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Ann Geriatr Med Res > Volume 28(4); 2024 > Article
Kim: Unraveling the Impact of Destabilizing Shoes on Balance Control and Fall Prevention in Older Adults: A Systematic Review

Abstract

Background

Falls pose a significant risk to older adults, often leading to severe injury and disability. One potential contributing factor to falls is footwear, particularly shoes with destabilizing features. This systematic review assessed the effects of destabilizing shoes on stability control and fall prevention in older adults, highlighting their effectiveness in balance control and fall prevention, and the detailing the specific review methodology.

Methods

We thoroughly searched relevant databases and meticulously screened the identified studies based on predetermined inclusion and exclusion criteria. We then extracted data from 30 eligible studies with various study designs and shoe types and synthesized this information to assess the impact of destabilizing shoes on balance and gait measures, fall incidence, and other relevant outcomes.

Results

While certain types of destabilizing shoes may improve specific aspects of balance and proprioception, they can also adversely affect steadiness control and potentially increase the risk of falls if not appropriately used. Therefore, the use of destabilizing shoes should be carefully considered and tailored to individual needs, with proper guidance and training to minimize fall risk.

Conclusion

The findings of this review significantly inform footwear design and selection in older adults and emphasize the need for additional research. By synthesizing the available evidence, this review highlights the potential benefits and risks associated with destabilizing shoes and suggests the need for careful evaluation of their use on a case-by-case basis. This review serves as a basis for future guidelines on the use of destabilizing shoes in older adults with the aim of developing effective fall prevention interventions.

INTRODUCTION

Falls in older adults are a significant public health challenge, leading to injuries and reduced quality of life.1,2) While various interventions have been proposed to prevent falls, the role of footwear remains underexplored.3-5) Shoes lacking stability features such as anti-slip heels/soles can hinder balance control and increase fall risk.4,5)
Destabilizing shoes, specifically designed to challenge balance through controlled instability, have emerged as a potential tool for fall prevention.6) These shoes aim to stimulate the neuromuscular and somatosensory systems to enhance balance and reduce fall risk in older adults prone to balance impairment. Fig. 1 shows photographs of three destabilizing shoes, which are characterized by their anterior-posterior curvature and cushioned heel. The curved or rocker sole destabilizes the foot and requires the wearer to adjust to maintain balance.
However, the effectiveness and safety of destabilizing shoes for fall prevention remains uncertain, with studies yielding mixed results. Thus, this review sought to synthesize existing evidence on the impact of destabilizing shoes on balance control and fall prevention in older adults. It addresses three specific research questions: 1) How do destabilising shoes affect balance control and fall prevention in older adults?, 2) What factors modulate the effectiveness of destabilising shoes in improving balance and preventing falls?, and 3) What are the advantages and disadvantages of employing destabilising shoes for fall prevention in older adults?
By analyzing the available evidence, this review aimed to provide insights into the effects of destabilizing shoes, considering different shoe types, characteristics, and potential moderating factors such as age, sex, baseline balance impairments, and physical activity levels. This review also explored the relationship between destabilizing shoes and slip resistance performance, a pivotal factor in fall prevention. The findings aim to inform fall prevention strategies and offer evidence-based recommendations for integrating destabilizing shoes into the lives of older adults, considering their benefits, limitations, and pragmatic implications. This review contributes to the current knowledge base, guides clinical practice, and directs future research in this critical domain.

