Contents
1 Aim
The wearing of suitable footwear has been linked to falls prevention. The following procedure highlights the importance of healthy feet and safe footwear and what to consider as part of falls risk assessment and management with patients.
2 Scope
This is a trust wide procedure which is applicable to all patients under our care. It focuses in particularly on the needs of those patients who are in the higher falls risk groups or who already have a history of falls (over 65’s and, or patients with pre-existing health conditions which means they are at a higher risk of falling).
3 Link to overarching policy, and or procedure
4 Procedure or implementation
4.1 Information for clinical colleagues, the importance of healthy feet and safe footwear
Robust and suitable footwear is key to safe mobility, safety and confidence and a person is much more likely to trip or fall if they are not wearing suitable footwear or if they wear footwear incorrectly. It is therefore very important that patients wear appropriate footwear to prevent slips, trips and falls and prevent injuries to their feet. Foot health is equally important as this can affect balance and gait. Routine checks of foot health must form part of the falls risk assessment process.
4.2 What is appropriate footwear
There is no definitive research on the safest type of footwear and different patients will have different footwear needs and preferences. Appropriate footwear can be described as a well-fitting shoe or slipper with a low wide heel, firm supportive sole, deep toe box, and a secure fastening, for example, lace, Velcro or buckle (so the width is adjustable). There should be plenty of room for toes (approximately half inch or 1.2cm gap between the end of the shoe and the toes), most of all they should be comfortable for the patient. For patients with sensory loss they may not feel if footwear is uncomfortable or ill-fitting therefore vigilance is required to inspect the skin for signs of pressure or damage.
4.2.1 Certain footwear is unsafe or less safe in any environment, including
- Anti-embolism stockings.
- Bandages or dressings only in situ.
- Backless shoes or slippers except for very confidently mobile patients.
- Shoes or slippers that are visibly too big or too small.
- Foam disposable slippers except for very confidently mobile patients.
- Shoes or slippers worn with squashed backs.
- Lace up shoes without laces, or with trailing laces.
- High heeled shoes except for very confidently mobile patients.
- Socks only, including the non-slip style.
- Bare feet.
4.2.2 Checking foot health
Inspect the feet for any red marks, pressure areas or blisters, any leakage of fluid indicating a new or existing wound, also check for nails that are causing tissue damage (impinging into skin), corns and other foot conditions that are impacting on individual’s ability to mobilise. If present, consider referral for further assessment and treatment, for example, podiatrist, ask the patient or family how they usually manage their foot care-self, carer or relative, private, NHS?
4.2.3 When should slipper socks be used?
- When a patient has been admitted with no adequate footwear.
- When the patient’s current footwear is ill fitting and unsafe and poses more of a risk to them than wearing slipper socks.
- When the patient continually removes their shoes or slippers and mostly mobilises in bare feet.
The decision to use slipper socks is as a temporary measure or last resort only. It should be discussed with the multi-disciplinary team (MDT) and regarded as a short-term option until proper fitting footwear is available. Consider ordering Kerraped all-purpose or ulcer boot if high risk of tissue injury, co-morbidities such as vascular disease, poorly controlled diabetes, neuropathy, chronic kidney disease stage 4 and above. Colleagues must ensure relatives (or patient’s representatives) are given the support and information to enable them to supply safe footwear as soon as possible.
Care must be made with the choice and fitting of slipper socks; some have rubber grips on one side only and if they work loose the grip can be ineffective.
4.3 Other risks
If the patient has any foot orthotics such as drop foot splint. Care must be taken to ensure that this is applied and managed in line with a care plan. These are always worn with suitable footwear, never in isolation and should always be fitted before a patient weight bears.
4.4 What about patient choice?
Whilst colleagues must of course allow for patient choice with relation to footwear, they also have duty to inform patients and their relatives about the risk of falls and ways the risk can be managed or reduced, including the choice and safety of footwear. If patients do not have the mental capacity to understand the risks and issues, colleagues have a duty to make decisions in their best interests.
For specific guidance about footwear needs of individual patients, ward colleagues are advised to discuss further with physiotherapy or occupational therapy or podiatry or chiropody colleagues.
Document control
- Version: 1.
- Unique reference number: 1050.
- Approved by: Clinical policy review and approval group.
- Date approved: 1 August 2023.
- Name of originator or author: Clinical team leader.
- Name of responsible individual: Executive director of nursing and AHP’s.
- Date issued: 11 August 2023.
- Review date: 31 August 2026.
- Target audience: Clinical staff.
- Description of change: Procedure to a manual.
Page last reviewed: April 23, 2024
Next review due: April 23, 2025