What shoes should older adults be wearing?
What’s an appropriate heel drop?
How wide should the toe box be?
What about barefoot shoes for older adults?
These are all very common questions that we see in clinical practice, especially as the evidence & properties of footwear continue to evolve. Let’s take a deep dive into what the current evidence says about shoes for older adults.
Current Evidence-Based Shoe Recommendations for Older Adults
Jellema et al, 2019 provided a really nice systematic review looking at what we should look for in a shoe for older adults:
- Good Fixation – A good lacing system that secures the foot to the shoe.
- Firm, Supportive Heel Counter – This keeps the heel snug in the shoe and limits excessive movement.
- 10 deg beveled heel – A slight upward slop of the heel makes for a smoother initial contact when the heel contacts the ground.
- <10mm Heel Drop – Keeping the heel drop <10mm prevents the center of mass from getting shifted too far anteriorly and allows people to lose most, if not all, of their available ankle dorsiflexion.
- Firm midfoot – A firm midfoot provides support to the midfoot which is a desirable thing for many older adults.
- Slip-resistance, multi-directional tread – Key here being multi-directional tread to allow traction in multiple directions.
- 10-15 deg rocker angle – A rocker angle, upwards slope towards the toe, helps if there is limited big toe extension and allows for a smoother terminal stance during gait.
- Anatomically shaped toe box – This allows the toes to move freely and splay throughout the stance phase.
Should Older Adults Wear Barefoot Style Shoes?
Minimal or barefoot style footwear has seen a recent growth in popularity. With this popularity, we have now started to see its application in the older adult population with promising results.
Ren et al., 2022 showed that barefoot shoe wearers demonstrated a faster swing phase which can result in an increased capacity to recover from a perturbation. Cudejko et al., 2020 showed that the use of a barefoot style shoe increased postural stability during gait.
These findings only showed slightly better results compared to individuals who were wearing traditional shoes. We feel that the main takeaway from this early research is that a barefoot style shoe can be a good option for many older adults and may actually be advantageous.
What should we be looking for when recommending a barefoot style shoe? We encourage clinicians to think about three main things if/when recommending barefoot style shoes. These are not hard stops but things to consider when making recommendations:
1. Do they have PROTECTIVE SENSATION?
Barefoot style shoes, with their minimal stack height, will help you feel every pebble you step on. This is a great thing unless you’ve lost your protective sensation (ie. Peripheral neuropathy).
2. Do they have at least 45 DEG OF BIG TOE EXTENSION?
Barefoot style shoes have no rocker angles (upward slope towards toes) so they’ll ask more of the big toe during several activities like terminal stance in gait, walking uphill, lunging, etc. If people don’t have this range, then they typically alter their mechanics like shortening their stride length. This isn’t necessarily a bad thing but something that we need to be aware of.
3. Do they have at least 10 DEG OF ANKLE DORSIFLEXION?
The zero drop (no difference in sole thickness from the heel to the forefoot) will ask more of the ankle, in activities like terminal stance in gait, walking uphill, squats, lunges, etc. Similar to the lack of big toe extension, this can result in an alteration of gait mechanics such as shortening of stride length. Not bad in & of itself, but we need to be aware.
We have enough evidence at this point to make some solid shoe recommendations for our older adult clients. This is an area we cannot neglect and can have a huge impact in their lives!