1167 JRRD JRRD Volume 45, Number 8, 2008 Pages 1167–1182 Journal of Rehabilitation Research & Development Optimizing footwear for older people at risk of falls Jasmine C. Menant, PhD; 1* Julie R. Steele, PhD; 2 Hylton B. Menz, PhD; 3 Bridget J. Munro, PhD; 2 Stephen R. Lord, PhD, DSc 1 1 Prince of Wales Medical Research Institute and School of Public Health and Community Medicine, University of New South Wales, Randwick, New South Wales, Australia; 2 Biomechanics Research Laboratory, University of Wollongong, Wollongong, New South Wales, Australia; 3 Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia Abstract—Footwear influences balance and the subsequent risk of slips, trips, and falls by altering somatosensory feed- back to the foot and ankle and modifying frictional conditions at the shoe/floor interface. Walking indoors barefoot or in socks and walking indoors or outdoors in high-heel shoes have been shown to increase the risk of falls in older people. Other footwear characteristics such as heel collar height, sole hard- ness, and tread and heel geometry also influence measures of balance and gait. Because many older people wear suboptimal shoes, maximizing safe shoe use may offer an effective fall prevention strategy. Based on findings of a systematic litera- ture review, older people should wear shoes with low heels and firm slip-resistant soles both inside and outside the home. Future research should investigate the potential benefits of tread sole shoes for preventing slips and whether shoes with high collars or flared soles can enhance balance when chal- lenging tasks are undertaken. Key words: accidental falls, aged people, balance, biomechanics, footwear, gait, heel height, insoles, rehabilitation, slips, trips. INTRODUCTION Many falls experienced by older people result from age-related deterioration of the balance and neuromuscu- lar systems [1]. Most falls occur during motor tasks [2], and footwear has been identified as an environmental risk factor for both indoor and outdoor falls [3–4]. By altering somatosensory feedback to the foot and ankle and modi- fying frictional conditions at the shoe-sole/floor inter- face, footwear influences postural stability and the subsequent risk of slips, trips, and falls. While the pri- mary role of a shoe is to protect the foot and facilitate propulsion [5], fashion has strongly influenced the design of footwear throughout the ages, compromising the natural functioning of the foot [5–6]. As a result, little is known about what constitutes safe footwear for older people under- taking activities in and around the home [7]. Because foot- wear appears to be an easily modifiable risk factor for falls, identifying the specific shoe features that might facilitate or impair balance in older people is imperative for the design of targeted fall prevention interventions and provision of evidence-based recommendations. In this systematic review, we initially describe the types of footwear commonly worn by older people. We then highlight studies in which footwear has been recog- nized as a risk factor for falls. Finally, we review the Abbreviations: COF = coefficient of friction, COM = center of mass, COP = center of pressure, MTP = metatarsal-phalangeal. * Address all correspondence to Jasmine C. Menant, PhD; Prince of Wales Medical Research Institute, Barker Street, Randwick, NSW, 2031, Australia; +61-2-9399-1066; fax: +61-2-9399-1204. Email: j.menant@powmri.edu.au DOI: 10.1682/JRRD.2007.10.0168