Footwear related problems following stroke: qualitative study of the views and experience of people with stroke in the SHOES Study

Purpose: Foot problems and suboptimal footwear are risk factors for falls among the elderly. Footwear choice may therefore be important for people with balance impairment following stroke but little is known about their experience. This study explored foot problems experienced following stroke, factors influencing footwear choices and views of footwear in use.Methods: Eligibility criteria were diagnosis of a stroke, able to walk and willingness to participate. Semi structured interviews with 15 people with stroke [PwS], purposively sampled from respondents to a screening survey. The sampling process drew on information about mobility (with or without falls), reliance on walking aids or other people, able to walk more than ¼ mile. Interviews were conducted in participant’s homes. Participants were asked to make available for discussion items of footwear currently being worn indoors and out. Data were managed and analysed thematically using Framework.Results: The sample comprised 15 people, 8 men and 7 women ranging in age from 52-84 years; mean 71 years with varying levels of mobility. Participants typically experienced impaired mobility with balance problems and felt at risk of falling. Stroke related foot problems, including altered sensation, oedema, and foot drop, predominantly on the stroke affected side, influenced footwear priorities. Footwear choices prioritised comfort, security and convenience, sometimes in tension with concern about appearance. Challenges included choosing appropriate indoor footwear and finding shoes to accommodate orthoses and oedema. Participants highlighted perceived lack of footwear advice from health care professionals [HCPs] and variable experience of shoe shopping.Conclusion(s): Foot problems, as well as gait and balance impairment, have implications for footwear priorities following stroke but PwS feel unsupported in making healthy footwear choices. HCPs could be trained to routinely deliver footwear assessment and advice and facilitate referrals to specialist podiatry services where appropriat