Falls Prevention | Footwear | Physio to Home

Up to 50% of falls in older adults involve inappropriate footwear. North Tasmania physiotherapist Michael Ghattas reveals which shoes are dangerous — and what to wear instead.

Up to 50% of falls in older adults involve inappropriate footwear. North Tasmania physiotherapist Michael Ghattas reveals which shoes are dangerous — and what to wear instead.

Micheal Ghattas

2/27/2026 · 9 min read

The Role of Footwear in Preventing Falls: What Older Tasmanians Need to Know

By Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience

Physio to Home, North Tasmania | Last reviewed: February 2026

Part of the Physio to Home Falls Prevention Series

This article is a companion to our complete guide: How to Prevent Falls at Home — A Guide for Older Tasmanians. For the full picture on fall risk — including balance training, dizziness, medications, and home hazards — we recommend reading the full series alongside this article.

Of all the fall risk factors we assess in home physiotherapy visits, inappropriate footwear is one of the most common — and one of the easiest to fix. Research shows that hazardous footwear is a contributing factor in up to 50% of falls in older adults, yet it is rarely the first thing people think of when discussing fall prevention.

This guide explains exactly what makes footwear safe or dangerous for older adults, delivers a verdict on the most common types of household footwear, and gives you a clear checklist for assessing any shoe before putting it on. No specialist equipment required — just the right information.

Who this guide is for

This article is written for older Tasmanians who want to understand how their footwear choices affect their fall risk at home and outdoors. It is also highly relevant for family members and carers who help with footwear selection. For people in rural North Tasmania, where podiatry and specialist footwear advice can be difficult to access, this guide provides practical, evidence-based guidance you can apply immediately.

Why Footwear Has Such a Big Impact on Fall Risk

Your balance system relies on three inputs — your inner ear, your vision, and your proprioceptive system (the sensors in your feet, ankles, and joints that detect position and movement). Of these three, the foot-ground contact point is the most direct interface between your body and the surface beneath you. Footwear sits right in the middle of this critical connection.

The wrong footwear affects fall risk in several ways simultaneously:

• Reduced grip: Smooth, worn, or hard-soled shoes slide on smooth floors, particularly wet tiles, polished floorboards, and linoleum — all common in Tasmanian homes.

• Impaired proprioception: Thick, cushioned, or overly flexible soles reduce the sensory information your feet send to your balance system, making it harder to detect uneven surfaces and respond to stumbles.

• Biomechanical instability: High heels, backless shoes, and poorly fitting footwear change your centre of gravity and reduce ankle stability — the joint most responsible for rapid balance corrections.

• Trip hazards: Floppy soles, long laces, and loose fitting shoes catch on carpet edges, thresholds, and uneven pavement.

• Toe grip compensation: Wearing backless slippers or thongs forces the toes to grip the shoe with each step — a subtle but significant gait disturbance that increases trip risk.

A note on socks alone

Walking in socks — even non-slip socks — on smooth floors is one of the most hazardous footwear choices an older adult can make at home. Socks provide almost no lateral stability, minimal friction on many surfaces when wet, and no proprioceptive anchoring for the foot. If comfort is the priority indoors, a well-fitting slipper with a closed back and firm sole is dramatically safer than socks alone.

Common Footwear Types: A Physiotherapist's Verdict

Here is an honest clinical assessment of the most common footwear choices among older adults — both indoors and outdoors.

Backless Slippers — HIGH RISK — avoid for everyday indoor use

The single most hazardous item of footwear in most older adults' homes. The absence of a heel counter means the foot is not secured — the toes grip with every step, the ankle has no lateral support, and the slipper can slip off during a stumble. They feel comfortable precisely because they are loose, which is the problem. If you wear slippers indoors, choose a model with a firm, closed back and a non-slip sole.

Thongs and Flip-Flops — HIGH RISK — avoid entirely

Thongs are designed for beach and pool environments, not for navigating the floors, steps, and uneven surfaces of a home or community. They provide zero heel support, zero ankle stability, and force a toe-gripping gait pattern. The risk is compounded on wet surfaces, stairs, and when moving quickly. They are not appropriate footwear for older adults with any balance impairment.

High Heels (above 2.5cm) — HIGH RISK — avoid entirely

High heels shift the body's centre of gravity forward and significantly reduce the base of support at the heel — the most important anchor point in balance recovery. They also place the ankle in a plantarflexed position that reduces its ability to make rapid stability corrections. The evidence is unambiguous: heel height is directly correlated with fall risk. A heel of no more than 2–2.5cm is the recommended maximum for older adults.

