Choosing Shoes for Older Feet

Why footwear matters for falls and comfort

• Studies of falls in older adults repeatedly find that barefoot walking, slippers and worn or poorly fitting shoes are linked with falls, while sturdy, well-fitting shoes with good grip are protective. See falls risk assessment at home and walking aids and footwear.
• Feet and ankles send information to the brain about the ground. Thick, soft or very hard soles can dull this feedback; a firm, thin-ish, grippy sole gives better feel.
• Painful feet change the gait, causing limping, shorter steps and altered balance.
• Poorly fitting shoes cause corns, calluses, ulcers and ingrown toenails, especially in diabetes or poor circulation.

Features of a good shoe

Fit. The most important feature. There should be about a thumb's width (1 to 1.5 cm) between the longest toe and the end of the shoe. The ball of the foot should sit at the widest part of the shoe. The heel should be held firmly without slipping. The shoe should not pinch, rub or press anywhere.

Width and depth. Choose a wide, deep toe box, so the toes can spread and curled toes are not squashed. Shoes with width sizing (narrow, standard, wide, extra wide) help. A shoe that is too narrow causes bunions and corns.

Sole. A thin to medium, flexible but not floppy sole, with a non-slip tread pattern. Rubber soles grip better than leather or plastic on wet surfaces. A very thick, soft sole can be unstable; a very thin sole offers little cushioning. The sole should flex at the ball of the foot, not at the middle.

Heel. Low, broad and stable. Heels of about 2 to 3 cm are fine; high or stiletto heels raise falls risk. A completely flat shoe is not always best for those with stiff ankles or Achilles tightness; a slight heel may be more comfortable. A heel flare, sloping outward at the base, can help stability, while a very wide flare may catch.

Heel counter. A firm cup at the back that holds the heel in place. Press the heel counter: it should not collapse.

Fastening. Laces, Velcro straps or buckles allow adjustment for swelling and hold the foot in. Slip-ons and backless shoes allow the foot to slide. For people with arthritic hands, Velcro or elastic laces help; see dressing aid guide.

Upper. Soft, breathable, flexible materials such as leather, canvas or breathable mesh, with no seams or stitching that rub, particularly over bunions and toes. Avoid stiff, hard uppers.

Insole. A cushioned, removable insole lets you insert orthotics if needed; see insoles and orthotics for foot and heel pain.

Weight. Light shoes are easier to lift, which helps people who shuffle or have weak hip flexors.

Colour. For people with poor vision, a contrast between shoe and floor helps them see their feet; a bright pair is easier to find at night.

What to avoid

• Backless slippers, flip-flops and loose sandals, where the foot slides and toes grip to keep them on.
• Smooth, slippery or very worn soles.
• High heels, pointed toes and tight shoes.
• Hard plastic or very stiff uppers.
• Shoes that are too big, which cause tripping and rubbing.
• Thick, soft platform soles, which reduce stability.
• Walking barefoot on hard or slippery floors. If a person prefers to be barefoot at home, check that the floor is safe and the feet are protected; people with neuropathy should not go barefoot.
• Wearing socks alone on polished floors. Use non-slip socks with grips.
• Hand-me-down shoes.

Slippers and indoor footwear

Many falls happen at home in slippers or socks.

• Choose closed-back slippers or shoes with a heel strap and a firm, non-slip, thin rubber sole, and a secure fastening.
• Avoid loose, soft, scuffed-up slippers that flap.
• Choose a washable, breathable lining.
• Wear indoor shoes for the whole house, not just in the bedroom, and keep a pair by the bed for night trips; see bedroom setup for night safety.
• At bath time, use bathroom slippers with a good tread; see non-slip bath mats and bathroom flooring and wet-floor safety.
• For temple visits where shoes are removed, bring socks with grips and plan for slippery floors; see mobility aids for temples and weddings.

Special situations

Diabetes and neuropathy. Feet may be numb, dry and prone to ulcers. Shoes should be roomy and soft inside, with no seams or rough edges, a deep toe box, adjustable fastening and cushioned, seamless insoles. Check inside shoes with your hand before wearing for stones, folds and damage. Avoid going barefoot. Therapeutic shoes may be prescribed. See diabetic foot care at home and neuropathy foot care.

Swollen feet and ankles. Choose shoes with adjustable fastening and extra depth; try shoes in the afternoon when feet are largest; avoid tight socks; see swollen legs in older adults.

Bunions, hammer toes and corns. Wide, deep toe box, soft stretchable upper, no seams over bumps; a cobbler can stretch shoes; see bunion correctors: what they can and cannot do.

Flat feet or heel pain. Supportive shoes with a firm heel counter and arch support, and insoles; see heel pain and plantar fasciitis after 60.

Arthritis. Light, cushioned shoes with Velcro; a rocker-bottom sole can ease forefoot pain, with advice.

Weak ankles or foot drop. Lace-up, ankle-height shoes for support; foot drop may need a brace; see ankle supports for weak or swollen ankles.

Wheelchair users. Shoes still protect the feet. Choose slightly roomier, easy-fastening shoes, and check heels and toes for pressure; see pressure care in a wheelchair.

After a stroke, one foot may be larger or weaker. Buy for the larger foot, and use insoles to adjust the other; see walking aids after a stroke.

Gout and inflamed joints. Soft, wide shoes, and open sandals in flares.

Hot, humid climate. Breathable materials, moisture-wicking socks, rotating shoes so they dry; open shoes may be comfortable but offer less protection. Sandals should have a heel strap and closed toe or secure straps. In the monsoon, avoid smooth rubber chappals on wet roads; choose a grippy tread.

How to shop for shoes

1. Shop in the afternoon or evening, when feet are at their largest. 2. Have both feet measured each time, standing, as foot size changes with age and one foot is usually larger. Fit the larger foot. 3. Wear the socks you will normally wear, or bring the insoles you use. 4. Check inside the shoe with your hand for seams, stitching and rough spots. 5. Press the toe box for room, the heel counter for firmness and bend the shoe at the ball of the foot. 6. Stand and walk around the shop, on a hard floor if possible. Check the heel does not slip and the toes do not touch the front. 7. Test on a slippery surface such as smooth tile, if the shop allows, to feel the grip. 8. Do not expect shoes to "break in." A good shoe is comfortable at once. 9. Check the return policy; see equipment returns, warranty and servicing. 10. Buy two pairs to rotate, if possible.

Care and replacement

• Check the soles and heels for wear every month. Replace shoes when the tread is smooth, the heel is worn unevenly, the midsole is crushed or the upper cracks.
• Air shoes after wear and let them dry out; use newspaper to absorb moisture in the monsoon.
• Clean and re-proof as the maker says.
• Check inside for stones or damage before putting on.
• Replace laces and Velcro as needed.
• Do not wear shoes that are damaged, even if sentimental.

Socks

Choose soft, seamless, cotton-blend or wool-blend socks that wick moisture, without tight elastic tops, which can leave marks and restrict circulation. Seamless or flat-seam socks suit diabetic feet. Change daily. Non-slip socks with grips help indoors.

Getting into and out of shoes

Use a long-handled shoe horn, elastic laces or Velcro to avoid bending; sit to put on shoes; see dressing aid guide and arthritis daily living gadgets.

When to ask a professional

See a podiatrist for foot pain, corns, calluses, nail problems, diabetes, neuropathy, deformity or advice on shoes and orthoses. A doctor should see sores, redness, swelling, numb or discoloured feet. A physiotherapist or occupational therapist can assess gait, balance and the need for aids. An orthotist can supply therapeutic footwear. Seek urgent care for a foot wound in someone with diabetes.