The effects of shoe fit on gait in community-dwelling older adults
Introduction
Shoes perform many functions in daily living, such as creating an interface between the feet and ground when walking, as well as giving protection and support to the foot during standing and ambulation. As age increases, shoes become more important because older people have age-related changes in foot function and experience problems with deformity and balance [1]. Indeed, inadequate footwear in the elderly increases foot problems [2], [3], postural instability [4] and fall risk [5], [6], [7], [8], and shoe features can affect the ability of standing balance and gait variables. In particular, elevated heels or soft soles can cause postural instability in the elderly [9], [10].
In addition to shoe features, the individual fit of a shoe is equally important. Because the assessment of shoe fit is not well standardized, however, the relationship of shoe fit with physical performance remains unclear. Some researchers have investigated shoe fit in terms of the length and width difference between the foot and shoe [3], [11]. In these cases, ill-fitting shoes were classified as “too loose” or “too tight” with the former indicating that the shoe was too long or too wide relative to the foot size. Burns et al. [11] found that nearly 65 percent of older people admitted to a general rehabilitation ward, regardless of gender, wore ill-fitting shoes that were too loose. Another study found that shoes fitting too tightly were associated with foot pathologies such as corns, calluses and hallux valgus [3]. These studies defined shoe fit from a parameter of size in two dimensions. However, shoe fit should be analyzed along the stereoscopic foot shape because foot function varies considerably according to forefoot, midfoot and rearfoot regions. Ill-fitting points that are too tight in a given foot region tend to affect the efficiency of the mechanical loading transmission between the foot and the shoe. If there is a point that is too loose in a region, the foot will be unstable at this point, and an unfavorable foot slippage may occur inside the shoe during a stance phase of walking.
We hypothesize that wearing ill-fitting shoes affects gait regularity in older adults. To evaluate gait objectively, we used a tri-axial accelerometer and obtained gait variables. We assessed shoe fit separately for forefoot, midfoot and rearfoot regions, as well as the association of shoe fit with gait parameters, in community-dwelling older adults in Japan.
Section snippets
Subjects
All subjects were participants of the program “Health promotion by walking” conducted for community-dwelling older people from November to February. The program had the purpose of increasing participants’ physical activity by encouraging them to walk while wearing well-fitting shoes. A total of 85 community-dwelling older adults (48 males and 37 females aged 60–78 years) volunteered to participate in the program. Data were obtained for a baseline before the program began. All subjects were free
Results
After the shoe fits for HS were evaluated, subjects were classified into the well-fit group (25 males and 23 females) or the poorly-fit group (23 males and 14 females). There were no significant group-differences in fit by age, gender, height, weight, physical activity, foot length, breadth or girth (well-fit vs poorly-fit, Table 1).
Discussion
The results of this study indicate that shoe fit affects gait. We observed that nearly half of the community-dwelling older adults in this study wore ill-fitting shoes, which were primarily too loose in the rearfoot region. Older people wearing ill-fitting shoes tended to walk more slowly, had shorter stride lengths and lower regularity than those wearing well-fitting shoes. The importance of shoe fit in walking was further substantiated by the finding that newly-fitted shoes significantly
Acknowledgments
We would like to thank the Kitasuma Community Association as a partnership. This study was supported by the Older People's Promotion of Health Grant from the Ministry of Health, Labour and Welfare in Japan.
Conflicts of interest: None.
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