Effects of footwear features on balance and stepping in older people.

BACKGROUND Although footwear has been linked to falls in older people, it remains unclear as to which shoe features are beneficial or detrimental to balance in older people. OBJECTIVE To systematically investigate how footwear features affect balance and stepping in older people. METHODS 29 community-dwelling people (mean (SD) age, 79.1 (3.7) years) undertook tests of postural sway, maximal balance range, coordinated stability and choice-stepping reaction time in a standard shoe and seven other shoes that differed from the standard shoe in one feature only, namely: elevated heel (4.5 cm), soft sole, hard sole, flared sole, bevelled heel, high heel-collar and tread sole. RESULTS Repeated-measures ANOVA with simple contrasts revealed significantly increased sway in the elevated heel versus the standard shoe condition (p < 0.05). A footwear performance index based on the sum of z-scores across three tests (sway, coordinated stability and choice-stepping reaction time) normalized to the standard condition indicated that the elevated heel was most detrimental to balance (p < 0.05) whereas a high heel-collar and a hard sole showed trends towards being beneficial. CONCLUSION An elevated heel of only 4.5 cm height significantly impairs balance in older people. The potential benefits of wearing shoes with a hard sole or a high heel-collar on balance in older people warrant further research in ambulatory tasks.