MATERIALS AND METHODS

We conducted the literature search for this review in two steps. Initially, we comprehensively reviewed the relevant literature, including randomized trials, systematic assessments, and meta-analyses, to address the outlined research questions. This search was initiated through extensive investigations across multiple academic databases and search engines. This comprehensive search aimed to minimize bias and ensure a holistic view of the effects of destabilizing shoes on balance control and fall prevention in older adults.
We searched various databases, including Google Scholar, PubMed, Scopus, MEDLINE, ResearchGate, ScienceDirect, and Web of Science. The search included studies published between January 2010 and December 2022, including recent studies, while also considering earlier relevant studies.
We selected a set of keywords to reflect the research questions in terms of precision and relevance. These keywords were thoughtfully combined using Boolean operators (AND and OR) to optimize search precision and relevance; for instance, “destabilizing shoes,” “balance control,” “fall prevention,” and “older adults.” These terms were adapted to satisfy the syntactic requirements of each database.
This review adopted multiple strategies to maintain a comprehensive approach and minimize the risk of bias. In addition to searching well-established electronic databases, we included unpublished studies and grey literature such as conference proceedings, dissertations, reference records of related studies, and pertinent reviews, to identify additional relevant studies. We applied these measures to minimize publication bias and ensure the inclusion of relevant studies from various sources. Fig. 2 illustrates the selection procedure for the research papers included in this review.
Second, the literature review involved a stringent screening process guided by two fundamental principles. The first principle focused on identifying experimentally based studies that examined the effects of destabilizing shoes on stability control and fall prevention in older adults. The second principle involved a critical evaluation of each study’s quality and methodology to ensure the robustness of the evidence. These efforts were directed at addressing the following strategic objectives regarding the effects of destabilizing shoes on older adults:
1) Objective 1: Assess existing literature on the impact of destabilizing shoes on balance control and fall prevention.
2) Objective 2: Examine the effects of different destabilizing shoes, including rocker-bottom and balance training shoes, on stability control and fall prevention in older adults.
3) Objective 3: Explore the moderating factors influencing the effectiveness of destabilizing shoes, including age, sex, balance impairment, and physical activity level.
4) Objective 4: Evaluate the safety and acceptability of destabilizing shoes as a fall prevention intervention for older adults.
5) Objective 5: Identify the potential relationships between the effects of destabilizing shoes on fall prevention and slip resistance in older adults.
These research objectives guided the development of a comprehensive research plan and study design to investigate the effects of destabilizing shoes on balance control and fall prevention among older adults.
This review also examined and analyzed studies published in peer-reviewed journals, including randomized controlled trials and observational studies investigating the effects of destabilizing shoes on balance control and fall prevention among older adults. The systematic assessment applied specific inclusion and exclusion criteria to delineate the study’s scope. Table 1 summarizes the selection criteria used to investigate the effects of destabilizing shoes on balance control and fall prevention in older adults.

RESULTS

Objective 1

This thorough investigation explored the effects of destabilizing shoes on steadiness and falls among older adults. The results of studies on various types of destabilizing shoes are summarized below.
Multiple studies have assessed shoes with unstable soles, which are characterized by uneven soles designed to stimulate proprioceptive input and challenge balance. Granacher et al.7) examined muscle movement and postural stability in older women wearing sandals with a wobbly part in the sole, regular sandals, and bare feet. Price et al.8) evaluated the instability induced by various commercially available unstable sandals compared with stable sandals during walking in women. MacRae et al.9) hypothesized that rocker-sole shoes might improve barefoot postural stability in individuals with chronic low back pain.
Rocker-sole shoes with curved soles that facilitate a rolling motion during walking have also been extensively studied. Kavros et al.10) investigated the unloading effects of rocker-sole shoes compared with flat-sole shoes with and without a plastisol insert. Hutchins et al.11) conducted trials using therapeutic shoes with a specially designed three-curve rocker sole in a hospital setting. Forghany et al.12) examined the effects of rollover shoes on lower limb rollover function during gait. Thies et al.13) studied the effects of a rocker-sole shoes on improving toe clearance without compromising gait stability in older individuals. Hemmati and Karimi14) evaluated the influence of toe-only rocker sole shoes on ground reaction force in older individuals. Hemmati et al.15,16) further analyzed the impacts of shoes with varying degrees of rockers on the dynamic stability of older individuals during walking. Tian et al.17) examined kinematic approaches in older women wearing different footwear on various ground surfaces using a three-dimensional motion capture system.
Son et al.18) introduced haptic shoes (RealWalk), vibrotactile shoes equipped with small vibrating motors to provide sensory feedback to the feet, and evaluated their impact in an interactive virtual reality application.
Cudejko et al.19) examined the influence of split-toe shoes, which separate the big toe from the rest of the toes to promote improved toe dexterity, on stability control and bodily functions in older people based on the timed up-and-go test. Li et al.20) studied the effect of bionic high-heeled shoes compared with bionic flat-bottomed shoes on the biomechanical features of the lower limbs during walking.

