Avoiding falls with the right shoes

Q: I'm a 70-year-old woman, and I have read that my chance of being injured by a fall will increase as I grow older. I also hear that foot problems cause many falls. Is that true? If so, what can I do about it?

A: You are correct that as we age, we are more likely to fall. Unfortunately, it is not uncommon for these falls to cause bruises, cuts, broken bones and even serious head injuries. But the good news is that there certainly are things you can do to lower your risk.

Why are older adults more likely to fall in the first place? Some experts believe that as we get older, natural changes in our feet cause us to fall more easily. For one, as you age you have less feeling in your feet. This may cause you to feel off balance.

Also, the shape of your feet changes as you age. Your feet flatten out. Your toes may curl into "claw toes" because of muscle imbalance. These and other physical changes may force you to walk differently or lose your balance, causing you to fall.

It is also possible that foot pain is responsible for increased falls. Both bunions and claw toes create extra pressure that can be painful. Injuries and chronic diseases such as diabetes can creep up in old age and cause foot pain, as well.

It's likely that natural changes and pain are both to blame for falls. No matter what the cause, it has been proven that taking care of your feet can help reduce your risk of falling. Here are some things you can do:

• First, choose your shoes wisely. Many people don't actually know their true shoe size. If you buy shoes in a store, be sure to have the salesperson measure you before you try shoes on. If you buy shoes online, use a standard conversion chart that can convert your foot's length and width in inches (or centimeters) into your shoe size. You should be able to find a chart online by typing "shoe size conversion" into a search engine. Be careful not to measure only the length of your foot. Width is important too. Your foot may need more room than it used to.

• Never wear shoes that are loose or untied. Don't wear shoes with shiny, slippery soles, or with thick rubber soles that can catch on carpets. Flat shoes with thin but wide soles will give you the best feel of the floor and the greatest stability.

• Wearing shoes, even at home, is important. Research shows that wearing shoes indoors, rather than padding around barefoot or in slippers or socks, may prevent serious injury from a fall.

• Another way you can avoid falling is to lose weight. Dropping a few pounds could literally take a load off your feet, sparing you some pain and possibly reducing your chances of falling.

• Orthotics may also be a good option. Studies show that orthotics may prevent some falls by stabilizing the feet, redistributing pressure, and providing additional tactile input so your brain gets a little bit of extra information about what your feet are doing.

Custom-made orthotics, made from an impression of your foot, cost at least several hundred dollars. The prefabricated kind cost about $50. Based on research, both types may work to reduce pain and prevent falls. It makes sense, then, to try the prefabricated orthotics first before investing in the expensive custom-made ones, unless you have a major foot deformity that clearly needs custom treatment.

• Lastly, you might consider exercising your feet to prevent falls. Exercises for the feet and ankles can help reduce age-related muscle loss and stiffness.

Some exercises may seem a little goofy, but they serve a purpose. For example, picking up marbles or small stones with your toes helps strengthen muscles that may counteract the tendency of toes to curl. But foot exercises aren't the only kind of activity that benefits the feet. Yoga, for instance, may prevent foot problems.

You asked about feet, but you should know that there are many other ways to reduce your risk of falling. Good nutrition, especially getting the right amounts of protein, calcium and especially vitamin D, can help. Avoiding sedatives and excess alcohol, doing exercises for leg strength and balance, and correcting problems with your vision are also important. And don't forget to make sure your environment is safe. That includes eliminating stray electrical cords and loose rugs at home and avoiding ice and snow outdoors.

Feet first? Perhaps. But don't forget the other things that can help keep you on the up and up.

Submit questions to harvard_adviser@hms.harvard.edu.