Does Footwear Affect Balance?
QUIZ: What is the connection between footwear and falling down?
A. All footwear improves balance
B. Footwear is a risk factor for falls
C. There is no connection
The results from the study below will give you the answer. But first, let’s learn about feet.
Your feet are the main contact with your environment, so it is not surprising that your feet give you important sensory information to help your body balance well. The sensation of touch in the somatosensory system tells you about the external environment, where the ground is, what the surface is like and the objects on it; proprioception tells you the position and movement of your feet and limbs (Menant et al.). Your footwear can alter your feet’s interaction with the environment and therefore, the information they can give to your body to help it to balance (Alghadir et al.) — and so, do shoes help or hurt your balance (which increases the risk of falling)?
Preliminary Study - do shoes help or hurt your balance?
ZIBRIO conducted a preliminary study of the balance of five people (mean age 57) with and without footwear over a period of five days. Balance was measured using the ZIBRIO Stability Home scale — creating a balance score that is predictive of whether someone will fall down in the next 12 months. The balance score is a number from 1 to 10; 1-3 is a high risk for falling, 4 is a high-moderate risk, 5-6 is a moderate risk and 7-10 is a low risk for falling.
Results
Participants’ balance scores were significantly worse while wearing their daily footwear than when barefoot, with scores dropping ~25%, (p<0.05). This result consistently showed across 5 days and at different times of day. Furthermore, wearing shoes also increased the participants’ risk of falling, shifting from the low-risk category to the moderate-risk category.
Figure 1: The Effect of Footwear on Balance
Figure 1. The balance scores (mean +/-SE) of the population across 5 days at 1:00 PM, 5:00 PM and 9:00 PM for two conditions: wearing footwear (Shoes) and not wearing footwear (Barefoot). The balance score is measured by the ZIBRIO Stability Home scale. and 1-3 is high risk, 4 is high-moderate , 5 and 6 is moderate and 7-10 is low risk for falling.
Conclusions
This study demonstrates that the use of daily footwear can hinder balance — thus increasing one’s risk of falling both indoors and outdoors. Other studies offer similar results (Reutimann et al., Alghadir et al.), but it is generally stated that more research is needed. In addition to effects on balance, shoes themselves can be hazards. One previous study reports that individuals using slip-on shoes and sandals demonstrated an increased risk of foot fracture from falling (Keegan et al.). Another study of 312 older people cited that those who wore slippers experienced more pain in their feet and yielded significantly greater fall risks than those who did not (Mickle et al.).
The present study specifically focused on the effect of footwear on the body’s ability to balance and the resulting fall risk. Ultimately, although more testing needs to be performed, it can be reasonably suggested that many types of footwear — including the footwear you may use daily — can negatively impact balance and increase fall risk. Whether you know it or not, components of your footwear thought to be fashionable could be tampering with the somatosensory feedback sent to your foot and ankle — damaging your ability to maintain balance and increasing your risk of falling. The CDC reports that 28% of people over 65 fall each year, costing a massive $50 billion annually; this makes it all the more important to ensure your footwear is not at fault.
Hence, the correct answer to the above question, what is the connection between footwear and falling down? is Option B: footwear can be an environmental risk factor for falls.
The shoes that impacted balance in this study had very cushioned soles; this worsened balance by dampening somatosensory feedback.
Naturally, the choice of which shoes to wear will be influenced not just by balance. Foot pain, neuropathy, the occasion, the weather, will all feature in the decision on any given day. There are studies which show that minimal support shoes are associated with stronger foot muscles and a lower incidence of flat feet (which can cause back, knee and plantar fasciitis pain). The key is to recognize that in choosing some types of shoes, there is a trade-off in balance ability. For those who don’t wish to sacrifice the comfort of soft soles, it may be beneficial to start a balance program that can help strengthen the rest of the balance system to compensate for the dampening effect of their shoes.
To measure your balance and test how your own shoes impact your balance, you can now buy your own ZIBRIO Stability Scale here.