Objective 2

This objective examined the impact of various types of destabilizing shoes on balance control and fall prevention in older adults. The studies summarized in this review shed light on the effects of specific categories of destabilizing shoes.
Rocker-sole shoes, which are characterized by curved soles, have been studied for their potential to challenge balance control and enhance proprioception. MacRae et al.9) suggested that rocker-sole shoes could improve barefoot postural steadiness in individuals with chronic low back pain. Menz et al.21) compared the effects of rocker-sole shoes to those of conventional shoes in older adults with a history of falls and found significant improvements in balance control and a reduction in falls over 12 months. Gargiulo22) investigated the effects of rocker-sole shoes on stability and gait control, concluding that they offer advantages in gait and balance restoration. Jordan et al.23) assessed three-curve rocker-soled shoes in older adults with cramp-like leg pain, finding no significant improvement in walking distance and advising against their use in individuals with intermittent claudication.
Balance-training shoes designed with an unstable sole to challenge balance control have also been studied. Tan et al.24) reviewed data on Masai Barefoot Technology shoes, suggesting that they alter lower limb biomechanics during walking but emphasized the need for further clinical trials. Sobhani et al.25) compared the efficacy of whole-body vibration (WBV) exercise with unstable shoes versus standard shoes, in which combining WBV with unstable shoes improved balance measures in older adults.
Other types of destabilizing shoes have been reviewed for their effects on stability control and fall prevention. Farzadi et al.26) provided specific recommendations for practice and future research on unbalanced footwear, emphasizing the impact of confounding factors on biomechanical findings.

Objective 3

This objective explored recent research on factors that moderate the effectiveness of destabilizing shoes, such as age, sex, balance impairments, and physical activity level. The relevant studies are summarized below.
Age is a critical factor that significantly influences the effectiveness of shoe destabilization. The natural decline in proprioception, joint mobility, and muscle strength experienced by older adults can compromise their ability to adapt to the unstable walking surface these shoes provide.27) Consequently, this can elevate fall risk and reduce balance control. However, some studies have suggested that older individuals can benefit from destabilizing shoes through appropriate training and exercise. Kazanski et al.28) assessed healthy older and young adults while virtually walking, observing lateral destabilizing perturbations of the visual field and treadmill platform. They found that lateral stepping control may not necessarily decline solely with age.
Sex differences also play a role in determining the effectiveness of destabilizing shoes. Women may experience more significant gait variability than men when using destabilizing shoes, indicating the potential challenges in adapting to footwear. However, women may experience significant long-term benefits in balance control after wearing destabilizing shoes. Nigg et al.29) examined sex differences during bilateral quiet stance and lower extremity gait kinematics and kinetics while using unstable shoes. The authors reported that individuals employ distinct strategies to control the ankle joint when standing or walking in unstable shoes, highlighting the importance of considering sex effects when assessing the functional or therapeutic impact of these shoes.
Balance impairment is another critical factor influencing the effectiveness of destabilizing shoes. Individuals with varying degrees of balance impairment may respond differently to destabilizing shoes. Spink et al.30) observed improved balance among older adults with mild balance impairments who wore unstable shoes for 12 weeks compared with those who wore stable shoes. However, individuals with more severe balance impairments did not exhibit significant improvements.
Physical activity levels can also affect the effectiveness of destabilizing shoes, particularly among older adults. Physically active individuals generally demonstrate better balance control and respond differently to interventions. Amiez et al.31) observed improved balance control among older people with higher physical activity levels exhibited wearing specially designed balance shoes compared with individuals with lower physical activity levels. The study emphasized the effectiveness of these balance shoes in improving postural balance in healthy older adults compared with regular footwear, thereby reducing the risk of falling.