Worn or Old Shoes — MODERATE TO HIGH RISK — replace promptly

Worn soles lose grip on smooth surfaces. Compressed midsoles lose shock absorption and reduce proprioceptive feedback. Stretched uppers no longer hold the foot securely. A shoe that feels comfortable because it has moulded to the foot is often a shoe that has lost its structural integrity. As a general rule, walking shoes used daily should be replaced every 12–18 months regardless of how they look.

Lace-Up Athletic or Walking Shoes — LOW RISK — the gold standard

Well-fitting lace-up athletic or walking shoes with a non-slip rubber sole, a low heel (under 2.5cm), a firm heel counter, and a snug but comfortable fit represent the evidence-based benchmark for safe footwear in older adults. The laces or velcro closure allow a customised, secure fit that slip-on shoes cannot replicate. For outdoor walking and community activities, this is the recommended default.

Closed-Back Slippers with Firm Sole — LOW TO MODERATE RISK — acceptable indoors if fitted correctly

A well-chosen indoor slipper can be safe for home use, provided it has a closed back with a firm heel counter, a non-slip rubber or textured sole, a firm (not floppy) midsole, and a snug fit that does not require toe-gripping. Avoid sheepskin or memory foam slippers that compress unpredictably. The slipper should feel secure on the foot when you shake it — if it flops around, it is not safe.

Orthopaedic or Prescribed Footwear — DEPENDS ON FIT AND CONDITION

Prescribed orthopaedic footwear, when correctly fitted and in good condition, can be highly protective — particularly for people with foot deformities, peripheral neuropathy, or significant arthritis. However, prescribed footwear that no longer fits correctly due to weight change, foot swelling, or wear is often worse than a good off-the-shelf walking shoe. If you have prescribed footwear, have the fit reviewed annually by your podiatrist.

The Safe Footwear Checklist: Five Features Every Shoe Should Have

Use this checklist to assess any shoe — indoor or outdoor — before relying on it for daily activity. For each feature, the green text describes what to look for and the red text describes what to avoid.

• Heel counter:

Look for — firm, upright back that cups the heel and does not collapse when pressed.

Avoid — soft, floppy, or absent heel — foot slides backward in shoe.

• Sole grip:

Look for — textured rubber sole that does not slide on smooth floor when you twist your foot.

Avoid — smooth, hard, or worn sole that slides easily.

• Heel height:

Look for — low heel of 2.5cm or less — flat to very slightly raised.

Avoid — heel above 2.5cm, stiletto, wedge, or platform sole.

• Sole flexibility:

Look for — firm midsole that bends only at the toe box — not in the middle.

Avoid — sole that folds completely in half with no midfoot support.

• Fit and fastening:

Look for — snug fit with laces, velcro, or adjustable strap — foot does not slide forward.

Avoid — slip-on with no fastening, or loose fit requiring toe-gripping.

Special Footwear Considerations for Older Tasmanians

Foot Swelling

Many older adults experience foot swelling from heart conditions, medications, or prolonged sitting. Shoes that fit well in the morning may be uncomfortably tight by afternoon. If swelling is significant, lace-up shoes with the ability to loosen the fit are far safer than slip-ons that become tight and are then abandoned in favour of socks or slippers. Consider buying footwear in the afternoon when feet are at their largest.

Peripheral Neuropathy

Diabetes and other conditions can cause reduced sensation in the feet — a condition called peripheral neuropathy. People with neuropathy cannot feel when their footwear is rubbing, too tight, or causing injury. They also have reduced proprioceptive feedback, making stable, well-fitted footwear even more critical. If you have peripheral neuropathy, have your footwear reviewed by a podiatrist and inspect your feet daily for pressure injuries.

Bunions and Foot Deformities

Hallux valgus (bunions), hammer toes, and other foot deformities are common in older adults and can make standard footwear fitting difficult. Wide-fit shoes, shoes with a deep toe box, and prescribed orthopaedic footwear are available options. Do not force a narrow foot into a wide shoe or vice versa — an ill-fitting shoe worn because it is familiar is more dangerous than a new shoe with a correct fit.

Tasmania's Climate and Wet Conditions

North Tasmania's weather — particularly in autumn and winter — means wet paths, wet grass, and damp floors are a regular feature of daily life. Outdoor footwear for Tasmanian conditions should have deep rubber tread designed for wet surfaces. Smooth-soled leather shoes that may be appropriate indoors become extremely hazardous on wet pavement or dewy grass. Waterproof walking shoes or lace-up boots with deep tread are the practical choice for Tasmanian winters.

