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Observational Study
. 2023 Aug;45(16):2630-2637.
doi: 10.1080/09638288.2022.2102679. Epub 2022 Aug 14.

Footwear characteristics and foot problems in community dwelling people with stroke: a cross-sectional observational study

Dorit Kunkel  1 , Louis Mamode  1 , Malcolm Burnett  1 , Ruth Pickering  2 , Dan Bader  1 , Margaret Donovan-Hall  1 , Mark Cole  1 , Ann Ashburn  1 , Catherine Bowen  1
Affiliations
Observational Study

Footwear characteristics and foot problems in community dwelling people with stroke: a cross-sectional observational study

Dorit Kunkel et al. Disabil Rehabil. 2023 Aug.

Abstract

Purpose: To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population.

Methods: Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments.

Results: Most participants wore slippers indoors (n = 17, 57%) and walking shoes outdoors (n = 11, 37%). Over half wore unsupportive ill-fitting shoes indoors and 47% of outdoor shoes fitted badly. All participants had foot problems (mean 6.5 (3.1), 95% CI: 5.4-7.7), including impaired single limb heel raise (93%), reduced range of movement (77%), sensation (47%), and muscle strength (43%). Many had foot-pain, hallux valgus (both 50%), or swollen feet (40%). Foot problems were associated with reduced balance confidence, activity, and community participation (all p < 0.05). A greater proportion of fallers (13/16) than non-fallers (4/14) reported foot problems (p = 0.029).

Conclusions: Many community-dwelling people with stroke wore poorly fitting shoes; all had foot problems. Foot problems were linked to reduced mobility. Finding more effective pathways to support people with stroke to select supportive, well-fitting indoor and outdoor footwear is indicated.Implications for rehabilitationPeople with stroke often wear unsupportive ill-fitting shoes and experience foot problems.Assessment of foot problems and footwear advice should be considered during stroke rehabilitation particularly when interventions target fall prevention or improvements in balance and mobility.Information on appropriate footwear and signposting that new shoe purchases should include measuring feet to ensure a good fit is recommended.

Keywords: Indoor and outdoor shoes; foot problems; footwear; poorly fitting shoes; stroke.

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Conflict of interest statement

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Research, NHS or the Department of Health.

The authors declare no conflicts of interest in relation to this work.

Figures

Plots a, b, and d show a negative correlation between foot problems and upper limb movement, physical activity and community participation as measured using the Stroke Impact Scale and plot c shows a positive correlation for balance confidence. The correlations shown suggest that people who presented with a greater number of foot problems were also observed to present with reduced upper limb function, were less physically active and had reduced balance confidence and reduced community participation.
Figure 1.
Four scatter plots showing the correlation between number of foot problems identified by the podiatrist during the assessment and three different Stroke Impact Scale sections and balance confidence as measured using the Tinetti Falls Efficacy Scale.
See this image and copyright information in PMC

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