Objective 4

This objective assessed the safety, acceptability, and effectiveness of destabilizing shoes in preventing falls among older individuals. Several relevant studies are summarized below.
Safety studies indicate that wearing rocker-bottom shoes for 6 weeks did not increase the risk of falls compared with conventional shoes,32) suggesting that wearing destabilizing shoes for a specific period is not associated with a higher risk of falling.
Acceptability is crucial for adherence to fall prevention interventions. Older adults are generally open to destabilizing shoes for fall prevention.6,31) This reflects a positive attitude toward incorporating destabilizing shoes into their routines for fall prevention. Maffiuletti33) also reported positive subjective feedback from older adults who used destabilizing shoes, including improved balance and increased confidence. This finding highlights the potential psychological benefits of these shoes in enhancing older adults’ sense of balance and self-assuredness. However, some reports have indicated discomfort and difficulties in walking or performing daily activities while wearing destabilizing shoes.32) Thus, while destabilizing shoes may be acceptable to some older adults as a fall prevention intervention, individual preferences and circumstances should be carefully considered. It is essential to acknowledge that not all individuals find these shoes comfortable or suitable for their daily activities.
While this review primarily focused on the safety and acceptability of destabilizing shoes, it is equally important to consider their effectiveness as interventions for fall avoidance. A recent systematic review suggested that destabilizing shoes may be associated with a modest enhancement in stability and gait measures in older adults. However, the evidence is limited and somewhat inconsistent.6,33) The potential benefits of these shoes on balance and gait should be weighed against their limitations and outcome variations across studies. However, some studies have reported no significant effects on fall prevention.32) Therefore, while destabilizing shoes may positively influence certain aspects of balance and stability, their direct impact on reducing falls might be limited.

Objective 5

This objective aimed to identify and summarize the latest relevant studies on the connections between the effects of destabilizing shoes on fall prevention and slip resistance performance in older adults. Several studies have investigated this relationship.
Kimel-Scott et al.34) investigated the impact of rocker-sole shoes on posture control in both older (age 50–75 years) and younger (age 20–35 years) adults when exposed to posterior slide perturbations. Their findings suggest that rocker-sole shoes or other unstable shoe designs might elevate the risk of falls, particularly in healthy older adults and populations prone to falls, especially during standing perturbations such as forceful slips or trips. This finding underscores the importance of considering the specific fall risk associated with destabilizing shoes, especially in certain populations.
Thies et al.13) examined the impact of rocker-sole shoes on gait stability and slip resistance in older adults. Their findings suggested the need to broaden the focus on slip resistance in footwear design to encompass other factors influencing the risk of trips and falls and emphasized the complex interplay between slip resistance and overall stability in older adults who use destabilized shoes.
Amiez et al.31) assessed the effectiveness of specially designed balance shoes in enhancing postural steadiness in healthy older adults compared to regular footwear. Their findings indicated that balance shoes may represent a potential solution to improve the safety of older individuals and reduce the risk of falls. This suggests that certain types of destabilizing shoes explicitly designed to enhance balance may offer benefits in terms of fall prevention, aligning with the broader theme of this objective.
The five key research objectives mentioned above underscore the unique challenges faced in balance control. Depending on the specific needs and capabilities, destabilizing shoes may be suitable for a diverse range of individuals. The existing literature consistently emphasizes the significance of consulting healthcare professionals or trained instructors before integrating destabilizing shoes into a comprehensive fall prevention program. The findings of several studies are summarized in Table 2, which categorizes the results according to the different types of destabilizing shoes.

DISCUSSION

This systematic review involved a two-step screening process based on five strategic research objectives concerning the effects of destabilizing shoes. The subsequent subsections provide further discussions of each research question. The overall findings are summarized and illustrated in Fig. 3.

Objective 1

The existing literature has demonstrated noteworthy improvements in balance control among older individuals wearing destabilizing shoes compared with those using regular or no shoes. However, some studies did not observe significant differences in balance control or fall prevention when comparing destabilizing shoes to conventional footwear. The varying effects of destabilizing shoes across studies may be attributed to differing physical activity levels and baseline balance control among older individuals. Older adults with higher initial balance control may not show significant improvements when using destabilizing shoes, whereas those with poorer balance control could experience substantial progress.31) Furthermore, older adults with higher physical activity levels may benefit more from wearing destabilizing shoes than their less active counterparts.31,32)
The potential negative implications of destabilizing shoes on steadiness control and fall prevention in the older population must be emphasized, given the high incidence of falls and the consequential impact of fall-related injuries in this demographic. This highlights the need for careful consideration of footwear design and selection when implementing fall prevention interventions in older adults.
The studies reviewed under this research objective demonstrated considerable heterogeneity, encompassing variations in the types of destabilizing shoes and methodologies employed to evaluate balance and fall risks. Consequently, drawing definitive conclusions regarding the impact of destabilizing shoes on fall prevention in older adults is a challenge.
While the existing literature points to the potential benefits of destabilizing shoes in enhancing balance control and reducing fall risk in older adults, these effects might be contingent on an individual’s physical activity level and baseline balance control. Therefore, educating older individuals and their caregivers regarding the potential risks of destabilizing shoes is crucial.