When Footwear Assessment Is Part of a Broader Falls Review

Footwear is one component of a comprehensive falls risk assessment — important on its own, but most powerful when reviewed alongside balance, strength, medications, vision, and home hazards together. In a home physiotherapy visit, Michael reviews footwear as a routine part of the falls assessment and can make specific recommendations based on your foot shape, any conditions present, and the specific flooring and surfaces in your home.

If footwear issues are complex — particularly for people with diabetes, peripheral neuropathy, or significant foot deformities — Michael will refer to a podiatrist as part of a coordinated care approach. In North Tasmania, podiatry services are available in Launceston and through some community health services in regional areas.

A simple action you can take today

Walk through your home and collect every pair of footwear you wear regularly — slippers, walking shoes, garden shoes, thongs. Apply the five-feature checklist to each one. If any item fails two or more features, it is contributing to your fall risk and should be replaced. For many people in North Tasmania, this single exercise identifies the highest-impact, lowest-cost improvement in their falls prevention plan.

Frequently Asked Questions

Are non-slip socks a safe alternative to shoes at home?

Non-slip socks are significantly safer than regular socks, and for very short distances — such as getting up in the night — they offer meaningful grip. However, they are not a substitute for properly fitted footwear for everyday indoor activity. They provide no heel support, no ankle stability, and no midfoot structure. If comfort is the priority at home, invest in a well-fitted, closed-back slipper with a non-slip sole rather than relying on non-slip socks.

My mother insists on wearing her backless slippers — how do I convince her to change?

Comfort and familiarity are powerful — slippers feel good precisely because they are loose and easy to put on, especially for people with reduced dexterity or swollen feet. The most effective approach is to find a safe alternative that addresses the same needs: a closed-back slipper with velcro fastenings, a roomy toe box, and a soft lining. Frame it as an upgrade rather than a restriction. Involving a physiotherapist or GP in the conversation can also help — the recommendation carries more weight when it comes from a clinician.

How much should I spend on safe footwear?

Effective falls-preventive footwear does not need to be expensive. Many excellent lace-up walking shoes are available in the $80–$150 range from major Australian retailers. The features that matter — firm heel counter, non-slip rubber sole, low heel, firm midsole, and secure fastening — are available at accessible price points. Spending more does not necessarily mean safer. The fit matters more than the brand or price.

Can footwear be funded through My Aged Care or NDIS?

Prescribed footwear and orthotic devices can be covered under some Home Care Package budgets and NDIS plans, particularly when there is a clinical recommendation from a physiotherapist or podiatrist. Standard retail footwear is generally not covered, but a podiatry assessment and prescription may be. Speak with your care coordinator or contact Physio to Home for guidance on what may be claimable in your specific situation.

Should I wear shoes indoors all the time?

For older adults with balance impairment or a history of falls, wearing appropriate footwear indoors at all times is the evidence-based recommendation. The majority of falls in older adults happen at home, most commonly in the bedroom, bathroom, and living areas where footwear is most often removed. A well-fitted, comfortable walking shoe worn consistently indoors and outdoors is the simplest and most effective footwear intervention available.

Want a Full Falls Risk Assessment — Including Footwear Review — at Home?

Footwear is just one piece of the falls prevention puzzle. A home physiotherapy assessment from Physio to Home covers your balance, strength, gait, dizziness, medications, home hazards, and footwear in a single visit — and leaves you with a personalised action plan you can start on the same day.

We serve older adults and rural residents across North Tasmania — including Launceston, George Town, Scottsdale, Ringarooma, and the Tamar Valley — with visits funded through Medicare, My Aged Care, NDIS, and private health insurance.

Book your home falls risk assessment today →

About the Author — Michael Ghattas, DPT

AHPRA Registered Physiotherapist | Doctor of Physical Therapy | 18 Years Clinical Experience

Michael is the founder of Physio to Home, a mobile physiotherapy practice serving older adults and rural residents across North Tasmania. He specialises in falls prevention, aged care physiotherapy, and home-based rehabilitation.

References & Further Reading

Menant JC, et al. Appropriate footwear can reduce the risk of slipping in older people. *Journal of the American Geriatrics Society*, 2008.

Tencer AF, et al. Biomechanical properties of shoes and risk of falls in older adults. *Journal of the American Geriatrics Society*, 2004.

Sherrington C & Menz HB. An evaluation of footwear worn at the time of fall-related hip fracture. *Age and Ageing*, 2003.

Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People. ACSQHC, Sydney, 2021.

My Aged Care. Home Care Packages Program. Commonwealth of Australia, 2025. www.myagedcare.gov.au