Dr. Michael Gross PT, PhD, FAPTA , Professor at UNC Chapel Hill, recently gave a presentation to a group of Alumni on Shoe Recommendations for the Older Adult based on some soon to be published research he had conducted.
I intend to highlight what I felt were the most important clinical pearls here:
Poor Balance:
**A heel lift of 1.3 in resulted in increased postural sway for older women. This was shown to decrease forward reach and decrease gait velocity. Take home: An older adult who demonstrates a slow gait pattern already would be even slower with higher heels. May not be functional to get across a street.
**Don't throw the heels out just yet; a person with tightness in the triceps surae would benefit from a heel lift to decrease the risk of backward falls
**Height of heel collar: Greater height shown to increase stability in gait, increase standing stability and reduce postural sway.
**Rocker Bottom or Not? The shoe that even Joe Montana gets his "work out" in, provides a limited base of support in both the anterior and posterior directions. Not what an older adult needs. Take Home: not all rocker bottoms are bad and some like the Etonic Minado (R) only have an anterior portion of the rocker bottom configuration which may be desirable for certain foot conditions
Slipping:
**Avoid very hard sole materials
**Wear shoes with wider and deeper tread surfaces
**Take shorter step lengths (reduces slip force and increases friction)
Risk for Falling:
**More likely to fall indoors if barefoot or in socks or slippers compared to when wearing athletic shoes specifically
**Increase surface area of sole material associated with decreased falls risk
Shock Absorption:
**Shock absorbing shoe is effective and inexpensive method for protection of total joint components
**Want a mid-range stiffness in the shoe (Thicker the sole the longer to deform it, but law of diminishing returns does apply)
**Older adults should select athletic shoes with thicker sole materials, with moderate stiffness, and should replace their shoes following prolonged use
How to tell when you need a new pair of shoes: Does the ground feel harder to you? Stop by a store and try on a new pair of the same shoe. If any different, time to get a new pair.
Knee Osteoarthritis:
Varus Knee (Medial Compartment OA): Load is reduced with lateral wedged insoles and very flexible shoes (basically get as flimsy a shoe as possible and have laces tied very loose)
Valgus Knee (Lateral Compartment OA): Medially wedged insoles and supportive shoes will reduce load
Heel Lift: Increased height of heel lift will increase plantarflexion forces and in turn will increase anterior load on knee
Thank you Dr. Gross for the useful information!
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