Objective 2

This review objective concerning the impact of destabilizing shoes on balance control and fall prevention in older individuals presents conflicting results in the literature. The following crucial findings are discussed:
Several studies reported notable enhancements in balance and gait measures using rocker-sole and balance training shoes.23) In contrast, others observed no substantial impact on quality of life and disability scores compared with regular footwear.34) Importantly, the effects of destabilizing shoes can vary significantly based on individual factors, including age, sex, and baseline balance impairments. For instance, rocker-sole shoes might benefit older adults with more severe balance impairments.23) Thus, consideration of these factors is essential when prescribing destabilizing shoes as a fall prevention intervention for older individuals.
Additionally, future studies should investigate the optimal design, duration, and specific characteristics of destabilizing shoes that contribute to improved balance and reduced risk of falls. Long-term impact assessments are necessary to evaluate the sustained benefits of destabilizing shoes in fall prevention interventions for older individuals. Such comprehensive investigations will aid in the development of evidence-based recommendations for the use of destabilizing shoes in fall prevention interventions in older adults.

Objective 3

This review objective suggests that the impact of destabilizing shoes on improving balance control and reducing fall risk in older adults can be affected by several moderating factors, including age, sex, balance impairments, and physical activity levels. The key findings are as follows.
Several studies noted that older adults, particularly those aged >80 years, exhibit diminished balance control and an increased risk of falls, which may limit their ability to safely and effectively use destabilizing shoes.35) Additionally, age-related declines in sensory input from the feet could affect their capacity to perceive and respond to the destabilizing stimuli introduced by the shoes.30,36)
Some studies suggest that women experience more pronounced balance impairments and a higher risk of falls than men, implying that women may derive more significant benefits from destabilizing shoes.31) However, other studies have reported no substantial sex differences in the efficacy of destabilizing shoes.31)
Some studies have demonstrated that individuals with more severe balance impairments may not benefit as much from destabilizing shoes, as these shoes may introduce excessive instability and elevate the risk of falls.31,32) Conversely, other studies have reported that individuals with specific balance impairments, such as Parkinson disease, may benefit from using destabilizing shoes to enhance their balance control.32,33) Other studies have indicated that individuals with higher physical activity levels may benefit more from using destabilizing shoes because they possess better adaptive capabilities to respond to destabilizing stimuli and improve their balance control accordingly.33,34,37)

Objective 4

This review objective suggests the promise of destabilizing shoes as an effective intervention for fall prevention in older adults, with compelling evidence supporting their safety and acceptability. The following noteworthy findings were obtained.
Several studies have evaluated the acceptability of destabilizing shoes as a fall prevention intervention for older adults, consistently reporting minimal adverse events. For instance, Gerards et al.38) highlighted perturbation-based balance training as a promising task-specific intervention targeting the enhancement of reactive balance control in response to destabilizing perturbations within a secure and controlled setting. Similarly, Gargiulo22) demonstrated no increased risk of falls or injuries among older adults who wore unstable shoes for 12 weeks compared with a control group.
The results of this review highlight that older adults generally approach destabilizing shoes positively as a fall prevention intervention. For instance, Amiez et al.31) reported that balance shoes significantly improved bipedal balance, mainly when performed with closed eyes. Most older participants felt more stable and safer when using balance shoes. These specially designed balance shoes effectively enhanced postural balance among older adults compared with regular shoes, potentially reducing the risk of falling in healthy older adults.
The overall evidence in the present review indicates that destabilizing shoes are generally considered safe and acceptable fall-prevention interventions for older adults. However, it is imperative to consider individual factors, such as balance and mobility impairments, and carefully monitor any adverse events or discomfort associated with using these shoes. Further research is necessary to better understand the efficacy and long-term safety of destabilizing shoes in this population.

