The Effects of Usual Footwear on Balance Amongst Elderly Women
The Effects of Usual Footwear on Balance Amongst Elderly Women
Objective: to examine the effects of footwear on balance in a sample of older women attending a day hospital.
Design: this was a crossover trial with a quasi-randomised allocation.
Setting: assessments took place in the geriatric day hospital.
Subjects: a cohort of 100 older women aged 60 years and over attending a day hospital.
Methods: demographic data and a brief falls history were recorded. Participant's footwear was assessed using a footwear assessment form. A Berg Balance Scale (BBS) was completed under two conditions--shoes on and shoes off with order counter-balanced.
Results: the mean BBS was 39.07 (SD 9.14) with shoes on and 36.54 (SD 10.39) with shoes off (P < 0.0001). Balance scores were significantly higher with shoes on for 10 of the 14 Berg subcategories. Lower barefoot BBS scores were associated with a greater beneficial effect of footwear on balance (P < 0.001). Shoe characteristics were not associated with change in the BBS score.
Conclusions: Wearing their own footwear significantly improved participants' balance compared to being barefoot. The greatest benefit of footwear was seen in those with the poorest balance. Further studies should investigate whether particular types of footwear are associated with greater benefit.
Around one in three older people falls each year with one-third of over 65s and half of over 80s falling each year. Some authors have suggested that poorly fitting footwear and slippers or shoes with inadequate fixation may increase the risk of trip-related falls. The slip resistance of shoes has not been extensively evaluated although it has been suggested that older people at risk of falls should wear textured slip-resistant soles and some laboratory mechanical tests to simulate heel contact suggest that a bevelled heel may increase slip resistance.
Wearing inappropriate footwear may also impair balance and alter gait patterns in the elderly. The shoe features which have been shown to influence balance performance include heel height, heel collar height and sole thickness and hardness.
Heel height and width influence a shoe's tendency to tip sideways on an uneven surface, as well as influencing gait and posture. Lord and Bashford evaluated balance in 30 older women when barefoot, wearing low-heeled walking shoes, wearing high-heeled shoes and wearing their own shoes. The worst balance performance was seen when subjects wore high heels.
High-heel counters have been associated with improved balance. The authors postulated that the heel collar height may be associated with improving proprioceptive feedback of ankle position and movement thereby providing an additional tactile cue and contributing to greater ankle stability.
Robbins found that older men performed better with thin hard-soled shoes rather than running shoes with soft soles and hypothesised that soft midsoles induce a more unstable foot position; the deformable material alters plantar feedback and may induce a greater maximum supination angle that is underestimated by the wearer which may limit postural adaptations to maintain stability.
Contrary to the findings of Robbins et al., Lord et al. found no relationship between sole hardness and balance in 42 older women. However, the results are not directly comparable as the authors used different balance tests (beam walking test versus swaymeter) and different methods to evaluate footwear midsole density.
The sole material and shoe tread design can affect the coefficient of friction on the walking surface, which may influence the risk of slipping.
Most of the studies to date have been carried out in community dwelling older subjects. The effects of footwear on older subjects at high risk of falls have been less studied. The aim of this study was to examine the effects of usual footwear (versus going barefoot) on balance in frail older women attending a geriatric day hospital.
Objective: to examine the effects of footwear on balance in a sample of older women attending a day hospital.
Design: this was a crossover trial with a quasi-randomised allocation.
Setting: assessments took place in the geriatric day hospital.
Subjects: a cohort of 100 older women aged 60 years and over attending a day hospital.
Methods: demographic data and a brief falls history were recorded. Participant's footwear was assessed using a footwear assessment form. A Berg Balance Scale (BBS) was completed under two conditions--shoes on and shoes off with order counter-balanced.
Results: the mean BBS was 39.07 (SD 9.14) with shoes on and 36.54 (SD 10.39) with shoes off (P < 0.0001). Balance scores were significantly higher with shoes on for 10 of the 14 Berg subcategories. Lower barefoot BBS scores were associated with a greater beneficial effect of footwear on balance (P < 0.001). Shoe characteristics were not associated with change in the BBS score.
Conclusions: Wearing their own footwear significantly improved participants' balance compared to being barefoot. The greatest benefit of footwear was seen in those with the poorest balance. Further studies should investigate whether particular types of footwear are associated with greater benefit.
Around one in three older people falls each year with one-third of over 65s and half of over 80s falling each year. Some authors have suggested that poorly fitting footwear and slippers or shoes with inadequate fixation may increase the risk of trip-related falls. The slip resistance of shoes has not been extensively evaluated although it has been suggested that older people at risk of falls should wear textured slip-resistant soles and some laboratory mechanical tests to simulate heel contact suggest that a bevelled heel may increase slip resistance.
Wearing inappropriate footwear may also impair balance and alter gait patterns in the elderly. The shoe features which have been shown to influence balance performance include heel height, heel collar height and sole thickness and hardness.
Heel height and width influence a shoe's tendency to tip sideways on an uneven surface, as well as influencing gait and posture. Lord and Bashford evaluated balance in 30 older women when barefoot, wearing low-heeled walking shoes, wearing high-heeled shoes and wearing their own shoes. The worst balance performance was seen when subjects wore high heels.
High-heel counters have been associated with improved balance. The authors postulated that the heel collar height may be associated with improving proprioceptive feedback of ankle position and movement thereby providing an additional tactile cue and contributing to greater ankle stability.
Robbins found that older men performed better with thin hard-soled shoes rather than running shoes with soft soles and hypothesised that soft midsoles induce a more unstable foot position; the deformable material alters plantar feedback and may induce a greater maximum supination angle that is underestimated by the wearer which may limit postural adaptations to maintain stability.
Contrary to the findings of Robbins et al., Lord et al. found no relationship between sole hardness and balance in 42 older women. However, the results are not directly comparable as the authors used different balance tests (beam walking test versus swaymeter) and different methods to evaluate footwear midsole density.
The sole material and shoe tread design can affect the coefficient of friction on the walking surface, which may influence the risk of slipping.
Most of the studies to date have been carried out in community dwelling older subjects. The effects of footwear on older subjects at high risk of falls have been less studied. The aim of this study was to examine the effects of usual footwear (versus going barefoot) on balance in frail older women attending a geriatric day hospital.