problems with shoe wear have long been recognized as an endemic issue among the geriatric population with a prevalence rate of nearly 80% .
women in particular are more susceptible to these problems than men . individuals having foot pathology
are often severely physically impaired , making it increasingly difficult to perform activities of daily living .
consequentially , this leads to physical inactivity , which is cited as one of the first signs of deterioration and the overall decrease in quality of life .
moreover , some studies have linked physical inactivity to suicide , depression , and increased risk of cardiovascular - related problems .
individuals with diabetes , chronic disease , nondiabetic neuropathy , and inflammatory conditions are at a severe disadvantage .
further complications of foot pathology , which include cellulitis , ulcerations , and difficulty in maintaining balance , have increased the risk of serious injuries and fractures from falls .
studies have shown that adults older than 65 years fall at least once per year on average , some of which are attributed to generalized thinning of skin and fat pad atrophy .
the increased risk of falls may highlight the need to promote preventative measures to combat this issue .
unfortunately , little current data or research focuses on the role of footwear in the prevention of inactivity in the elderly patients . common foot pathologies like corns , hallux valgus ( bunions ) , and hammertoes have been known to increase plantar pressure , cause discomfort , pain , and swelling .
multiple etiologies have been noted to cause foot problems , and studies have indicated ill - fitting shoes as one of the major underlying cause .
a prevailing hypothesis is that wearing the appropriate footwear will improve factors such as plantar pressure , thereby mitigating pathology while facilitating balance .
this review aims to form a general basis of understanding footwear - associated foot pathologies pertaining to the elderly patients .
elderly individuals with preexisting clinical conditions such as diabetes , neuropathies , and musculoskeletal disorders are at a higher risk of developing foot problems when compared to normal , healthy individuals .
furthermore , factors such as exercise and living conditions contribute to the development of foot problems .
finally , the uneven pressure provoked by ill - fitting footwear has been documented as a key factor that can cause , accelerate , or exacerbate foot - related conditions .
some common foot pathologies include hallux valgus ( bunions ) , corns ( callus ) , and hammertoes .
callus formations , or corns , result from continuous pressure from tight footwear , leading to hyperkeratosis of the skin .
if left unattended , callus formations can lead to ulcerations , which are particularly troublesome for diabetic patients . 
 
the hallux valgus deformity , or bunion , is also frequently linked to ill - fitting ( ie , tight , narrow ) footwear .
it is caused by the lateral deviation of the great toe , which causes a valgus deformity in the first metatarsophalangeal ( mtp ) joint .
lesser toe deformities , such as hammertoes , are also associated with ill - fitting footwear .
these deformities of the second , third , fourth , and fifth toe are caused by contracture of the phalangeal joints .
clinical presentations include the deformity accompanied by pain over the dorsal surface of the foot , which tends to worsen with ill - fitting footwear .
one of the unifying elements to these 3 common forms of foot pathology is their link with ill - fitting footwear and their tendency to go unnoticed in the elderly population .
nonoperative approaches have been employed as the first line of treatment for the most common foot pathologies .
measures are taken to adjust or alleviate pressure from the affected area . as a result ,
foot inserts ( ie , dr scholls ) are also used to facilitate balance by improving arch support , which can decrease the width of the foot during weight bearing maneuvers . furthermore , met pads and splits
operative management is considered only when conservative measures fail to relieve progressed , advanced - stage pathology .
usually , symptomatic relief can be achieved with more accommodating shoe wear after the soft tissue envelope around the foot is stabilized .
this process of relieving the pressure areas and encouraging natural healing of ulcerations or soft tissue problems to heal before using modified shoe wear and orthotics often involves close follow - up in the office or wound care center .
special consideration is given to diabetic patients , who have a higher risk of developing ulcerations due to peripheral neuropathy .
therefore , routine physical examination is encouraged to detect and address these issues early before they lead to progressive deterioration .
