As we age, our feet and the way we walk and move change, and shoes that once felt great when we were younger become increasingly uncomfortable or unsafe. Natural changes, such as decreased muscle strength, arthritis, swelling, and foot deformities, mean that the right pair of shoes can make the difference between walking confidently, suffering pain, or even falling. A study in the Journal of the American Geriatrics Society found that over 50% of older adults who fell were wearing unsafe or poorly fitting shoes at the time of their fall. Shoes do more than protect our feet; they also affect balance, posture, mobility, and overall independence. Well-designed shoes can reduce the risk of falls, improve stability, and alleviate joint and foot pain, helping older adults stay active and independent for longer.
Shoe Features that Reduce Fall Risk
Multiple reviews and studies converge on several recurring design features that improve stability in older adults:
Secure fixation (laces, Velcro, or buckles): shoes that hold the foot to the sole reduce internal slipping and improve control. Many studies and reviews identify good fixation as a core feature.
Low, wide heel and firm sole: low heel height (small elevation), a broad heel base, and a medium-firm sole/midsole reduce postural sway and improve balance. Very high or narrow heels destabilize gait.
Slip-resistant tread: a sole with good traction and an appropriate tread pattern reduces slip events (particularly outdoors and on wet surfaces). The CDC and hospital podiatry guidance emphasize non-slip soles.
A correct fit and roomy toe box: with adequate length, width, and depth (especially at the toes, avoids crowding, reduces pain, and allows for natural toe motion that helps maintainbalance. Up to half of older patients have poorly fitting shoes, as determined by clinical examination.
Heel counter & ankle collar: a firm heel counter (the back part of the shoe) and a collar that supports the ankle can help stabilize the rear foot during walking.
Sole stiffness and cushioning (moderation matters): overly soft or highly compressible soles can reduce stability; conversely, very rigid soles may reduce sensory feedback. Evidence suggests that a medium-firm sole often strikes a balance between cushioning and stability. Some newer studies also examine “minimal” or balance-training shoes, which can enhance foot sensory feedback for some older adults; however, results vary by individual.
Foot Shapes and Common Health Issues
Here are specific foot and health-related issues common in older adults, along with guidance on selecting footwear that is appropriately matched to their needs.
- Wide fore-foot/bunions (hallux valgus): Choose shoes with a wide, rounded toe box and low seams across the medial forefoot. Narrow shoes can increase pressure or pain.
- Hammer toes/dorsal toe pressure: Avoid shoes with narrow toe boxes and high seams, and choose soft, roomy uppers.
- Swelling/edema: Choose shoes with adjustable fixation, removable insoles, and stretchable or adjustable materials to help accommodate foot size changes throughout the day.
- Peripheral neuropathy/diabetes: Protective, well-fitting shoes with smooth interiors, seamless linings, and room to avoid pressure points are recommended. While not exclusively older-adult-specific, many older people have neuropathy and require appropriate footwear.
- Poor balance/gait changes: As age advances, older adults often have increased gait variability, reduced proprioception, and slower stepping — making stable footwear even more important.
Comparison: Velcro, Laces, and Slip-ons
Both laces and Velcro can provide good fixation when used appropriately. In addition, hands-free/slip-on styles (which allow for easy entry without tying) are increasingly used, especially when hand dexterity, bending, or mobility is limited.
Velcro
Advantages:
- Fast and easy for people with reduced hand dexterity (e.g., arthritis) or limited reach.
- Allows quick adjustment during the day (e.g., if foot swells) for a better fit.
Considerations:
- Ensure the strap(s) are wide and secure; multiple adjustment points are optimal.
- The shoes should properly secure the heel.
- The Velcro should provide secure fixation, similar to well-laced shoes.
Laces
Advantages:
- Allows adjustment across the fixation from the instep and forefoot, which can help prevent heel lift.
- Elastic or “no-tie” laces are a good compromise for those who may have difficulty with tying.
Considerations:
- Tying laces may be difficult for those with hand arthritis or reduced mobility; assistive devices (long shoehorns, reachers) may help.
Hands-free / Slip-on
Advantages:
- Very easy entry/exit—ideal for older adults with limited bending (hip/knee surgery, back pain) or reduced hand function.
- Can improve adherence (shoes actually worn) when tying or bending is a barrier.
Considerations:
- Convenience does not automatically equal safety; the same core design features (secure fixation, firm heel counter, appropriate heel height, slip-resistant outsole) must be present.
- Evidence comparing slip-ons to laced/Velcro shoes regarding fall outcomes remains limited. A systematic review found mixed evidence linking footwear style alone with falls.
Bottom line: Choose the fastening style that you can reliably use to achieve a snug, stable fit. If you have arthritis, reduced hand function, or mobility/lowering challenges, Velcro, elastic, no-tie, or well-designed slip-ons may be helpful, but always ensure you meet the underlying safety criteria.
