Stepping with confidence: footwear’s positive influence on entropy in senior gait

Abstract Background Age-related changes increase fall risk in older adults, making gait stability crucial for independence. Footwear significantly influences gait patterns, yet quantitative methods for evaluating footwear effects on statistical regularity remain limited. Aim To investigate footwear impact on center of mass (CoM) regularity, quantified by approximate entropy (ApEn), in older adults during 6-min walk tests. Methods Twenty community-dwelling older adults (mean age 72 ± 7 years) completed randomized 6-min walk tests under three conditions: barefoot (BF), flat shoes (FS), and sports shoes (SS). CoM motion in the resultant direction (combination of vertical, mediolateral, and anteroposterior components) was captured using inertial measurement units. ApEn was calculated from time series data. Repeated-measures ANOVA examined footwear effects on ApEn, walking speed, and distance covered. Cluster analysis identified participant subgroups based on demographics and footwear preferences. Results BF walking yielded significantly higher ApEn values compared to FS (13.52% increase, p < 0.001) and SS (13.28% increase, p < 0.001), with no difference between shod conditions ( p = 1.000). No significant differences were observed in walking speed ( p = 0.729) or distance covered ( p = 0.729) between footwear conditions. Cluster analysis revealed subgroups differentiated by physical activity levels and fall history. Conclusion Older adults exhibited higher CoM irregularity during BF walking compared to footwear conditions, while maintaining similar walking performance across all conditions. This suggests that footwear influences neuromuscular control strategies independently of functional capacity. Cluster analysis identified distinct subgroups based on physical activity levels and fall history, highlighting the importance of footwear for enhancing gait stability without compromising mobility.