Older people and ill fitting shoes

Abstract

Background: Foot health is an important issue in older people. Inappropriate shoes increase the risk of callous and ulcer formation, as well as increasing the risk of falls. There are no data defining the size of this problem. Objective: The aim of the study was to investigate the proportion of elderly people on a general rehabilitation ward wearing incorrectly sized shoes and to look for the presence of complications. Methods: Sixty five consecutive patients (mental state questionnaire score >6) admitted to a rehabilitation ward had their foot length and width measured, and the size of their current footwear recorded. Sensation was tested with a standard 10 g monofilament. The presence of ulceration was noted. Foot pain was recorded by the patient on a visual analogue scale. Any history of diabetes mellitus, peripheral vascular disease, or peripheral neuropathy was noted. Results: The median age of the subjects was 82 (range 64-93). Six (9%) had a history of diabetes, seven (11%) had symptomatic peripheral vascular disease, and 17 (26%) had sensory impairment. Ten patients (15%) had foot ulceration present, and 47 patients (72%) had ill fitting shoes (a discrepancy in length of more than half a British shoe size fitting or more than one British width fitting, 7 mm).Incorrect shoe length was significantly associated with the presence of ulceration (odds ratio (OR) = 10.04, p = 0.016). Presence of ulceration was significantly associated with a history of peripheral vascular disease (OR = 11.56, p = 0.008). Pain was significantly associated with incorrect shoe length (p = 0.0238) and with sensory impairment (p = 0.0314). Conclusion: Most older people on a rehabilitation ward wore ill fitting shoes. An association was found between ill fitting shoes and self reported pain, and between ill fitting shoes and ulcer formation. A straightforward assessment of footwear in older people could improve comfort and avoid preventable foot disorders.

Prevalence of active foot disease and foot disease risk factors in a subacute inpatient rehabilitation facility: a cross-sectional prevalence study

“…These outcomes highlight the potential burden of foot disease within the rapidly expanding Australian subacute inpatient sector and forecast the need to ensure evidence-based foot disease management is available in subacute inpatient rehabilitation facilities to prevent acute inpatient re-admission and amputation. The prevalence of foot disease in this subacute inpatient population were similar, and in some cases higher, than those reported in other at risk populations for foot disease and other smaller subacute inpatient studies [15][16][17][18][19][20][21][22][23]. For example active foot disease prevalence reported in this study via current foot ulcers (12%) appears to broadly align with the foot ulcer prevalence reported in two other smaller subacute inpatient studies [22,23]; foot ulcer prevalence in those studies were 7% (Australian study) [22] and 15% (UK study) [23].…”

Obese older adults suffer foot pain and foot-related functional limitation

“…Although feet that are structurally sound can perform daily tasks with ease, deviations from normal foot structure can compromise foot function and, in turn, cause discomfort and/or pain [6]. Extensive research has confirmed that overweight and obesity negatively affect foot structure and function in children, whereby obese children have been found to have flatter feet and generate significantly higher plantar pressures during walking relative to non-overweight children [7][8][9][10][11][12][13].…”

The impact of different footwear characteristics, of a ballet flat pump, on centre of pressure progression and perceived comfort

“…Shoe sizing changes have been previously reported within running shoes where the marketed size is not representative of the actual size of the shoe [30]. If consumers are not aware of this sizing error, shoes that are too small or big could be worn without any knowledge by the user contributing to potential pathology [7].…”

“…A shoe that is either too loose or too tight can also influence comfort with tissue compression in a snug shoe and slippage or friction in a larger shoe [4]. Observations on shoe wearing habits in the elderly indicates that up to 72% wear shoes that are ill-fitting associated to foot pain and ulceration [7]. Despite the strong evidence to support the notion that ill-fitting footwear can cause foot pain and ulceration, people continue to wear shoes that do not fit the foot [8].…”