Your feet are the only part of you touching the ground. What happens there — in the joints, the nerves, and the shoes — shapes everything above it.
Footwear and foot health are among the most overlooked causes of falls, partly because they seem too ordinary to matter. They matter a great deal. Foot problems affect roughly one in three community-dwelling people over the age of 65, and both foot pain and shoe choice have been linked in prospective studies to whether a person falls.
This page covers what the research actually supports, where the evidence is weaker than commonly claimed, and what you can do about it.
The Single Strongest Finding: Bare Feet and Socks Indoors
If you take one thing from this page, take this.
A twelve-month prospective study followed 176 residents of a retirement village, aged 62 to 96, recording every fall and assessing footwear in detail. After controlling for age, sex, medication use, physiological fall risk factors, and existing foot problems, the people who fell indoors were dramatically more likely to have been going barefoot or wearing socks inside the home. The odds ratio was 13.74, with a confidence interval running from 3.88 to 48.61.
A separate review reported a similar magnitude of risk for walking barefoot, in socks, or in slippers. And in the MOBILIZE Boston Study, over half of the older participants who fell at home were in slippers, barefoot, or wearing socks without shoes at the time.
Socks on a hard floor are close to the worst possible arrangement. They reduce friction at exactly the point where you need it and they provide no support to the foot or ankle. Bare feet at least preserve sensation, but they offer no protection and no stability on a slick surface.
The practical version: wear real shoes inside the house, not just outside it. This is one of the cheapest and most immediately actionable changes in all of fall prevention.
What Makes a Shoe Safer
A systematic review of the footwear literature concluded that older people should wear shoes with low heels and firm, slip-resistant soles, both inside and outside the home. Research has repeatedly identified the same set of design features as relevant to stability:
Heel height
Heel height is the shoe feature most consistently linked with falls. One prospective study found that shoes with heels above roughly 2.5 cm (about one inch) increased fall risk compared with athletic or canvas shoes. High-heeled footwear has been linked with impaired balance in older people, and a history of habitual high-heel wearing has been identified as a predisposing factor for falling.
Fixation
Fixation means how the shoe stays attached to your foot — laces, buckles, or straps across the top. Shoes without it, including slip-ons, mules, and backless slippers, have been associated with trip-related falls. Worth noting honestly: fixation is one of the most common recommendations in fall prevention education, and the direct evidence for it is thinner than that recommendation implies. It is sensible, mechanically logical, and not as well proven as heel height.
Sole hardness and slip resistance
Very soft, thick soles reduce the sensory information reaching your foot, which matters because your brain uses that information to know where the ground is. Firmer soles preserve more of that feedback. Tread and material affect friction against the floor, which is what determines whether a step becomes a slip.
Heel collar height
The collar is the part that wraps the back of the ankle. A higher, firmer collar provides more lateral support. It appears in most expert recommendations, though it is also flagged in the literature as an area needing further research.
Fit
Ill-fitting shoes are extremely common among older adults, and a shoe that is too large is not a harmless error — it shifts and slides, changing how the foot loads and how the toes clear the ground.
Where the Evidence Is Weaker Than People Claim
Two honest caveats belong on this page.
First, the same twelve-month study that found such a strong effect for bare feet and socks found no significant differences in the specific footwear characteristics of fallers versus non-fallers. A separate systematic review similarly found inadequate evidence linking particular footwear styles to falls among healthy community-dwelling older adults. The strong, well-replicated finding is about wearing shoes at all. The finer points about collar height and tread are reasonable and mechanically sound, but they are not established with the same confidence.
Second, non-slip hospital socks have inconclusive evidence behind them. They are widely used, but reviews have not established that they prevent falls, and they do not provide the heel and forefoot support a shoe does.
We say this plainly because a site that overstates its evidence is not worth trusting on the parts where the evidence is strong.
The Foot Itself
Shoes are only half of it. The structure and function of the foot is an independent risk factor.
Prospective research has identified a specific set of foot and ankle characteristics that predict falls:
- Reduced ankle range of motion, particularly dorsiflexion — the ability to pull your toes up toward your shin. This is what lets your foot clear the ground during a step.
- Reduced toe strength. Weakness in the big toe and lesser toes is associated with poorer balance and mobility. Toes do real work in the final push-off of every step.
- Toe deformity, including bunions (hallux valgus) and clawed or hammer toes.
- Reduced plantar sensation — the feeling in the sole of the foot, which is a major input to proprioception.
- Foot pain. Pain changes how you walk, and altered gait is itself a risk.
Foot Pain Is Not Something to Simply Live With
A randomized controlled trial published in the BMJ enrolled 305 community-dwelling adults with disabling foot pain and elevated fall risk. One group received routine podiatry care. The other received routine care plus a combined program: foot orthoses, footwear advice, help obtaining appropriate shoes, a home program of foot and ankle exercises, and a fall prevention education booklet.
The combined program reduced the rate of falls by 36% over twelve months. The intervention group also showed measurable improvements in ankle strength, ankle range of motion, and balance.
The reason this trial matters is that every component of it is inexpensive and simple. Nothing in it was exotic. The takeaway is that persistent foot pain is a modifiable fall risk factor, and treating it appears to change outcomes.
What to Do
- Put shoes on indoors. Not slippers without backs. Not socks. Actual supportive shoes with a sole.
- Look at the heel height of what you wear most. Lower is steadier.
- Check that your shoes fasten. Laces, straps, or buckles hold the shoe to the foot; slip-ons do not.
- Replace worn soles. Tread wears smooth long before a shoe looks worn out, and smooth tread is the mechanism of a slip.
- Take foot pain seriously. It is treatable, and treating it has been shown to reduce falls.
- Work ankles and toes. Ankle mobility and toe strength are trainable, and both predict balance.
- Check your feet regularly, particularly if you have diabetes or reduced sensation. Loss of feeling in the soles removes a sense you rely on without realizing it.
Topics in This Section
- Choosing safer shoes: what the research supports
- Slippers, socks, and going barefoot at home
- Foot and ankle exercises for balance
- Foot pain: causes and when to seek treatment
- Bunions, hammer toes, and other deformities
- Diabetes, neuropathy, and loss of sensation in the feet
- Ankle mobility and why dorsiflexion matters
- When to see a podiatrist
When to Seek Professional Help
See a doctor or podiatrist if you have foot pain that limits what you do, numbness or tingling in your feet, an open sore or wound that is not healing, a toe deformity that makes shoes difficult to fit, or diabetes combined with any change in sensation. If your ankle feels stiff enough that you catch your toes on floors or steps, that is worth raising as well.
Sources
- Menz HB, Morris ME, Lord SR. Footwear characteristics and risk of indoor and outdoor falls in older people. PubMed
- Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. Journal of Rehabilitation Research and Development, 2008. PubMed
- Spink MJ, Menz HB, Fotoohabadi MR, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. BMJ, 2011. BMJ / PMC
- Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services. PMC
- Enhancing Footwear Safety for Fall Prevention in Older Adults: A Comprehensive Review of Design Features. Annals of Geriatric Medicine and Research, 2024. AGMR
Senior Health News publishes free educational guides on fall prevention, home safety, and healthy aging. This page describes shoe characteristics supported by research. It does not recommend, endorse, or sell any brand or product, and we accept no sponsorship. Nothing here is medical advice — talk to your doctor or podiatrist about your own feet.
Last reviewed: September 7, 2026.