By Lisa Rapaport

(Reuters Health) – Because our feet change shape as we age, shoes that fit when we were young may become uncomfortable and unsafe in our senior years, a research review suggests.

Safe footwear for older adults should have a proper anatomical fit, a well-fitted toe box, a low heel height, a broad enough heel, a snug fit, and be easy to get on and off, researchers note in Maturitas.

While ill-fitting shoes can cause problems at any age, the risks increase for seniors, said Dr. Selene Parekh of the North Carolina Orthopedic Clinic and Duke University in Durham, North Carolina, who wasn’t involved in the review.

Shoes that don’t fit older adults “can mean painful toes, mid arch or foot pain, or even heel pain,” Parekh said in an email.

“This can have implications for stability and risk of falls, and it can also lead to sprains, fractures, and even psychological issues with chronic pain,” Parekh said. “A proper fitting shoe can help alleviate any issues ranging from plantar fasciitis and heel pain, to arthritis, to bunions and hammertoes.”

To assess the optimal characteristics of shoes for older adults, Anton Jellema of Delft University of Technology in the Netherlands and colleagues reviewed 57 previously published studies of footwear and various health issues encountered by older people. Jellema didn’t respond to requests for comment.

Older adults tend to have a lower arch but increased circumference of the forefoot, ankle and instep than younger people, the study team writes.

Shoes that are too narrow or too small can cause pain, but shoes that are too loose can result in lower gait speed, shorter stride length, and an irregular gait pattern, the study team notes.

When older adults get fitted with new shoes tailored to match their foot length and width at the ball of their foot, their gait improves, the research review found.

Wearing high heels can cause problems like heel pain and plantar calluses. While high heels aren’t advised for older adults because of their potential to impair balance and stability, some women who have worn heels for years may experience pain when they switch to flats, the researchers note.

When older women do wear heels, they should look for lower, broader heels that will provide more support.

Soles with a broader surface area may help improve balance and stability and prevent falls, the study team notes. Rigid insoles may also help improve postural stability more than soft insoles.

Older adults who use arch supports may have better balance, functional mobility, and less pain than seniors who don’t, the study team writes.

The review didn’t identify an ideal shoe design for older adults.

“The main limitation of the study is that it outlines some basic footwear features that would be possibly beneficial for an older adult population,” Parekh said. “However, there is no clinical data to suggest that they are recommendations that are correct.”

Still, it makes sense for older adults to pay attention to how their shoes fit and feel, Parekh said.

“When you look to buy the best shoes, you really need to find something that feels comfortable and stable to you,” Parekh advised. “Do not fall into the trap of some of the marketing that tries to fit individuals all into one model or brand of shoe.”

SOURCE: Maturitas, online June 3, 2019.