Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services: an observational cross-sectional study

Abstract

Background: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with illfitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests. Results: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.

Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study

“…6 Even though no serious injury is caused, ill-fitting footwear causes loss of confidence, a fear of falling, and a restriction in activity. 30 Our findings are in line with those reported in the literature in that aspect At the beginning of the study, it was considered that wearing appropriate-fitting footwear reduces the fear of falling in older adults. Consistently, the number of repetitive falls in the last year was less in the group wearing suitable shoes than the other group in our study.…”

“…27,29 One study comparing appropriate-fitting and ill-fitting shoes showed that wearing ill-fitting shoes did not have an effect on TUG scores. 30 In the present study, it was shown that functional performance did not change according to footwear suitability.…”

“…28 Numerous studies have uniformly shown that gait speed changes depending on footwear suitability. 26,27,29,30 Gait speed and step length increased, while step width decreased when different aspects of footwear suitability such as base material, dorsal fixation feature, and footwear upper material were compared. 26 Footwear with dorsal fixation improved minimum foot clearance compared to slippers and bare feet conditions and less heel slippage than slippers and an increase in double support.…”

Incorporating foot assessment in the comprehensive geriatric assessment

“…Use of inappropriate footwear was very common in this cohort and similar rates have been reported by other inpatient and outpatient studies of older adults [17,56,57]. Footwear interventions have been shown to improve foot pain and function [58,59].…”

Perception of footwear comfort and its relationship with the foot structure among youngest-old women and men

“…Improperly selected footwear may intensify age-related foot changes, be a direct cause of pain, health disorders of the feet and higher parts of the kinematic chain, and reduce the comfort of locomotion and the ability to undertake everyday life activities (Jiménez-Ormeño et al, 2011;Ikpeze, Omar & Elfar, 2015;Hinojo-Pérez et al, 2016;Jellema et al, 2019). It may cause pressure on some parts of the foot, change the distribution of pressure forces on the foot, thereby increasing the anteroposterior and mediolateral tilts of the body's centre of gravity, which, combined with weakening posture control mechanisms, predisposes to loss of balance and, consequently, to falls (Hatton et al, 2013;Ikpeze, Omar & Elfar, 2015;O'Rourke et al, 2020). The use of excessively worn or slippery footwear has a negative effect, as well as its improper construction, e.g., wrong height of the heel or upper, heel stiffening (Saghazadeh, Kitano & Okura, 2015).…”