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Toni Talks about PT Today

Shoes are Important

Published October 29, 2008 11:27 AM by Toni Patt
As PTs we know shoes are an important part of gait. Unsafe shoes cause falls. Good shoes prevent falls. So when I work on fall prevention with patients, one of the things I look for is the footwear. Eliminating unsafe footwear for high-risk fallers seems like a no-brainer to me. Patients, I have discovered, don't see it that way. The one sure way to rile up a little old lady is to tell her to change shoes. For some reason, that suggestion is along the lines of telling them to cut off a limb. I have been yelled at, scolded and lectured. I've had family members tell me I'm wrong. One 76-year-old woman refused to work with me because I told her she would be better off if she stopped wearing her high heels.

I'm not sure where this comes from. There must be a connection between footwear and loss of independence. Or maybe changing shoes is seen as a sign of getting old. I just don't understand the logic behind someone who'd rather wear shoes that may cause falling and breaking a hip rather than different shoes that would lower their fall risk. It's universal. One of the facilities I worked for required residents to "dress" for meals. At every meal there was a parade of older women teetering on high heels on the way to the dining room. These women could have been "dressed" just as nicely in a shoe with little or no heel.

It isn't just women. Recently I worked with a Parkinson's patient. When I asked for his shoes for gait, his daughter handed me a pair of cowboy boots. Okay, this is Texas. But cowboy boots?! I couldn't even get his feet into them. His daughter said they were his favorite shoes. Favorite or not, the two inch heel would throw him further into forward flexion in standing and facilitate increased knee flexion during gait. I don't think that's the best posture for someone who is already unstable.

Another thing I don't understand is what people refer to as a slipper. Maybe this is a Texas thing like the cowboy boots, but a flip-flop is not a slipper. It is a beach sandal. It is not appropriate footwear for someone with a weak, paralyzed or desensitized lower leg. I have seen patients put more effort into keeping the flip-flop on a foot than into walking. This doesn't even account for the lack of foot and ankle support vital to neuro patients. I'm not an advocate of bracing, but a good shoe protects the foot and ankle while waiting for return of motor function.

Insisting on wearing tight shoes is another thing I don't understand. Why do patients insist on squeezing an edematous foot into a too-tight shoe? Most hospitals stock treaded socks which can accommodate most swollen feet. While there may be a black market for those things outside of the hospital, patients don't always want them. They want to walk barefoot if they can't wear their shoes-bare feet on one of the slickest surfaces to walk on. There is no support for the foot. And I don't care how often a hospital floor is cleaned, I wouldn't want my bare feet on it. Yet patients have trouble understanding why I insist on putting something on their feet.

I've become careful when addressing the shoe issue. Each situation is different. The presence of dementia makes things worse. Explaining things becomes much more difficult. The introduction of Velcro fastens and stylish low heel flats have been a big help in the footwear struggle. Easy off donning and doffing seems to trump style. Sometimes I still have to bite my tongue and accept that I can make someone change if they don't want to. At least I know I tried.


Can you give me some input on hospital patients wearing non skid socks?  I would like to find something else, I see my patients who share bathrooms with  3 to 4 patients so setting hygiene aside, do you have any ideas on safe footwear for these guys to wear during their hospital stay.  I am looking for something safe that will help prevent falls.

joanna, med surg & hospice - RN, Veteran's hosp. January 26, 2009 11:29 PM

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