what-when-how
In Depth Tutorials and Information
figure 8.7
Excessive heel wear and instability
balance in older people (
Menant et al 2008
).
Figure 8.7
shows an example
of heel wear caused by an unstable heel, further leading to instability.
Heel height and width may affect a shoe's tendency to tip sideways
on an uneven surface, as well as affecting gait and posture. Soft-soled
shoes impair beam-walking performance (
Robbins et al 1992
), and high
heel counters have been shown to improve balance compared with
standard, low-cut footwear (
Lord et al 1999
). Inadequate slip resistance
of the outersole of the shoe is also thought to increase the risk of slipping
accidents (
Menz et al 2001
) but no studies have directly evaluated this in
elderly subjects. Based on this information, the 'ideal' safe shoe for older
people is thought to consist of a low, sturdy heel, high heel counter, a
thin, firm midsole and a textured sole.
The available evidence seems to indicate that inappropriate footwear
may impair balance in older people, possibly leading to an increased risk
of falling.
Sherrington and Menz (2003)
concluded that many older people
who have had a fall-related hip fracture were wearing potentially hazard-
ous footwear when they fell. The wearing of slippers or shoes without
fixation may be associated with increased risk of tripping and it is also
known that the risk of falls increases in barefoot elderly.
If we are to recommend new shoes to our patients, we must ensure
that they have access to facilities where their feet can be measured and
