3 Factors to a Slip & Fall Injury: Shoes, Floor & Person

Slip and fall accidents are among the most common and costly causes of personal injury in the United States. According to the National Floor Safety Institute (NFSI), slip and fall cases account for more than one million visits to hospital emergency rooms each year. In 2023, the National Safety Council (NSC) recorded 47,026 deaths from falls nationwide — the highest number of fall-related fatalities ever recorded. The economic toll is staggering as well: compensation and medical costs associated with slip and fall accidents amount to approximately $70 billion annually, according to the NFSI.

Despite the frequency of these accidents, many people do not realize that a slip and fall injury rarely results from just one isolated hazard. In fact, forensic investigators, safety engineers, and courts consistently recognize that most falls involve an interaction of three distinct contributing factors: the footwear the person was wearing, the condition of the floor or walking surface, and the behavior or physical condition of the person who fell. Understanding how each factor contributes — and how courts weigh them in a premises liability claim — is essential for injury victims, property owners, and legal professionals alike.

Factor 1: Footwear — The First Line of Defense Against a Slip

The shoes a person wears at the time of a fall are far more significant than most people appreciate. Footwear affects the coefficient of friction (COF) between a person’s foot and the walking surface. When that friction is insufficient, the risk of slipping increases dramatically regardless of what the floor looks like.

How Footwear Affects Slip Resistance

The NFSI recognizes the COF as the primary scientific measurement used to evaluate slip risk. A wet static COF of 0.6 or greater is considered high traction and capable of reducing slip and fall claims by up to 90 percent, according to clinical studies performed by the NFSI. Footwear that is worn down, smooth-soled, or made of materials that produce a low COF on specific surfaces significantly increases the likelihood of a slip occurring.

Common footwear-related risk factors include:

Smooth leather soles with minimal tread depth
High heels that reduce the contact surface area between shoe and floor
Overly flexible soles that cannot properly grip irregular surfaces
Wet or contaminated soles that transfer moisture to the walking surface
Improper footwear for the environment (e.g., dress shoes in a commercial kitchen setting)

The American National Standards Institute (ANSI), in conjunction with the NFSI, published the ANSI/NFSI B101.1 wet static coefficient of friction test method (2009) and the ANSI/NFSI B101.3 wet dynamic coefficient of friction test method (2012). These standards allow experts to test shoes and floors in combination to determine whether a particular shoe-floor pairing is reasonably safe. These testing standards are now commonly used in litigation as benchmarks for establishing or defending against negligence claims.

Footwear as Evidence in Litigation

Courts and defense teams routinely investigate the footwear worn at the time of a fall. Legal practitioners advise clients to preserve the shoes worn during a slip and fall incident because footwear is a recognized piece of physical evidence. The sole condition, heel wear, and material composition of the shoe can be examined by a forensic expert to determine whether the shoes contributed to the accident.

In comparative negligence jurisdictions — which include the majority of U.S. states — wearing inappropriate footwear can reduce a plaintiff’s recovery. Under comparative negligence principles, if a court finds that the plaintiff was 25% responsible for their fall because of unsuitable shoes, the plaintiff recovers only 75% of their total damages. For example, the Restatement (Second) of Torts § 463 defines contributory negligence as conduct that falls below the standard to which the plaintiff is required to conform for their own protection, and footwear choice has been cited under this framework.

Some states still apply the harsher doctrine of contributory negligence, under which even a 1% finding of fault against the plaintiff — including for wearing inappropriate footwear — can bar recovery entirely. Maryland is a notable example of a contributory negligence state, and its courts have specifically recognized that wearing inappropriate footwear and ignoring posted hazard warnings can eliminate a plaintiff’s right to compensation under Maryland common law.