Objective 5

The use of destabilizing shoes in fall prevention interventions for older adults is a promising and relatively novel approach. The key findings are as follows.
While some studies suggest that rocker-sole and balance-training shoes can enhance balance control and decrease fall risk, research investigating the association between footwear and slip resistance is scarce.12,37) Integrating slip-resistant shoes with destabilizing shoes could offer a complementary approach to fall prevention programs for older adults.
The collective evidence from this review underscores the potential need for a more nuanced approach that simultaneously considers balance enhancement and slip resistance. Given the critical role of slip resistance in preventing falls among older adults, evaluating the potential tradeoffs and balance between fall prevention and slip resistance in the context of footwear interventions is imperative. Investigating various slip-resistant materials in the heels/soles of destabilizing shoes could offer valuable insights into enhancing slip resistance.
Given the uncertainty surrounding their effects on slip resistance, caution is required when integrating destabilizing shoes into fall prevention programs for older adults. While these shoes may improve balance and stability, the shoe type and specific environment in which they will be used must be carefully considered to ensure optimal slip resistance performance.
A comprehensive fall prevention program encompassing strength and balance training alongside mindful consideration of shoe type and environmental factors could offer substantial benefits. Therefore, healthcare professionals should thoroughly assess individual needs and risks when recommending destabilizing shoes for fall prevention among older adults. This holistic approach ensures that both balance enhancement and slip resistance requirements are adequately addressed.
Table 3 presents the comprehensive relationship between the reviewed studies and five critical strategic objectives regarding the effects of destabilizing shoes on balance control and fall prevention in older adults. Although we found extensive relevant literature, it highlights certain areas that require further exploration. The results focused on specific factors, including age, sex, balance impairments, and physical activity levels, underscoring their influence on the effects of destabilizing shoes. However, the safety and acceptability of these shoes and their potential relationship with slip resistance performance have not been thoroughly investigated. Consequently, the findings of the current review underscore the need for further in-depth studies to address the remaining gaps in our understanding of the broader implications and potential benefits of destabilizing shoes in fall prevention in older adults.

ACKNOWLEDGMENTS

CONFLICT OF INTEREST

The researcher claims no conflicts of interest.

FUNDING

This study was supported by a competitive Project Grant from the University of Sharjah, UAE (No. 2102040551172).

AUTHOR CONTRIBUTIONS

The author performed the design and implementation of the proposed method and read and approved the final manuscript.

