The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability in older adults

Abstract

Objective: Falls in older adults are common and may result in serious injury. Inappropriate footwear has been suggested to be a contributing factor to many falls. However no studies have been undertaken to determine whether clinicians can reliably assess footwear variables thought to influence postural stability in older adults. The aim of this study was therefore to develop a simple clinical footwear assessment form and assess its reliability, both between examiners and with repeated assessments over time. Design: Two examiners assessed seven footwear variables (shoe type, heel height, heel counter stiffness, longitudinal sole rigidity, sole flexion point, tread pattern and sole hardness) in 12 different shoes, and repeated the measurements three weeks later. The examiners were blinded to each other's and their own previous results. Results: Analysis using the kappa (and percentage agreement statistics revealed the examiners' footwear assessments to be generally highly reliable (= 0.47–1.00 for inter-tester comparisons, = 0.40–1.00 for intra-tester comparisons), with the exception of inter-tester assessment of sole hardness (= 0.03–0.48). Conclusion: The Footwear Assessment Form is a reliable clinical tool for the assessment of shoe type, heel height, heel counter stiffness, longitudinal sole rigidity and tread pattern; however, a more objective protocol may be required to improve the reliability of sole hardness evaluation. The Footwear Assessment Form can now be used with confidence in the clinical setting and in future investigations to determine the contribution of footwear characteristics to instability and falls in older adults.