Adaptive Footwear

Footwear is the interface between the person and the floor — and it is one of the most modifiable, most overlooked fall risk factors. The right shoes can dramatically reduce fall risk. The wrong footwear can undermine every other safety measure in the home.

Section 01

What Makes Footwear Safe or Unsafe

Safe footwear characteristics

Non-slip, rubber sole
Low heel (less than 1 inch)
Closed toe and heel
Fits snugly — does not slip off foot
Adequate ankle support
Easy to put on (for compliance)

Unsafe footwear characteristics

Smooth leather or plastic sole
High heel of any height
Open back (mules, backless slippers)
Too large or too loose
Flexible sole with no grip
Slippers worn as primary footwear

Section 02

The Slipper Problem

⚠ Slippers are the most common unsafe footwear

The majority of indoor falls involve clients wearing slippers or socks. Many older adults wear backless slippers ("mules" or "scuffs") that require the foot to grip the shoe to keep it on — this significantly alters gait and can cause trips. Even well-fitting slippers typically have smooth soles with minimal grip.

The standard in fall prevention is: non-slip, closed-toe, closed-heel footwear worn at all times when ambulating. "I'll just walk to the kitchen — I'll be fine in my slippers" is not an acceptable risk for a high-fall-risk client.

Section 03

Fitting Issues That Increase Fall Risk

Too large: Shoes that are too large shuffle and catch on transitions. Older adults frequently continue wearing the same size despite foot changes — edema, bunions, and soft tissue changes often require a larger or differently shaped shoe.
Too small: Pain from poorly fitting shoes causes compensatory gait changes that reduce stability.
Laces that come undone: An untied shoelace is an immediate fall hazard. Ensure laces are tied before the client ambulates, or consider Velcro closures or elastic laces for clients who struggle to tie shoes.
Edema: Swollen feet may not fit into regular footwear correctly. Report significant edema that prevents proper shoe fitting to the nurse.

Section 04

Putting Shoes on Safely

Putting on shoes is itself a fall risk — particularly if the client attempts to stand on one foot to put on the other shoe. Safe shoe-donning technique:

Always seated: The client should never stand on one foot to put on shoes. Always seated on a stable surface.
Long-handled shoehorn: Allows shoes to be put on without bending far forward — which shifts the center of gravity dangerously.
Sock aid for clients with limited flexibility: A sock aid allows socks to be put on without bending to the foot level.
Elastic laces or Velcro: Remove the need to tie — simplifying compliance and reducing time spent in a bent-forward position.

Section 05

What to Check and Report

✓ Footwear safety checklist

Is the client wearing closed-toe, closed-heel, non-slip footwear during all ambulation?
Are shoes the correct size — not too large, not too small?
Are laces tied before the client stands?
Are soles in good condition — not worn smooth?
Does the client have appropriate footwear for all conditions (including outdoor/weather)?

Report to the nurse: client ambulating in socks only, backless slippers as primary footwear, shoes with smooth worn soles, client unable to put on appropriate shoes due to edema or flexibility. These require OT evaluation and possibly prescription footwear.