Off-campus UMass Amherst users: To download campus access dissertations, please use the following link to log into our proxy server with your UMass Amherst user name and password.

Non-UMass Amherst users: Please talk to your librarian about requesting this dissertation through interlibrary loan.

Dissertations that have an embargo placed on them will not be available to anyone until the embargo expires.

Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Rachel Walker

Second Advisor

Cynthia Jacelon

Third Advisor

Richard van Emmerik

Subject Categories

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.


Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.