studies have shown that women are more susceptible than men to problems associated with inappropriate footwear 
in terms of the choice of footwear in the elderly patients , lord et al concluded that individuals had better balance when wearing shoes with higher collars than with lower ones .
wide shoes are effective against bunions , and extra - depth shoes are more appropriate if the individual has hammertoes or mid - foot arthrosis .
low - heeled footwear is known to reduce the risk of falls , likely due to the associated lowering of the center of gravity . while assessing different footwear , athletic and canvas shoes ( sneakers )
are associated with the lowest risk of a fall when compared to other types of shoes . moreover ,
some suggested that sole hardness have a little effect on overall balance in the absence of a specific condition , such as hallux rigidus , which may benefit from application of hard sole .
as an extra preventative measure , better fitting footwear with slip - resistant soles is recommended both inside and outside the household to reduce the risk of falls . taken together ,
these studies seem to support the use of footwear with low heels , slip - resistant soles and wider frames to ensure comfort , better balance , and reduced risk of injury in the elderly population . in the event of multiple deformities , an individual may benefit from the combination of both extra - depth , wide , and low - heeled footwear to increase foot stability and facilitate balance .
the use of appropriate shoe wear in the elderly patients is related to the socioeconomic factors .
millions of elderly individuals live at or below the poverty level . in fact , women older than 75 years are 3 times more likely to become poor . without established financial programs such as social security , nearly half of all elderly individuals would be considered poor today .
changes in living conditions ( ie , community homes , nursing homes , etc ) can often worsen the socioeconomic status of elderly patients .
deteriorating health conditions followed by reduced physical activity can lead to a shift in clinical care , one that emphasizes the management of illness . in the face of such socioeconomic constraints ,
furthermore , retail stores often do not stock the customized shoes ( ie , extra wide ) needed for elderly customers , making availability an issue for elderly patients .
the neglect of appropriate footwear in the elderly has been linked to early amputation , and in rare cases , early demise . 
  to help alleviate the financial burden
, elderly patients enrolled in medicare part b may benefit from the medical coverage of certain medical supplies and preventative services .
eligible patients typically have diabetes or other severe foot diseases . under the medicare part b provision ,
such patients are entitled to a pair of custom - molded shoes , 3 pairs of inserts , or a pair of extra - depth shoes per calendar year .
the patient will be held responsible for only 20% of the cost while medicare covers the rest .
. some of these hazards such as wet pavements and bad weather conditions are capable of causing serious injury .
these pathologies , in return , have contributed to the growing risk of even more serious injuries such as falls and fractures .
ultimately , the noticeable decrease in physical activity in the elderly patients has been linked to depression and an overall decline health and quality of life .
clinically , preventative measures such as appropriate footwear should be continually emphasized to stop or delay the progression of some foot problems .
while recommending appropriate footwear is a cost - effective approach when compared to other options , it is often hindered by socioeconomic obstacles .
nevertheless , studies have shown that it can be a vital step to ensure prolonged musculoskeletal and overall health among the elderly patients .
 foot pathologies are common in nearly 80% of all elderly patients , and studies have indicated inappropriate footwear as one of the major underlying cause . 
 it has been postulated that ill - fitting shoe wear affects plantar pressure , thus exacerbating weak balance . 
 complications arising from foot pathologies , which include difficulty in maintaining balance , have increased the risk of falls that can result in fractures and other serious injuries . 
 the link between footwear and the onset or progression of certain foot pathologies has emphasized the need to explore and promote preventative measures to combat the issue . 
 wider and higher toe boxed shoes , along with sneakers , are examples of footwear documented to evenly distribute plantar pressure , increase comfort , and facilitate appropriate balance and gait . 
 ultimately , the use of appropriate footwear can help to better stabilize the foot , thus reducing the risk of sustaining debilitating physical injuries known to drastically decrease the quality of life among the geriatric population . 
Introduction
Common Foot Pathologies: Footwear as a Contributor
Assessing Footwear as a Treatment Option
Challenges and Limitations
Conclusion