Employer Obligations Regarding Footwear

In the workplace context, footwear becomes an occupational safety issue. OSHA’s standard for walking-working surfaces, 29 CFR 1910.22, requires that employers keep all workroom floors clean and dry, and provide drainage and dry standing places when wet processes are used. While OSHA does not mandate specific footwear in its general industry walking-working surfaces standard, it does note that slip-resistant footwear may be useful in reducing slipping hazards in areas where wet or slippery conditions are likely. Many industries — particularly food service, healthcare, and manufacturing — have specific footwear requirements embedded in their safety programs.

Factor 2: The Floor — Surface Conditions and Property Owner Liability

The condition of a walking surface is the factor most commonly examined in slip and fall litigation. According to the NFSI, walking surfaces contribute to 55% of all slips, trips, and falls. The Consumer Product Safety Commission (CPSC) further reports that floors and flooring materials directly contribute to more than 2 million fall injuries each year in the United States.

What Makes a Floor Dangerous?

A floor can become hazardous in a number of ways. The most common include:

Wet or Contaminated Surfaces: Liquid spills, tracked-in rain, mopping residue, leaks, and condensation are leading causes of slip and fall accidents in retail, restaurant, and hospitality environments. Consolidated Floor Safety estimates there are between 3 and 9 falls in the average restaurant each year, many of which involve wet floor surfaces.

Insufficient Slip Resistance: Floors may be inherently slippery due to their material composition — polished marble, glazed tile, and certain laminates are known to have low COF values, especially when wet. ANSI/NFSI B101 standards define thresholds below which a surface is considered hazardous. Although many floor finishes are classified under the ASTM (formerly American Society for Testing and Materials) D2047 standard as “slip resistant,” this designation is measured under dry laboratory conditions and does not guarantee safety under real-world conditions, particularly when wet.

Uneven or Defective Surfaces: Raised tile edges, cracked concrete, abrupt transitions between floor materials, holes, and warped floorboards create tripping hazards distinct from slipping hazards. Courts have held that sidewalk elevations and surface defects must be more than slight inequalities to be actionable. In Martin v. Mayor and City Council of Rockville, 258 Md. 177, the Maryland Court of Appeals held that a dangerous obstruction or depression is required; minor defects do not give rise to a cause of action. This “trivial defect” doctrine is recognized in most states as a valid defense for property owners.

Improper Maintenance: Even inherently slip-resistant surfaces become dangerous when improperly maintained. Cleaning products that leave a residue, waxes applied too thickly, and failure to use NFSI-certified high-traction cleaning products can render a safe floor hazardous over time.

Legal Standards for Floor Safety

Under OSHA 29 CFR 1910.22(a), the floors of every workroom must be maintained in a clean and, to the extent feasible, dry condition. When wet processes are used, drainage must be maintained and dry standing places — such as false floors, platforms, and mats — must be provided. OSHA further requires that walking-working surfaces be maintained free of hazards such as sharp objects, loose boards, corrosion, leaks, spills, snow, and ice under 29 CFR 1910.22(a)(2). These are enforceable federal standards in employment settings.

Outside of the workplace context, property owners’ duties are governed by premises liability law. The foundational framework comes from the Restatement (Second) of Torts § 343, which holds that a possessor of land is liable for physical harm caused to an invitee by a condition on the land if: (a) the possessor knows or by the exercise of reasonable care would discover the condition and should realize it involves an unreasonable risk of harm; (b) the possessor should expect that the invitee will not discover or realize the danger or will fail to protect themselves against it; and (c) the possessor fails to exercise reasonable care to protect the invitee against the danger.

The key concept embedded in § 343 is notice — the property owner must have known about the hazardous condition, either actually or constructively. Constructive notice means the condition existed long enough that a reasonable property owner exercising due diligence would have discovered and corrected it. Courts examining this question look at factors such as how long a substance had been on the floor, how visible it was, and what inspection practices the owner had in place.

In Craig v. [Mall], Pennsylvania courts applying Restatement (Second) of Torts § 343 granted summary judgment to the property owner because the plaintiff produced no circumstantial evidence of the duration of the spill sufficient to establish constructive notice. The court, citing Lanni v. Pennsylvania Railroad Co., 88 A.2d 887, 889 (Pa. 1952), confirmed that where jury resolution would require conjecture or guesswork rather than reasonable inference, a court may resolve the question as a matter of law.