Fig. 1.
The destabilizing shoes shown in Fig. 1 possess specific features designed to challenge balance control: (A) Shoe #1: This shoe features a moderate anterior-posterior curvature with a cushioned sole, which encourages controlled instability during walking or standing, activating the user's postural control mechanisms. (B) Shoe #2: This design exhibits a pronounced rocker sole, facilitating a rolling motion during gait. It reduces forefoot pressure while increasing instability, requiring the wearer to make continuous balance adjustments. (C) Shoe #3: This shoe combines a highly curved sole with a softer, more flexible midsole, enhancing dynamic instability while stimulating proprioceptive input.
agmr-24-0030f1.jpg
Fig. 2.
A flowchart of article screening and selection.
agmr-24-0030f2.jpg
Fig. 3.
Summary of strategic research questions and major findings on destabilizing shoes.
agmr-24-0030f3.jpg
Table 1.
Summary of the detailed selection criteria for investigating the effects of destabilising shoes on balance control and fall prevention in older adults
No. Inclusion criteria Exclusion criteria
1 Study focus: The effects of destabilising shoes on stability control and fall prevention in older adults. Non-destabilising interventions: Other types of footwear interventions or fall prevention strategies.
2 Participant age: Studies should encompass participants aged 65 years and older. Neurological or musculoskeletal disorders: Disregard studies that include participants with neurological or musculoskeletal disorders.
3 Publication timeframe: Studies published in English from January 2011 to December 2022. Running-related studies: Studies focusing on running, running gait, or shoes designed specifically for runners.
4 Publication type: Studies published in peer-reviewed academic journals. Pre-2011 publications: Studies published before January 2011.
5 Research design: Prioritise studies utilising randomised controlled trials or quasi-experimental designs. Stable shoes: Studies that solely investigate the effects of stable shoes on balance control or fall risk.
6 Specific focus: Studies with a clear focus on destabilising shoes and their effects on stability control and fall prevention in older adults. Younger adults: Studies exclusively involving younger adults.
7 Methodological approaches: Studies employing quantitative or qualitative methods to assess balance control or fall prevention. Self-reported measures: Studies primarily rely on self-reported falls or balance control measures.
8 Objective measures: Studies employing objective measures of balance control or fall risk, such as force plates, wearable sensors, clinical tests, or virtual realities. Irrelevant populations or interventions: Studies focused on populations or interventions unrelated to destabilising shoes in older adults.
9 Variety of destabilising shoes: Studies focusing on different types of destabilising shoes, such as rocker-bottom shoes, balance training shoes, and other related variations. Methodological quality: Studies that exhibit poor methodological quality.
10 Demographic considerations: Studies investigating potential moderating factors affecting the effectiveness of destabilising shoes, such as age, gender, baseline balance impairments, and physical activity levels in older adults. Language and publication type: Studies not published in English or those not appearing in peer-reviewed academic journals.
Table 2.
Summary of the 29 articles in this review covered various aspects such as shoe types, participants, findings, and methods
Author Year Shoe type Participant Finding Country Method Publication
Nigg et al.29) 2010 Unstable shoe Young and old adults Gender effects should be considered if unstable shoes' functional or therapeutic impact is assessed. Canada Experimental study Journal
Granacher et al.7) 2011 Unstable sole shoes Women elderly During quiet standing and locomotion, postural control and muscle activity with unstable sandal construction were assessed. Germany Experimental study Journal
Kavros et al.10) 2011 Shoes with a stiff rocker bottom sole Older adults Off-loading properties of provisional shoes with a rocker sole were compared to flat sole shoes. USA Experimental study Journal
Spink et al.30) 2011 Destabilising Shoes Older adults with mild balance impairments Older adults with mild balance impairments showed improved balance after wearing unstable shoes for 12 weeks. Australia Experimental study Journal
Hutchins et al.11) 2012 Rocker sole shoes Older adults with claudication Comparison of therapeutic shoes with a specifically designed three-curve rocker sole. UK Experimental study Journal
Gusi et al.35) 2012 Destabilising Shoes Older adults No gender differences were found in the effects of destabilising shoes on balance control. Spain Experimental study Journal
Maffiuletti33) 2012 Destabilising Shoes Older adults Positive subjective feedback from older adults who wore destabilising shoes, including improved balance and confidence. Switzerland Experimental study Journal
Forghany et al.12) 2013 NBT and roller shoes Not reported Beneficial for people with impaired rollover function and seeking strategies for sagittal plane motion in lower limb joints. UK Experimental study Journal
Price et al.8) 2013 Unstable sole shoes Females Instability induced by commercially available unstable sandals compared to stable control sandals. UK Experimental study Journal
Kimel-Scott et al.34) 2014 Rocker bottom shoes Older adults and younger adults Rocker bottoms or unstable shoes may elevate the fall risks in healthy elderly and people liable to falls when faced with challenges. USA Experimental study Journal
