How to Choose the Right Footwear for Elderly Fall Prevention Indoors
Indoor footwear has a bigger impact on fall risk than most people realise — going barefoot, wearing socks alone, or wearing soft, backless slippers is linked to a substantially higher risk of falling at home, while a supportive, well-fitted shoe with the right features measurably improves stability. In one well-known study, over half of in-home falls happened while the person was wearing slippers, walking barefoot, or in socks without shoes — making indoor footwear one of the more overlooked, genuinely modifiable fall risk factors in the home.
Why Indoor Footwear Matters So Much
Most falls happen inside the home, which makes indoor footwear choices — often treated as an afterthought compared to "proper" outdoor shoes — a significant, addressable factor. Walking barefoot or in socks alone has been associated with a substantially increased fall risk, since bare feet and socks reduce the sensory feedback the sole normally provides and offer no grip against hard flooring. Backless and soft-soled slippers, while comfortable, have been specifically linked to falls and fall-related fractures, largely because they don't hold the foot securely and offer little support around the heel.
The Footwear Features That Actually Reduce Fall Risk
Research on footwear and balance in older adults points to a consistent set of features worth looking for, whether shopping for indoor shoes or slipper-alternatives:
- A low, broad heel — a stable heel around 2–2.5cm high, rather than completely flat or elevated, tends to support balance best. Avoid anything narrow or elevated.
- A supportive, closed collar around the heel — shoes that hold the heel securely (rather than backless slip-ons) prevent the foot sliding within the shoe, which is a common trigger for a stumble.
- Secure fastening — laces, velcro straps, or another proper fastening mechanism keep the shoe snug to the foot; slip-on styles with no fastening are more prone to shifting during walking.
- A firm, slip-resistant, treaded sole — enough grip to prevent slipping on hard flooring, without being so thick or rigid that it reduces ground feedback. Check tread periodically and replace footwear once it wears smooth.
- A medium-firm, sturdy midsole — soles that are too soft and flexible make it easier to twist a foot or ankle; too rigid can also affect natural gait. A medium-firm, supportive sole strikes the right balance.
- A proper, snug (not tight) fit — feet naturally spread slightly during walking to aid stability, so shoes that are too narrow or too small can restrict this and affect balance, while shoes that are too loose allow the foot to shift inside.
- Lightweight construction — heavier shoes are more tiring to walk in and can encourage shuffling, which itself increases trip risk.
What to Avoid
- Backless or open-heel slippers — comfortable, but consistently linked in research to a higher risk of falls and fall-related fractures.
- Walking barefoot or in socks alone, particularly on hard flooring — associated with a markedly higher fall risk than wearing any supportive footwear at all.
- Traditional soft, floppy slippers with no structure — comfortable for sitting, but offer little of the support, grip, or fixation that meaningfully protects balance while walking.
- High heels or narrow-heeled shoes, indoors or out — these reduce ground contact and directly affect balance and ankle stability.
The Non-Slip Socks Myth
"Grip" or "non-slip" socks are widely used, particularly in hospitals and care settings, on the assumption that the rubberised tread makes them a safe alternative to shoes. Current evidence doesn't strongly support this — reviews haven't found reliable proof that non-slip socks meaningfully reduce fall risk compared to proper footwear, and the lowest rate of footwear-related falls in research consistently belongs to people wearing actual shoes, not socks of any kind. Non-slip socks aren't harmful, but they shouldn't be treated as a substitute for supportive, properly fitted footwear.
Comfort and Safety Don't Have to Be a Trade-Off
A common reason people choose soft slippers at home is comfort — proper shoes can feel formal or restrictive for lounging around the house. The good news is this doesn't have to be an either/or choice: a growing range of footwear is specifically designed to offer slipper-level comfort with proper structure — a supportive heel collar, secure fastening (often velcro rather than laces), and a firm, gripped sole — genuinely built for indoor wear rather than adapted outdoor shoes. Framing the choice as "supportive shoes worn indoors" rather than "slippers versus shoes" tends to make this change easier to actually adopt and stick with.
Rehalign provides home visit physiotherapy and home safety guidance for older adults across the West Midlands, including Birmingham, Solihull, Coventry, Walsall, Wolverhampton and Dudley — including practical footwear and home hazard guidance as part of a falls risk assessment. Book a falls risk assessment or get in touch for personalised guidance on footwear and home safety.
Frequently Asked Questions
Traditional soft, backless slippers are consistently linked to a higher fall risk in research, mainly because they lack heel support and secure fixation. Supportive "slipper-shoes" with a closed heel, proper fastening, and a firm sole are a safer alternative that still offers indoor comfort.
No — walking barefoot or in socks alone is associated with an even higher fall risk than most footwear, including slippers, since it removes grip and the sensory and structural support a shoe provides.
Current evidence doesn't strongly support non-slip socks as an effective fall prevention measure on their own — research consistently finds lower fall rates in people wearing proper shoes compared to any type of sock, gripped or otherwise.
Once the tread on the sole visibly wears smooth, or the shoe no longer holds the foot securely, it's time to replace it — worn tread significantly reduces the grip the shoe is providing, even if the shoe still looks otherwise fine.