Effects of shoe sole geometry on toe clearance and walking stability in older adults

Thies, Sibylle B.; Price, Carina; Kenney, Laurence; Baker, Rachel

doi:10.1016/j.gaitpost.2015.04.011

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…Bassett & Walsh (2011) [83] shoes improved postural stability among older adult subjects; Brenton-Rule D'Almeida, Bassett, Carroll, Dalbeth and Rome (2014) [84] found that sandals may negatively impact postural stability through their study of women with RA (mean age 67.6 years); Thies et al (2015) [85] found that sole geometry may have an effect on toe clearance and stability during walking; and finally Yamaguchi,…”

Section: Figure 5 Pathway For Use Of Footwear Linked To Fallsmentioning

confidence: 99%

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis

Neville¹,

Nguyen²,

Ross³

et al. 2020

Journal of the American Podiatric Medical Association

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Background: Despite evidence suggesting that lower-limb related factors may contribute to fall-risk in older adults, lower-limb and footwear influences on fall-risk have not been systematically summarized. This study was undertaken to systematically review the literature related to lower-limb and footwear factors that may increase fall-risk among community-dwelling older adults. To facilitate the transfer of findings to clinical care, the literature was synthesized and used to inform recommendations as well as the development of clinical pathways for each factor found to be an influence on fall risk. Methods: PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine were searched for articles pertaining to age-related changes in the lower-limb and their association with fall-risk. To describe the trajectory leading or potentially leading to increased fall-risk, we examined articles that linked age-related changes in the lower-limb, footwear and orthoses to evidence-based fall-risk factors (e.g., balance impairment) or prospectively demonstrated a relationship with falls. Results: The systematic review consisted of 81 articles that met the inclusion criteria. Our results reflect a narrative review of the appraised literature for 8 pathways of lower-limb related influences on fall-risk in older adults. Six out of the eight pathways, including range of motion, orthoses, strength, footwear, pain, and deformity support a direct link with fall-risk. The two other pathways, including plantar skin/soft-tissue and sensory-loss, are connected via intermediate factors but lack studies that provide evidence of a direct link. The overall strength of the evidence available varied considerably for the 8 pathways presented. Conclusions: Findings provide much needed guidance supporting the identification and management of lower-limb and footwear-related influences on fall risk among older adults. Due to the lack or low quality of the evidence in specific areas, some recommendations should be applied with caution until more robust evidence is available.

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Section: Figure 5 Pathway For Use Of Footwear Linked To Fallsmentioning

confidence: 99%

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis

Neville¹,

Nguyen²,

Ross³

et al. 2020

Journal of the American Podiatric Medical Association

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“…Thies et al also report higher MTC over tactile paving of the kind used for the visually impaired, suggesting that subjects perceive an increased POT and compensate by increasing MTC (Thies et al, 2011). Surface inclination also affects MTC with both declines and inclines causing an increase in MTC (Thies et al, 2015(Thies et al, , 2011. Footwear also influences MTC.…”

Section: Minimum Toe Clearance To Infer Probability Of Trippingmentioning

confidence: 96%

“…For example, slippers cause a decrease in MTC when compared to well-fitted shoes, implying a higher POT (Davis et al, 2016). Increasing the angle of the shoe sole to the ground at the toe region of the shoe (rocker angle) has been shown to increase MTC (Thies et al, 2015(Thies et al, , 2011. High heeled shoes can also increase MTC, a possible reaction to a perceived increase in POT, while high-top shoes have the opposite effect on MTC, which may be a consequence of reduced ankle mobility and dorsiflexion during swing.…”

Section: Minimum Toe Clearance To Infer Probability Of Trippingmentioning

confidence: 99%

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Alternative measures of toe trajectory more accurately predict the probability of tripping than minimum toe clearance

Byju

Nussbaum

Madigan

2016

Journal of Biomechanics

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Tripping is responsible for a large percentage of falls. Minimum toe clearance (MTC) during the swing phase of gait is commonly used to infer the probability of tripping (POT). However, there is limited empirical evidence to support the relationship between these two variables, and other measures of toe trajectory may better predict POT than MTC. The goals of this study were to: 1) quantify the relationship between MTC and POT; and 2) explore alternative measures of toe trajectory that may predict POT more accurately than MTC. POT was estimated by comparing the distribution of tripping obstacles measured along heavily-used, paved sidewalks on a university campus, to the toe trajectory of 40 young adults obtained while walking over an obstacle-free walkway in a research laboratory. POT exhibited a curvilinear relationship with MTC, and regression equations were established to predict POT from MTC. POT was more accurately predicted when using virtual points on the bottom of the anterior edge of the shoe to determine MTC, compared to using a physical marker located on top of the toes to determine MTC. POT was also more accurately predicted when using a new measure of toe trajectory (the area below 40mm and above the toe trajectory, normalized by the swing length), compared to just MTC. These are the first empirical results supporting a direct, quantitative relationship between MTC and POT. These results may improve the ability to identify risk factors that influence POT, and aid in developing interventions to reduce POT.

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“…A posterior 10-degree heel bevel is optimal [41]. To enhance toe clearance during the swing phase of the leg, a bevelled nose of 10-15 degrees (this is called a rocker angle) is advised [42]. See Fig.…”

Section: Bevelled Heel and Bevelled Nose Of The Shoementioning

confidence: 99%

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear

et al. 2019

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Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidencebased elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person. 1.1. Morphological changes Changes in foot morphology occur with ageing, [2-7], and might differ between men and women [5]. Older adults have a lower medial foot arch but an increased circumference of the forefoot, ankle and instep [2]. For the same foot length, older men have larger foot parameters than women, including foot width, ball girth, upper arch, and toe depth [3]. Flat feet are more common in older women [8] and the first and fifth metatarsophalangeal angles are increased, which might be due to the higher prevalence of hallux valgus in women [4]. For older women, ball width, high instep circumference, and heel instep circumference also increase with age [5]. 1.2. Pain Many older adults are confronted with foot pain when wearing shoes [4,3,9-11]. This may be due to an increased prevalence of foot deformities, such as hallux valgus, mallet toes, hammer toes and claw toes [8]. Hallux valgus is related to the wearing of shoes with small toe boxes at age 20-39 years [12]. 1.3. Doffing and donning, i.e. getting in and out of shoes Ageing frequently leads to problems with doffing and donning, i.e. getting in and out of shoes [10]. Therefore, easy and effective closing mechanisms are usually preferred. 1.4. Ill-fitting shoes and safety aspects As a consequence of the afore-mentioned changes, older people often wear ill-fitting shoes [13,14] or resort to comfort shoes or slippers, especially in and around the home [9,10]. Unsafe or unsuitable shoes affect balance and gait, and might play

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Effects of shoe sole geometry on toe clearance and walking stability in older adults

Cited by 22 publications

References 21 publications

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis

Alternative measures of toe trajectory more accurately predict the probability of tripping than minimum toe clearance

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear

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