Variable-Friction Footwear Tied to Fewer Falls in MS, Survey Finds

Falls remain a persistent mobility challenge for people with multiple sclerosis (MS). A recent retrospective survey study published in JMIR Rehabilitation and Assistive Technologies examined whether a passive footwear device was associated with changes in self-reported falls, injuries, and health care use. More than half of the study’s respondents reported having MS.¹

Falls and Fall Concerns in MS

A nationwide cross-sectional survey of 965 adults with MS was published in 2024 in the American Journal of Physical Medicine & Rehabilitation. In that survey, 56% of respondents reported falling in the past 6 months, and about 30% of those who fell reported an injurious fall. Most respondents (87%) were concerned about falling, and 68% reported cutting down on activities because of that concern. Among participants who had received information about falling, 9% had taken a formal fall prevention course.²

Tripping is one pathway to falls that has been linked to gait changes in MS. In an exploratory study published in 2020 in Frontiers in Neurology, 11 people with MS had a mean toe clearance of 80.3 mm during the swing phase of walking, compared with 123.6 mm in speed-matched healthy controls. The authors noted that many falls in people with MS can be traced to tripping. After 20 sessions of treadmill training, toe clearance in the MS group increased to 103.6 mm.³

Evaluating Variable-Friction Footwear

Researchers at Shirley Ryan AbilityLab and Northwestern University surveyed adults who had purchased Cadense Original variable-friction (VF) shoes and worn them for at least 3 months.¹ The shoe is an FDA-registered Class I device with no electronics. Low-friction slides at the forefoot are designed to let the toe glide if it touches the ground as the foot swings forward. A high-friction outsole engages when the foot bears weight.

Of 14,570 invited customers, 705 provided usable data, a 4.8% response rate. Mean age was 59.5 years, and 391 participants (55.5%) reported having MS. Other reported conditions included peripheral neuropathy, stroke, spinal cord injury, and Parkinson disease.

Reported Changes in Falls and Health Care Use

Mean monthly self-reported falls decreased from 2.4 before VF use to 0.3 during use. The proportion of participants reporting zero falls increased from 22.7% to 84.4%. Among participants with MS, 78% reported fewer falls and 56% reported fewer injurious falls.

Nathan Estrada is a physical therapist and vice president of clinical at Cadense, and he was not a study author. He told The American Journal of Managed Care® that identifying candidates should start with “the person’s walking mechanics rather than the diagnosis.” He noted that patients with similar diagnoses can have different mobility needs. “You don’t have to have a Parkinson’s shoe. You don’t have to have an MS shoe,” he said.

Across the cohort, the proportion requiring medical attention after a fall decreased from 27.2% to 1.7%. Hospital or urgent care visits decreased from 18.6% to 1.4%. Mean annualized self-reported insurance-related fall costs decreased from $5946 to $46 per person-year. The 95% CI for the mean difference ranged from −$12,907 to $1105, and median costs were $0 in both periods. Some participants reported how they fell in both periods. Among them, the share of falls attributed to tripping decreased from 52.3% to 31.5%. Assistive device use declined from 70.8% to 16.6%. Walking and balance were not objectively assessed. For that reason, the authors stated that this decline should not be interpreted as improved functional mobility or as a recommendation to discontinue prescribed devices. Estrada said the company does not advise users to reduce assistive device use.

Interpreting the Findings

The study used a retrospective pre-post design without a control group. The low response rate and the 3-month minimum use requirement may have favored participants who perceived a benefit. Outcomes were self-reported and were not verified through medical records or claims. The Cadense founder, who contributed to the study design, and a company employee were coauthors. Cadense also secured the study’s funding through the charitable arm of Rise Together Ventures. According to the authors, the company provided the customer list but had no role in recruitment, survey administration, data collection, or analysis.

“This is an early signal; it’s not definitive proof of effectiveness,” Estrada said. He added that a prospective controlled study and a prospective actuarial study in a Medicaid population are underway. He said the footwear is “not intended to replace rehab or strengthening or bracing.”

References

1. Nataletti S, Bartloff J, Prokup S, et al. Participant-reported reductions in falls and fall-related injuries associated with variable-friction footwear: retrospective pre-post survey study. JMIR Rehabil Assist Technol. 2026;13:e104177. doi:10.2196/104177
2. Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Nationwide update on prevalence of falls, injurious falls, concerns about falling, and fall prevention in persons with multiple sclerosis. Am J Phys Med Rehabil. 2024;103(9):811-818. doi:10.1097/PHM.0000000000002454
3. Jonsdottir J, Lencioni T, Gervasoni E, et al. Improved gait of persons with multiple sclerosis after rehabilitation: effects on lower limb muscle synergies, push-off, and toe-clearance. Front Neurol. 2020;11:668. doi:10.3389/fneur.2020.00668