When it comes to choosing fall-proof footwear, elderly people should wear athletic shoes whenever possible, and avoid going barefoot, new research suggests.

In the report on footwear and the risk of falls in older adults, athletic and canvas shoes were associated with the lowest risk. In contrast, going barefoot or walking around in stockinged feet appeared to greatly increase the chances of falling.

Study author Dr. Thomas D. Koepsell explained that sneakers may protect against falls because their large soles provide a lot of surface area contact, and their wide heels help protect people from tipping sideways on an uneven surface. A relatively low heel height also likely helps, he said.

Alternatively, people may fall in bare feet if they step on an unexpected obstacle, while stocking feet may increase the risk of slipping, Koepsell added.

Older adults should consider taking these findings “into account when making choices about footwear,” the researcher, based at the University of Washington in Seattle, told Reuters Health.

According to the report, which is published in the Journal of the American Geriatrics Society, falls are the number-one cause of fatal injuries among older Americans.

To investigate which type of footwear protects the elderly best from these potentially fatal accidents, Koepsell and his colleagues followed 1,371 adults 65 and older for two years, noting who fell and what shoes they were wearing.

Footwear was grouped into 5 categories, described as shoeless, athletic or canvas shoes, loafers or flats, lace-up oxfords, or other.

During the study, 327 people fell while going about their day-to-day activities, without any loss of consciousness or being pushed or hit.

Most of the falls took place while people were in or around their homes, and more than 60 percent occurred on a level surface. The falls caused 15 fractures and 15 head injuries.

The authors found that wearing anything besides canvas shoes or athletic shoes increased the risk of falling by an average of 30 percent. Loafers or flats and lace-up oxfords increased the risk by 50 and 20 percent, respectively. Going barefoot or in stocking feet upped falling risk by more than 11-fold.

The risk of falling associated with going shoeless persisted even after Koepsell and his colleagues accounted for potential confounding factors such as gait problems, grip strength and difficulty rising from a bed or chair.

SOURCE: Journal of the American Geriatrics Society, September 2004.