Falls? Dizziness can happen at any age, but if it results in falling it can be a serious health concern, particularly in the older adult. Because a loss
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Proper footwear is essential for individuals with balance issues, particularly seniors and those at risk of falling.
Proper footwear is can reduce the risk of falls, especially for people with balance issues.
As more people age, the frequency of falls also increases, along with the associated financial burden.
Fall prevention for seniors is crucial to reduce serious physical injury, disability, and even death. Other impacts of falls include:
Older people are at risk for falls due to age-related changes in the neuromuscular system, among other factors. Postural stability (ability to balance) also plays a role and is affected by damage to the vestibular system in the inner ear, which sends signals to the brain to tell you where you are in space.
Many risk factors have been identified that contribute to falls. One easily modifiable risk factor is proper footwear.
The goals of proper footwear include comfort, safety, function, stability/support, and mobility. Certain types of footwear can help you improve your strength and balance.
Understanding the structural components of footwear can help you choose the shoe that is best for you.
Individuals at risk of falls should select a shoe that provides them with a sense of stability and support. Unfortunately, perceptions about footwear, such as style or comfort, may lead someone to choose a shoe that is not the most appropriate or safest.
The bottom of the shoe includes:
The upper part of the shoe consists of:
Conventional shoes typically have a thick, cushioned sole with a raised heel and a narrow toe box, which can restrict natural foot movement. These features are often found in athletic shoes, dress shoes, and everyday footwear.
Don’t let the name fool you. Destabilizing shoes are a type of footwear designed to intentionally challenge the wearer’s balance and stability, potentially stimulating and strengthening the neuromuscular and somatosensory systems.
Minimalist shoes, also known as barefoot shoes, are designed to mimic the natural barefoot experience, emphasizing a minimal barrier between the foot and the ground. They prioritize a thin, flexible sole, minimal cushioning, and often a zero-drop platform (where the heel and forefoot are at the same level). This design promotes a more natural gait and enables greater foot and ankle movement.
Some people prefer to wear slippers, socks, or go barefoot in their homes. However, in a sample of 312 older persons, those who wore slippers had more foot pain and significantly greater fall risks compared to those who wore fastened shoes or no shoes at all. Numerous studies report that walking barefoot or wearing socks or slippers increased fall risk by up to 11 percent as compared to wearing athletic or canvas shoes.3
Many people assume that walking without shoes decreases their risk of falling because it improves their ability to feel the ground. However, this is not the case for older individuals with neuropathy (loss of nerve function in their feet).
Most falls occurred in people’s homes (48%), where slippers are commonly worn.4 Since wearing slippers or socks can increase the risk of falls, it is recommended that you wear shoes even when inside your home. You may want to keep a specific pair of comfortable shoes for indoor use only if you are concerned about tracking dirt from outside. For individuals who must or prefer to wear slippers at home, it is best to choose slippers that are well-fitting, have a closed back, and a non-skid sole.
A local shoe store may have staff and technology to assess your specific needs. Don’t hesitate to visit a running shoe store, which will offer options for walking shoes that optimize balance. Key brands include Asics, Altra, Brooks, Hoka, New Balance, Mephisto, Vionic, Orthofeet, Propet, SAS, and Ecco. If you are unsure where to look, consult your physical therapist, podiatrist, or another skilled healthcare professional.
In addition to proper footwear, a comprehensive fall prevention program, including strengthening and balance exercises, is crucial for keeping you safe from falls. Consult a physical therapist to design a personalized program tailored to your individual needs.
By Denise Schneider, DPT, FAAOMPT, ATC, based on an article written by Julie Shein, PT
CDC, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
Connell BR, Wolf SL. Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group. Arch Phys Med Rehabil. 1997;78(2):179-86.
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Household shoe wearing habits of older adults: Are they associated with falls risk? In: Frederick EC, Yang SW, editors. Proceedings of the 8th Footwear Biomechanics Symposium; 2007 Jun 27-29; Taipei (Taiwan). p. 77-78.
Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, Frankenfeld CL, Tautvydas M, Larson EB. Footwear style and risk of falls in older adults. J Am Geriatr Soc. 2004;52(9):1495-1501.
Sherrington C, Menz HB. An evaluation of footwear worn at the time of fall-related hip fracture. Age Ageing. 2003; 32(3):310-14.
Keegan TH, Kelsey JL, King AC, Quesenberry CP Jr, Sidney S. Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture. Am J Epidemiol. 2004;159(2):192-203.
Robbins S, Waked E, McClaran J. Proprioception and stability: Foot position awareness as a function of age and footwear. Age Ageing. 1995;24(1):67-72.
Burns SL, Leese GP, McMurdo ME. Older people and ill fitting shoes. Postgrad Med J. 2002;78(920):344-46.
Gabell A, Simons MA, Nayak US. Falls in the healthy elderly: Predisposing causes. Ergonomics. 1985;28(7):965-75.
Robbins S, Gouw GJ, McClaran J. Shoe sole thickness and hardness influence balance in older men. J Am Geriatr Soc. 1992;40(11):1089-94.
Perry SD, Radtke A, Goodwin CR. Influence of footwear midsole material hardness on dynamic balance control during unexpected gait termination. Gait Posture. 2007; 25(1):94-98.
Ottaviani RA, Ashton-Miller JA, Kothari SU, Wojtys EM. Basketball shoe height and the maximal muscular resistance to applied ankle inversion and eversion moments. Am J Sports Med. 1995;23(4):418-23.
Gard G , Berggard G . Assessment of anti-slip devices from healthy individuals in different ages walking on slippery surfaces. Appl Ergon. 2006;37(2):177-86.
Menant J, Steele J, Menz H, Munro B, Lord S. Optimizing footwear for older people at risk of falls. JRRD. 2008;45 (8):1167-1182.
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