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We examined the hypothesis that awareness of foot position in terms of the slope of the weight-bearing surface declines with age. We further postulated that the decline would be due to a change in plantar tactile sensibility, and that footwear would further impair position judgments. We compared 15 men aged over 65 years (mean age 73) with 36 men aged under 40 (mean age 30) in terms of estimates of amplitude and direction of surface slopes. We employed a ratio scale of 0-10 representing actual slopes of 0 degrees-25 degrees in increments of 2.5 degrees. In order to examine whether subjects overestimated high angles they were told that the scale ranged from 0 to 15. We found significant differences between the two groups in terms of estimates and the effect of footwear. Psychophysical functions for estimate of slope were 0.95 for the young when barefoot and 0.71 when shod compared with 0.80 and 0.81 respectively for the older men. We conclude that sensitivity to foot position declines with age, mainly owing to loss of plantar tactile sensitivity. Footwear impairs foot position awareness in both young and old. Loss of foot position awareness may contribute to the frequency of falls in later life.

For optimal stability, shoes with thin, hard soles are preferable for older individuals. Health professionals should exercise caution when recommending shoes with thick, yielding midsoles, such as running shoes, to unstable elderly individuals. Older men and women with a history of falls or who are obviously unstable, should avoid barefoot locomotion.

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Foot position awareness is related causally to stability; shoes with thin, hard soles provide better stability for men than those with thick, soft midsoles. Foot position awareness declines with advancing years.

Stable equilibrium during locomotion is required for both superior performance of sports and prevention of injuries from falls. A recent report indicated that currently available athletic footwear impairs stability in older men. Since this discovery, if confirmed, seems important to both competitive athletes and the physically active general public, we performed an experiment using similar methods on a younger population. We tested the hypothesis that midsole thickness is negatively, and hardness positively related to dynamic equilibrium, in 17 healthy adult men (mean(s.d.) age 33(11.13) years) via a balance beam method. Subjects walked along a 9-m long beam at 0.5 m sl once barefoot and six times wearing identical pairs of experimental shoes which differed only in midsole hardness and thickness which spanned the respective ranges currently available in footwear. Falls from the beam (balance failures) were quantified. Balance failures varied significantly in relation to midsole hardness and thickness, and there was a strong trend toward interaction of these variables (P = 0.09). Midsole hardness was positively related to stability, and midsole thickness was negatively related, which confirms the previous report. Hence, shoes with thick-soft soles, similar to modem athletic footwear and 'walking shoes', destabilize men, and shoes with thin-hard soles provide superior stability. The pair with the poorest stability (A 15 -thick; 12.34 balance failures per 100 m) produced 217% more balance failures than those associated with the best stability (A 50 -thin; 3.89 balance failures per lOOm).Since most types of athletic footwear and many other shoes incorporate midsoles with hardness and thickness associated with poor stability, we conclude that both athletic performance and public safety could be enhanced through stability optimized footwear. Footwear that incorporates expanded polymer foam of a certain range of thickness and hardness, which includes most commercially available athletic footwear, and presently popular 'walking shoes', has recently been reported substantially to impair equilibrium in older men. For example, these authors have shown that differences in fall frequency from a balance beam varied by an amazing 128%, when comparing footwear associated with the best stability with that of the poorest8. Since stability differences of this magnitude must have major health and athletic performance effects, products providing poor stability are currently being marketed to the general public specifically for use in performing physical activity (walking shoes and athletic footwear), and no safety standards are in force that can provide the public with relative stability with the use of these products. Further examination of the relation between footwear soles and stability seems justified.The previous report examined footwear midsole hardness and thickness exclusively in an older male cohort8. It seems unwise to assume that their results apply to the general population without testing a younger group. Accordingly, ...

We examined how adult children in Canada whose parents were hospitalized in an acute care setting perceived responsibility for their parents' care. Using a visual analogue scale, adult children rated the amount of financial, emotional, and physical support families "should" and "could" give to elderly persons described in four vignettes. All scores were high, with "should" consistently higher than "could" for every vignette and for each of the three types of support. For daughters, the more aggressive the parent, the lower the "should" score for financial support. The same relationship was observed for incontinence and these findings were consistent over all four vignettes.

The scientific literature suggests that barefoot activity may be beneficial. There is a current trend in recreational barefoot activity in children and adults, and barefoot running among athletes. Although the type of skin over most of the body (hairy skin) seems to be easily injured by painful abrading loads, little is known about protection provided by plantar sensory feedback against damage from excessive wear during barefoot locomotion. To evaluate this, we administered a volley of 35 painful abrading loads to glabrous and hairy skin sites over a 5-min period, and examined its effects for signs of cutaneous injury in a sample of 12 normally shod healthy male subjects. Compared with hairy skin of the thigh, plantar skin required approximately 600% greater abrading loads to reach pain threshold. Furthermore, painful stimulation produced visible redness and hypersensitivity in all subjects at the hairy skin site 24 hr after stimulation, whereas only 8.3% reported hypersensitivity and none showed erythema at the plantar area 1 day later. We found that plantar skin possesses a higher pain threshold to abrading stimuli than hairy skin. In fact, loading of the plantar area was limited to innocuous levels due to intolerable pain. We conclude that plantar skin is well protected through sensory feedback from abrasive injuries when barefoot. This information combined with previous reports suggests that risk of injury when normally shod individuals perform barefoot locomotion should be low.