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Author ORCID Identifier
Open Access Dissertation
Doctor of Philosophy (PhD)
Year Degree Awarded
Month Degree Awarded
Richard van Emmerik
Alternative and Complementary Medicine | Geriatric Nursing | Medicine and Health Sciences | Nursing | Occupational and Environmental Health Nursing | Public Health and Community Nursing
Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement.
Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing.
Outcome measures: Toe pressures, experiences of pain and comfort.
Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of shoe, specific lacing pattern snugged.
Results: 19 participants, aged 65-91(Av 74.7), 14 women, 5 men. When the participant’s heel was secured to back of shoe, and their chosen lacing was snugged (Intervention #1), there were 129/190 (68%) decreases in average peak toe pressures and 57% (11/19) stated there was an improvement in comfort. When the heel was secured to back of shoe, and a specific lacing pattern snugged. (Intervention #2) there were 148/190 (78%) decreases in average toe pressures and 133/190 (70%) decreases of Intervention #2 over Intervention #1. 63% (12/19) experienced greater comfort over Intervention #1. Orders of magnitude of the changes varied. ANOVA and two sample t-tests resulted in statistical significance on the 2nd and 4th left toes.
This study was fueled by observations of nurses operating in the field doing foot care, who are trying to enhance mobility and quality of life for older people desiring to remain in their communities. The strength is the simplicity of the intervention and the focus on older adults and combination of qualitative and quantitative data that offset many of the weaknesses of each method. Limitations of this study were the sample was small, not diverse and the lab based nature of this study excluded those less able who are make up a large segment of the older adult population. Conclusion: Results supported the initial hypotheses that changing the foot position in a shoe and the lacing pattern can positively impact experiences of comfort/pain and reduce toe pressures.
Clayton-Jones, Mary C., "NURSE-DELIVERED SHOE-LACING INTERVENTION: EFFECT ON COMFORT AND TOE PRESSURES FOR ACTIVE COMMUNITY-DWELLING ADULTS (AGE 65+)" (2021). Doctoral Dissertations. 2171.
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