McKeon et al.32) 2015 Rocker-Bottom Shoes Older adults Wearing rocker-bottom shoes for six weeks did not increase the risk of falls compared to conventional shoes. USA Experimental study Journal
Mansfield et al.6) 2015 Destabilising Shoes Older adults Limited and inconsistent evidence regarding the effectiveness of destabilising shoes on balance and gait measures. Canada Systematic review Journal
Thies et al.13) 2015 Rocker-Bottom Shoes Older adults The impact of rocker-bottom shoes on gait steadiness and slip resistance in older adults was examined. The authors suggested considering other factors affecting trip risk. UK Experimental study Journal
MacRae et al.9) 2016 Unstable sole shoes Older adults with back pain Rocker-sole shoes enhanced postural stability in individuals with chronic low back pain compared to barefoot settings. UK Experimental study Journal
Menz et al.21) 2016 Rocker-bottom shoes Older adults with a history of falls Older adults with a fall history showed enhanced balance control and decreased falls with specialised shoes. Australia Not reported Journal
Tan et al.24) 2016 MBT shoes Young and old adults MBT shoes changed lower limb biomechanics in asymptomatic and symptomatic individuals during gait. Australia Systematic review Journal
Farzadi et al.26) 2017 Unstable footwear Older adults Improved kinetic and kinematic parameters, so made specific practice recommendations. Iran Experimental study Journal
Gargiulo22) 2017 Rocker-bottom footwear No participants Reviewed the effects of rocker-bottom footwear on balance and gait. US Systematic review Magazine
Sobhani et al.25) 2018 Unstable shoes Older adults WBV technology integrated into unstable shoes shows long-term benefits in improving balance measures for older individuals. Iran Experimental study Journal
Son et al.18) 2019 Vibrotactile shoes Not reported Comparison of RealWalk haptic shoes with vibrotactile-based haptic shoes in a virtual reality space. Korea and USA Experimental study Conference
Jordan et al.23) 2019 Three-curve rocker-soled shoe Older adults with a cramp-like leg pain Three-curved rocker shoes did not augment gait sufficiently to enhance walking distance, compared to control shoes, so they cannot be suggested. UK Experimental study Journal
Cudejko et al.19) 2020 Split-toe shoes Older people Effects of minimal footwear features on stability and physical functions in older people. UK Experimental study Journal
Kazanski et al.28) 2020 Own shoes in a virtual environment without and with across destabilising perturbations Older and young adults Age alone need not degrade lateral stepping control. USA Experimental study Journal
Li et al.20) 2020 Split-toe shoes Not reported Impact of bionic high-heeled shoes on biomechanical characteristics of lower limbs. China and Singapore Experimental study Journal
Amiez et al.31) 2021 Specifically designed Shoes Older adults with varying physical activity levels When wearing specifically designed balance shoes, older adults with higher physical activity levels demonstrated better balance control. France Experimental study Journal
Hemmati and Karimi14) 2022 Rocker sole shoes Older adults The influence of toe-only rocker sole shoes on ground reaction force in older adults was analysed. Iran Experimental study Journal
Hemmati et al.15) 2022 Rocker sole shoes Older adults The impacts of rocker shoes with various degrees on dynamic stability and ground reaction force were investigated. Iran Experimental study Journal
Hemmati et al.16) 2022 Rocker sole shoes Older people The impacts of toe-only rocker shoes on walking adaptability in older people were assessed. Iran Experimental study Journal
Tian et al.17) 2022 Rocker sole shoes Older females Exploration of kinematic strategies in response to different footwear and ground surfaces. China Experimental study Journal
Table 3.
Summary of a comprehensive relationship between the reviewed studies and five strategic questions on the effects of destabilising shoes for balance control and fall prevention in older adults
Study Year Study design and research methods Five strategic question
Q1 Q2 Q3 Q4 Q5
Nigg et al.29) 2010 Experiments
Granacher et al.7) 2011 Experiments
Kavros et al.10) 2011 Experiments
Spink et al.30) 2011 Experiments
Gusi et al.35) 2012 Literature review
Hutchins et al.11) 2012 Experiments
Maffiuletti33) 2012 Case-control & interviews
Forghany et al.12) 2013 Semi experimental
Price et al.8) 2013 Experiments
Kimel-Scott et al.34) 2014 Prospective observational
McKeon et al.32) 2015 Descriptive observational
Mansfield et al.6) 2015 Experiments
Thies et al.13) 2015 Observational survey & interviews
MacRae et al.9) 2016 Systematic review
Menz et al.21) 2016 Randomized control trial
Tan et al.24) 2016 Experiments & questionnaire
Farzadi et al.26) 2017 Systematic review
Gargiulo22) 2017 Literature review
Sobhani et al.25) 2018 Literature review
Son et al.18) 2019 Experiments & questionnaire
Jordan et al.23) 2019 Experiments & questionnaire
Cudejko et al.19) 2020 Systematic review
Kazanski et al.28) 2020 Quasi-experimental
Li et al.20) 2020 Data analysis
Amiez et al.31) 2021 Observational cross-sectional
Hemmati and Karimi14) 2022 Observational cross-sectional
Hemmati et al.15) 2022 Crossover, controlled, randomized single-blind
Hemmati et al.16) 2022 Comparative observational single blind
Tian et al.17) 2022 Experiments
Total number of studies 16 8 8 5 4

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