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Anatomy of a slip and fall

Loose footwear, especially with worn treads, poses risks despite the comfort
By Robert Parkinson and Kathleen Denbeigh
April 29 2016 issue

Branchegevara / iStockphoto.com

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Slippery walking conditions are familiar to Canadians, but slips and falls also occur on indoor surfaces, with potentially serious consequences. Such falls are a major source of injury and lost-time costs in the workplace. In 2013, there were 11,814 lost-time injury claims from falls in Ontario, and 70 per cent were falls on the same level (including falls resulting from slips and trips, according to Health and Safety Ontario).

In 2010, according to Parachute Canada, a charitable organization dedicated to preventing injuries, there were more than one million emergency room visits in Canada due to falls, and the total cost of fall-related injuries was $8.7 billion, including direct healthcare costs and indirect costs (e.g., reduced productivity and disability).

As the population ages, the frequency and severity of slip and fall injuries is likely to increase. It is estimated that 1 in 3 persons 65 years of age and older fall each year, says the World Health Organization, and 20 years from now Statistics Canada estimates this age group will account for nearly 25 per cent of the population.

The selection and maintenance of appropriate flooring is a critical factor in reducing slip and falls. However, there are other factors that can potentially contribute to a slip initiating, including the environment and walking surface, individual walking biomechanics and footwear properties. The likelihood that a slip, once initiated, will result in a fall can also be influenced by footwear, as well as pedestrian characteristics and their ability to recover balance.

The selection and condition of appropriate footwear can contribute to slip and fall prevention. Consider shoes such as Crocs, clogs and flip-flop sandals, which are not secured to the foot in the same way as “typical” footwear, like running shoes. Recently, some of this footwear has been used in both leisure settings and in the workplace (e.g., in hospitals), as it is considered comfortable, easy to clean and take on and off. However, their design may also increase the risk of slips leading to a fall in wet conditions due to the potential for motion not only between the shoe and floor, but also between the foot and the shoe. A research study comparing Crocs, flip-flop sandals and “slip resistant” lace-up shoes during use over contaminated, slippery floors found that both the Crocs and flip-flops demonstrated larger slip distances and velocities during unexpected slips, indicating a greater risk of an unexpected slip leading to a fall. Although this footwear may be considered appropriate for a variety of conditions, it may explain why one pedestrian falls while traversing an area where many others have not.

Even footwear that initially has high slip resistance can become hazardous if not replaced once extensively worn. Consider the case of a young, healthy individual who slips and falls in a public hallway on a rainy day. A review of a surveillance video that captured the incident confirms that, based on the mechanics of the fall, it was likely precipitated by a slip. However, tests of the available friction of the flooring indicate a high level of slip resistance, even when wet. While there could have been a local contaminant on the flooring at the time of the incident, review of surveillance video also shows numerous people successfully crossing the same section of flooring without slipping in the time leading up to the fall. The individual who fell had no balance or mobility impairments, and was wearing lace-up shoes at the time. On closer inspection of their footwear, however, the tread pattern was worn away to the point that the sole was nearly flat. It has been shown that footwear treads are important in reducing the incidence and severity of slips, as channels in the tread are thought to allow for water to be pushed out from under the foot during a step. This would have allowed the shoe to contact the underlying slip resistant floor, despite the presence of water. As such, the condition of the footwear must be considered a factor in the slip and fall.

When assessing the role of footwear in a slip and fall, experience can also be a factor. It has been shown that pedestrians can adapt their gait for the different mechanical demands of varying types of footwear, such as high heels and flip flops. Pedestrians can also adapt their gait when they are aware that the surface they are walking on may be slippery. In this way, experience, warning and gait adaptation may interact with the contributions of footwear. Such considerations may also explain why an individual experiences a slip and fall when other pedestrians in the area have not.

Notably, there is no one type of footwear that has been shown to perform well in all walking conditions, and no single factor (whether footwear or flooring) can be expected to ensure slip resistance in all scenarios. It is important that the footwear is appropriately sized and is suitable for the environment and the activity undertaken. Research continues to provide us with a better understanding of the various footwear design factors that can impact slip resistance and allows for a determination of the possible contribution of footwear to a slip incident, as well as the selection of safer footwear for workers and pedestrians alike.

Robert Parkinson is principal of the biomechanics and personal injury assessment groups at Giffin Koerth Forensic Engineering & Science. Kathleen Denbeigh is an intermediate associate.

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