What to Prefer and Avoid
Recommended (generally safer)
- Supportive walking shoes / low-profile athletic shoes: Firm midsoles, heel counters, textured rubber outsoles, laces or secure straps; widely supported in trials and guidance.
- Enclosed shoes with adjustable fastenings (Velcro or laces): Provide protection and an adjustable fit.
- Properly constructed slippers with firm soles and heel straps, for indoor use only: Because many indoor falls happen when people are barefoot or in loose slippers, choosing a safer indoor shoe is essential.
Use with caution / avoid
- Loose socks, sock-only, or loose slippers: Strongly associated with indoor falls in older populations.
- Backless slippers/mules, high-heeled or very narrow fashionable shoes: These styles increase fall risk and foot deformity.
- Unstable “destabilizing” shoes or extreme rocker soles (unless under clinician supervision): A recent systematic review found mixed results for destabilizing/rocker-sole footwear in older adults and emphasized that their safety and efficacy remain uncertain.
Hands-free / Slip-On Footwear for Older Adults
- For older adults with limited bending ability (due to hip/knee replacement, back pain) or mobility challenges, reduced hand dexterity (arthritis or tremor), tying laces or reaching down to put on shoes can pose a fall risk.
- Slip-ons reduce the need to bend or tie, thus potentially increasing independence and reducing balance-risk during donning/doffing.
- Given that adherence (wearing shoes) is a key component of fall-risk reduction, improving ease of use may matter.
What to watch for in slip-on / adaptive models
Even if the style is slip-on, the same core safety and design features still apply, so look for:
- Firm heel counter and secure fit (foot should not slide laterally or lift at heel).
- Rubber slip-resistant outsole with good tread (not simply a smooth sole).
- Wide or adjustable entry and toe box, especially if foot width or swelling is a concern.
- Good overall stability, avoid overly soft or floppy soles.
- For older adults using orthoses or with foot problems, ensure the insole is removable or the shoe is compatible.
- Ensure the slip-on feature does not compromise fixation. Some models incorporate elasticized heel straps or locking heel cups to secure the foot.
Practical tip
If choosing a slip-on/adaptive entry shoe, have the person walk in them, test the heel lift, check how secure the foot is, and walk indoors and outdoors (on expected surfaces). If there is a heel lift, lateral instability, or excessive foot movement inside the shoe, the shoe may not be safe, despite being easy to wear.
Practical Shopping and Fit Tips
- Shop late in the day. Feet are slightly larger later due to swelling.
- Bring current orthoses or the socks you usually wear.
- Try both shoes on and walk on a hard floor; the heel should not slip over a few millimeters.
- Check toe-room. Approximately a thumb’s width between the longest toe and the shoe front when standing.
- Look for secure fastenings and a firm heel counter (or heel cup).
- Avoid worn-out soles; replace shoes when the tread is low or the midsole is overly compressed.
- For slip-on models, test how easily the foot enters/exits and whether heel lift or internal sliding occurs.
When you shop late in the day, you’re accounting for a natural, daily change in your feet. Here’s what it means:
Gravity and regular activity cause fluid to move downward toward your feet and ankles throughout the day. Standing, walking, or sitting for long periods allows this fluid to accumulate in the soft tissues of the lower legs and feet. As a result, your feet become slightly larger, both longer and wider, by afternoon or evening compared to first thing in the morning.
This is called physiologic swelling or diurnal variation in foot size, and it’s completely normal. The difference may be slight (a few millimeters) for most people. Still, the size increase can be more noticeable for older adults, especially those with circulatory changes, reduced venous return, or mild edema.
Why it matters:
If you buy shoes early in the morning, when your feet are at their smallest, they may feel comfortable in the store but become tight, restrictive, or painful later in the day. Tight shoes can cause rubbing, pressure points, blisters, or worsen foot problems such as bunions and hammertoes.
By shopping for shoes later in the day, when your feet are at their largest, you ensure they will still fit comfortably even after mild swelling. In other words, you fit shoes for your real-world foot size during regular activity.
Tip:
If you’re prone to swelling, you can also try on shoes after a typical day of walking or other activity and wear the socks you usually wear. This will provide you with the most accurate fit, helping you select comfortable and supportive footwear throughout the day.
Popular Brands and Footwear Sources for Older Adults
Clinical guides and consumer health organizations often recommend brands that offer supportive designs, adjustable closures, and wide sizing options. The following brands are frequently recommended in clinical resources and consumer reviews for older adults:
- New Balance: wide sizing, many podiatrist-endorsed models.
- Brooks, Hoka: supportive walking/running shoes; firm support features.
- Vionic: podiatrist-designed support; several prior reviews for older adult populations.
- Orthofeet, Dr. Comfort / Propet: therapeutic/diabetic-friendly shoes.
Note: Brand availability and specific model features are subject to change over time. Always look for individual shoes that meet the feature checklist above and, when appropriate, seek podiatry endorsement or APMA recognition.