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Adam,

Thanks for a great question. I wrote about shoes fitting in general a year or so ago and have added some special things for geriatric consideration.

PICKING SHOES FOR OLDER PEOPLE

The American Orthopaedic Foot and Ankle Society (of which I am a member), the National Shoe Retailers association and the Pedorthic Footwear Association have this advice for both men and women when buying shoes.

1. Don't automatically assume that "your" size is the right size. Shoe sizes vary among brands and styles, so select the pair that fits your feet best and ignore the number that's printed inside.
   

2. Make sure the shape of your shoe roughly matches the shape of your foot. (In other words, pointy-toed shoes are "out".)
   

3. Ask a salesperson to measure your feet from time to time. Foot size can change as you get older.
   

4. Always measure both feet. If sizes differ, fit the shoes to the larger foot.
   

5. Try on shoes at the end of the day. That's when feet are the largest.
   

6. Make sure that there is enough space (3/8" to 1/2") at the front of each shoe to accommodate your longest toe then you stand up.
   

7. Check that the ball of your foot fits comfortably into the widest part of the shoe.
   

8. Don't assume that shoes will "stretch" to fit. You'll just end up with a pair that's too tight.
   

9. Choose shoes that fit your heel comfortably- there should be minimal slippage.
   

10. To ensure fit and comfort, make it a point to walk in new shoes before you leave the store. They will never be any more comfortable than right then.
    

11. Older folks need lace-up or Velcro shoes that don't get sloppy. Loose shoes cause broken hips. Slippers are a poor choice. Be sure there is a lot of room in the boxy toe section for the often-crooked older toes. In particular, those people with Diabetes have poor feeling in their feet and don't get good balance messages from the ground. They like to wear shoes very tightly so they can "feel" them on their feet. This leads to sores and ulcers if not inspected daily by someone with good eyes.
    

12. Make sure shoes are well padded and avoid seams to rub raw spots. Thick socks avoid moisture buildup avoiding infections. Soles should be shock absorbent but not too flexible.
    

13. For initial expert opinion see an Orthopaedic Surgeon skilled in Foot problems; a Podiatrist; or a Member of the Podiatric Footwear Association.

George L. Dixon, Jr., M.D.