If you did not know all that I know about feet, you would think geriatricians (doctors for patients 65+ years old) have a foot fetish. We are obsessed with feet, but in a good way. You see, feet play a big role in balance and preventing falls. We really care about our elder patients’ health, which is why we care about what our patients wear. Falls kill, and if one is fortunate enough to survive a fall, they can still leave a patient disabled for life.

I can, and I will tell you all that I know in terms of research, but here is what I have a hard time with, geriatricians have great academic knowledge but translating that into practical advice is ridiculously hard. I can tell what to look for in a shoe, but the way the shoe industry is popping, it is extremely hard to really know what shoe is the right shoe. Also, elders can have deformities in their feet, making it even more challenging for us to give practical advice on shoes.

But you know what I find even harder to believe? The entire shoe industry has completely side-lined a demographic of customers. If you have shopped online or in stores, you will notice that the shoes are organized based on purpose. There is a section called lifestyle which is for everyday wear; then there are activity-based shoes like tennis, basketball, running, etc. Imagine if there was a section for seniors based on the current evidence for shoes. Wouldn’t that be great? If researchers did a randomized controlled trial on popular shoes to see if the shoes could prevent falls or reduce them. Wouldn’t that be cool?

I have a dream. I prescribe shoes instead of more pills. I think that is every geriatrician’s dream. Nike, are you listening? Evidence-based shoe therapy for seniors to prevent falls could be a thing in 2023.

As promised, I will share with you our trade secret. So studies have shown that elders like to wear slippers more than shoes, likely because slippers are more accommodating of foot deformities than shoes. Also, it is easier for them to slip into them. Bending down to wear shoes can be difficult for a lot of elders. So slippers often win. When elders do wear shoes, physical therapists have noted that elders wear ill-fitting shoes, either they are too big for them or too narrow or too tight. When shoes are too tight, it can lead to problems like Morton’s neuroma (the painful spot between toes in the ball of the foot due to nerve irritation), corns, and ulcers. Yikes.

A lot of the seniors will ditch shoes or slippers at home. One would think that would actually help them fall less because they can feel the ground better, but that is not the case. Walking barefoot increases the risk of falls by almost 11 times compared to when wearing an athletic shoe. We aren’t entirely sure why that happens, but it does.

Heel height matters too. Women, it is time to give up those heels. Heels greater than 2.5 cm can contribute to falls. So flat shoes with a greater surface area are crucial. I am not sure how one will go to a store and figure out the surface area of a shoe, but that is what research tells us to do, buy shoes with more surface area.

Also, some things are counterintuitive. One would think comfortable soft soles would be the best, but it is actually not so. Firmer soles fare better than soft soles in terms of falls. Soft soles somehow confuse the brain; the brain cannot accurately know how the foot works in real-time when the foot is resting on a nice soft foam. It is almost unfair. But yes, hard soles are better for you if you are prone to falling. Also, make sure the soles are not too thick. A shoe with a thin sole and firm consistency is what you should go for.

But will these shoes exacerbate pain in your foot? That I cannot answer. Most of these studies made people in the geriatric age group walk a metal beam barefoot and then with a shoe and measure their balance. Or these studies were observational; they just compared what people wore and how much they fell. They weren’t designed to answer if these hard thin soles would hurt after a long day. And knowing that is important because I am sure many people will ditch these shoes if they are uncomfortable.

Researchers in England actually tried to see if podiatrists could do certain things to improve falls. They taught patients exercises for their ankles, got them better-fitting shoes or orthotics if need be, and compared if these interventions helped them reduce falls. Unfortunately, the study failed to show a significant difference between those who received this intervention vs. those who did not. They also saw an increase in pain in patients who received this intervention. So the verdict on shoes is divided right now. There aren’t really large Randomized controlled trials on commercial shoes as such to help guide clinicians, which I really wish there were. It is truly a low-hanging fruit; shoes aren’t as costly as a new drug, and everyone needs shoes. So it’s a shame we have not looked into it yet.

Sheetal Gambhir is a geriatrician.