Footwear & Fall Prevention

Why footwear matters

The shoe is the mechanical interface between the older adult and the ground. Sole hardness, heel height, heel-collar height, tread pattern, and fit all directly affect balance, gait stability, and the ability to recover from a stumble. A well-chosen shoe can meaningfully reduce fall risk; a poor shoe — or bare feet, or socks on hard floors — can undo everything else in a fall-prevention plan.

What the evidence recommends

• Low, broad heel. Heel height under about 2.5 cm (1 in) with a wide base. High and narrow heels shift the center of gravity forward and shrink the base of support.
• Firm, slip-resistant sole with visible tread. Avoid fully smooth soles and avoid overly soft foam that collapses under weight — both reduce stability and sensory feedback from the floor.
• Thin, firm midsole. Thick, cushioned midsoles dampen the sensory input from the foot that older adults rely on for balance. Firmer, thinner soles improve postural sway.
• Supportive heel collar. A snug, higher heel collar (around the ankle) improves stability, especially on uneven surfaces.
• Secure fastening. Laces, velcro, or straps that hold the foot in place. Backless shoes, loose slippers, and flip-flops are consistently associated with higher fall risk.
• Proper fit. Enough room for the toes, no heel slip, measured late in the day when feet are largest. Refit every 1–2 years — foot shape changes with age.
• Indoors counts. Wear supportive shoes or well-fitted, non-slip footwear indoors. Walking barefoot or in socks on hard floors is a known fall risk.

What to avoid

• High heels, narrow heels, and heels over ~2.5 cm.
• Backless slippers, mules, and flip-flops.
• Fully smooth-soled dress shoes.
• Overly soft, thick foam soles that compress under weight.
• Socks alone on hard flooring.
• Shoes that are too big, too loose, or stretched out.

Buying checklist

1. Try shoes on late in the day, wearing the socks you'll actually use.
2. Press the sole — it should be firm, not squishy.
3. Bend the shoe — it should flex at the ball of the foot, not in the middle of the arch.
4. Check tread — visible pattern, not glass-smooth.
5. Fasten it — laces, velcro, or a real strap. No slip-ons for daily walking.
6. Walk in the store on a hard floor. If your heel lifts or your foot slides, keep looking.