Right Foot Forward

Taking each step with confidence, the sandal, named “Silver Generation Footwear”, gives the added reassurance to elderly patients that they can move around with minimum risk of slipping and hurting themselves. With an increasingly ageing population, where one in four people will be aged 65 and above by 2030, healthcare innovations like the “Silver Generation Footwear” sets the stage for value added healthcare.

Developed by a collaboration of professionals in diverse fields within healthcare, the Silver Generation footwear was customised to provide good foot support by enhancing the footwear with appropriate width, changing static alignment, improving kinesiology factors, gait parameters and plantar pressure distribution.

But what makes this footwear different from others in the market, and how did the footwear go from concept to realisation? CHI spoke to Sister Loh Sok Hiang, Nurse Clinician at Tan Tock Seng Hospital, who shared how they walked the talk.

The Challenge

In 2016, Chief Nurse Dr Hoi Shu Yin, who had taken charge of reviewing patient fall indicators, found that a lot of slips and falls were due to inappropriate footwear worn by patients. Based on the Incident Response Improvement System (IRIS), this reason accounted for approximately 10 percent of the fall incidents.

Patients warded at the hospital often bring their own footwear, which could be worn out, or have soles that have been smoothened due to frequent wear, causing it to become slippery when in contact with water. Sadly, there were also some elderly patients who were admitted with no footwear at all, thus affecting their mobility. Very often, some nurses would go out of the hospital to purchase footwear for the elderly if there was no one to purchase on their behalf, but they could not be sure if the footwear purchased were anti-slip.

The Idea

Determined to minimise the risk of falls, Dr Hoi formed a team with members from various areas of expertise to develop a footwear that patients could use during their stay at the hospital. For patients without footwear, they would be issued the footwear to enable mobility in the wards.

The key benefit of this footwear would be to minimise accidental fall due to slips and trips that could lead to bone fractures and other health complications. It should optimise safety and comfort, and be made with waterproof material, anti-slip soles, and easy usage for patients with dexterity issues. High on the list would also be providing the footwear at an affordable cost for patients.

Sister Loh shared: “One of the key challenges is getting the team together, was finding a vendor who would be willing to collaborate and invest in developing this footwear. This was largely due to the high cost of creating a mould, material needed, and safety tests were conducted to ensure its suitability for patients.”

The team was introduced to KPR Footwear Company who was keen to develop the footwear and provide a free mock-up of the product. While the materials and mock-ups would have cost quite a lot, the vendor shared the same sentiments about providing the elderly community with such a footwear.

The team comprised of:

Physiotherapist – Who provided advice and recommendations on suitable footwear to reduce risk of falls related to unsafe footwear. The physiotherapist was also consulted on the characteristic alteration of the footwear, such as increasing the width of the footwear to achieve well-fitting, secured fastenings and anti-slip soles.

Occupational Therapist - The occupational therapist actively involved the patient in the fall prevention process to better understand individual fall risk factors and intervention priorities. Teaching patients how to identify and solve problems is an important part of the occupational therapy process. As such, they were able to recommend appropriate footwear features to minimise risk of falls related to unsafe footwear.

Geriatric Nurse Clinician – The geriatric nurse clinician gave insights to the team on the common fall situation and the mechanics involved that could cause falls.

KPR Footwear Company – The company provided the know-how on footwear technology and production.

Rigorous Tests

Through various iterations and testing, the Silver Generation footwear was customised to provide good foot support by enhancing the footwear with appropriate width, changing static alignment, improving kinesiology factors, gait parameters and plantar pressure distribution.

Figure 1: Tests conducted by the footwear company to ensure the quality and safety of the footwear.

As the table shows, the footwear cleared the tests with results in the acceptable parameters, for patient use.

Customised for Comfort

Breaking down the specifics of the footwear, Sister Loh shared the considerations and features of the product. “The footwear adopted an open toe design, which made it easier for the elderly to put on, just like a slipper, but with a strap at the back.”


The top part of the sandal was made of 1.6-2.0 mm double sided black performance cloth, water resistant, and should not be buffed or snuffed. The chemical used for treatment in the production of the footwear would not cause any allergy or skin problems to wearer.

The adjustable velcro fastener strap allows for easy adjustment, especially useful for patients who have joint dexterity issues to minimise the effort of putting on or taking off the footwear. Designed with a reflective strap, it would facilitate visibility of footwear in the dark.

The strap at the ankle also provided support on the Achilles region to prevent the footwear from slipping off.


The mid-sole was made of approximately 1.2mm – 1.4mm thick BASF Polyurethane, using the DESMA direct injection technology. Thin and hard soles were more appropriate to improve foot position and optimise balance. Footwear with a high sole would cause the patient to lose balance and fall.


Insole is shaped to the contour of the foot and made of non-abrasive material and suitable fabric that was water resistant or dried up moisture quickly. The broad front of the footwear allowed for better stability and provided toes with adequate wiggle space.


The outsole was made of BASF Polyurethane using DESMA direct injection technology, which prevented disintegration, cracking, or deterioration for at least four years under normal storage conditions.


The weight of the footwear was not more than 200 grm for a size 7, to enhance patient mobilisation. 

Future Plans

The project to develop and test the footwear took three years to complete, breaking into the market in September 2019. With retail sales starting just before the Covid-19 pandemic hit in March 2020, sales have been modest. Even then, Sister Loh shared that they were looking at ways to make the footwear more attractive, which is only available in white for now, and hoped that it would appeal to a larger market.

“If all goes well, we can expect the new selections in one to two years,” quipped Sister Loh cheerfully.


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