Footwear, Home Safety and Mobility: A Shared Concern

The foot, and what goes on it, is a part of the falls picture that is never given the credit it deserves elsewhere in the system.

The shoes kept for best while the shoes without a heel counter work the day away, the foot pain that stealthily alters how we move, the nails and lesions that make every step a negotiation. Fall prevention is a multidisciplinary process, and the role of podiatry in it is specific, evidence based and, like all of this campaign, reliant on who happens to be in the home at the time. This article is the podiatrist's succinct message to that individual.

The footwear discipline, delivered daily

Like all the other prescriptions of daily life, the clinical recommendations, the shoes that fit and fasten and are supported by the heel, inside and out, the slippers taken off, the new shoes worn in incrementally, fail at the daily moment of choice, when the well-loved old shoes wait at the door. The support worker's short paper makes the right choice the easy one: the right shoes are in place where the dressing takes place, the worn shoes are not discarded but retired, so the client can still use them indoors, the fastening is assisted where hands are unable to do it, and the bare-feet and socks-only walking, which the client's feet with neuropathy cannot tolerate, is gently interrupted, as outlined in the never list in the first article of this campaign. There's no clinical in it, it's the prescription's delivery mechanism.

The observation overlap

Both the worker's foot watch-list from this campaign's third article, and the falls precursor watch-list from this library's physiotherapy series, apply to the same person, and the podiatrist's brief can add the items distinctly podiatry-related: wear patterns on footwear have changed, shoes suddenly not worn, the client rubbing or favouring a foot, gait changing in a way the worker can detect before anyone measures, new reluctance on stairs or outdoor surfaces. They are either a foot ailment presenting or a falls risk assembling, and both go the same route: reported to the number on the brief, and from there the podiatrist and the rest of the team determine whether it is a foot ailment or a falls risk, since the sorting is clinical and the noticing is not.

How this plays out in practice

Imagine an 80-something woman who fell last year, sees her podiatrist for nail trims, and has support workers tending her feet every day. The briefed version sets the fitted shoes at the bedroom chair, takes the agreement to retire the twenty year old shoes, and takes the overlap watch-list. The worker calls in that she's begun to refuse the shoe on the left foot, and the appointment finds the bunion inflamed and the shoe too tight, which had been changing her gait, the sort of change that ends in a fall, now interrupted at the noticing stage. The intervention chain was followed exactly as designed: daily eyes, same day report, clinical sort, and a winter without fracture as the process unfolded.

Next steps

Include the three footwear lines in your typical support brief: place the right shoes, agree to retire the wrong ones, and report shoe-avoidance and gait changes. The falls team will appreciate it, and so will the feet.