Experts offer evidence-based footwear recommendations for older adults
Using rigid rocker soles and custom insoles to reduce plantar pressure and ulcer recurrence in diabetic neuropathy and flexible shoes with laterally wedged insoles and minimal heel lift to reduce medial knee loads and pain in osteoarthritis were among the recommendations.
Older adults can reduce risk for falls and other poor outcomes by selecting appropriate footwear tailored to their needs, according to recent recommendations.
Researchers conducted a topic review to evaluate footwear characteristics specific to geriatric patients, including sole stiffness, tread patterns, heel elevation, and orthotic modifications. The goal of the paper was to provide updated, evidence-based recommendations that could help reduce fall risk, balance impairments, plantar fasciitis, and other conditions. The recommendations, which were based on updated findings in the literature and expert clinical experience, were published Sept. 30 by the Journal of the American Geriatrics Society.
For all older adults, properly fitted, comfortable shoes with moderately firm insoles, slip-resistant outsoles, and secure fastening mechanisms improve safety and function, the recommendations stated. To improve balance and fall risk, shoes with wide soles, medium-firm materials, low heels, and high collars can provide improved stability and reduced postural sway. Cupped, rigid insoles can enhance dynamic control, while slipping can be minimized with treaded rubber outsoles, the recommendations said. Older adults should also avoid wearing slippers unless they are enclosed, have firm soles, and include straps for secure fastening, the authors noted.
In patients with knee osteoarthritis, flexible shoes with laterally wedged insoles and minimal heel lift can reduce medial knee loads and pain, while supportive shoes and medially wedged insoles can decrease lateral knee loads and pain, the recommendations said. Rocker-bottom shoes and stiffer soles to reduce motion at the first metatarsophalangeal joint can help alleviate pain in patients with hallux rigidus, while shoes with extra width and depth can accommodate bunions and prevent further irritation, according to the paper.
Orthoses, supportive therapies, and stretching regimens are efficacious for patients with plantar fasciitis, while rigid rocker soles and custom insoles reduce plantar pressure and ulcer recurrence in patients with diabetic neuropathy, the paper said. In addition, for patients with limb-length discrepancies, gradual introduction of shoe lifts, with incremental increases of 3 to 5 mm per week, can alleviate low back pain, according to the paper. Patients with limb-length discrepancies should also be evaluated for potential causes such as hip or knee replacement surgeries or joint degeneration, the paper said.
“Physicians, physical therapists, podiatrists, and other health care professionals can take the information regarding shoe wear construction features and write ‘a prescription’ that the patient can take to athletic shoe stores to procure appropriate shoes,” the paper said. “These same construction features can be communicated to the patient in an understandable manner so that the patient is also able to select appropriate shoes.”