Importantly, the Restatement (Second) of Torts § 343A also provides that a possessor of land is not liable for physical harm caused by any activity or condition whose danger is known or obvious to the person on the land, unless the possessor should anticipate harm despite that knowledge. This means that a wet floor clearly marked with a warning sign may significantly undermine a plaintiff’s claim — unless the warning was inadequate for the circumstances or the plaintiff had no reasonable ability to avoid the area.

Under § 332 of the Restatement, a business owner is not an insurer of the safety of invitees — only a guarantor of reasonable care. This was affirmed in Swift v. Northeastern Hospital of Pennsylvania, 456 Pa. Super. 330, 690 A.2d 719 (1997), where the court held that the mere existence of a harmful condition is neither evidence of breach nor a presumption of negligence. The plaintiff must affirmatively demonstrate the existence of a dangerous condition and show that the possessor created it, had actual notice of it, or had constructive notice through its failure to inspect and maintain the premises.

Specific Floor Hazard Categories in Case Law

Grocery Stores: Consolidated Floor Safety reports that most liability claims in grocery stores arise from slip and fall incidents. Courts across the country have examined the duties of grocery retailers extensively. Plaintiffs must typically show that a spill or slippery substance was present on the floor, that the store knew or should have known about it, and that the store failed to remediate the hazard within a reasonable time.

Nursing Homes: The NFSI data reveal that as many as 60% of nursing home residents suffer a fall injury annually, with nearly 1,800 dying each year in nursing homes from fall-related injuries. These facilities face heightened duties of care under both state elder law statutes and general premises liability principles, given the known vulnerability of the resident population.

Hospitals: Individuals who fall in hospitals may have claims under both premises liability law and, in some circumstances, medical malpractice law — particularly where a fall results from negligent administration of medication (e.g., drugs causing dizziness), failure to monitor a known fall-risk patient, or failure to correct a known floor hazard.

Factor 3: The Person — Individual Characteristics and Conduct

The third factor — often the most legally sensitive — involves the characteristics, behaviors, and physical condition of the person who fell. Slip and fall incidents are not experienced uniformly across all populations. Age, physical health, attentiveness, and behavior at the time of the fall all play significant roles in both the occurrence and severity of the injury.

Age and Physical Vulnerability

The Centers for Disease Control and Prevention (CDC) reports that falls send 2.3 million people to emergency rooms annually. Among older adults, the risk is dramatically higher: 1 in 3 adults aged 65 and older falls each year, and fractures occur in as many as one-third of adults over 65 who suffer a fall. Fewer than half of these fall victims even report the incident to a medical provider, meaning the actual numbers are likely higher.

The NFSI further reports that slip and fall accidents are the primary cause of occupational injuries among workers aged 55 and older and also the leading cause among people aged 15–24 years, suggesting that both ends of the age spectrum carry elevated risk. Among elderly nursing home residents, the injury rates are staggering — up to 60% experience a fall annually.

Several physical factors contribute to elevated risk:

Reduced muscle strength and balance: Age-related loss of muscle mass (sarcopenia) impairs the body’s ability to correct balance disruptions. A younger person might recover from a slight slip; an older person may not.
Medication effects: Polypharmacy — the concurrent use of multiple medications — is a recognized risk factor for falls. Drugs that cause dizziness, impaired coordination, or lowered blood pressure (antihypertensives, sedatives, antihistamines) significantly elevate fall risk.
Visual impairment: Reduced depth perception and peripheral vision make it harder for older adults to detect uneven surfaces or wet areas.
Assistive devices: Canes, walkers, and wheelchairs, while helpful, change the physics of movement and can interact with floor hazards in unexpected ways.
Pre-existing musculoskeletal conditions: Arthritis, joint replacements, and balance disorders further reduce stability.

Behavioral Factors and Contributory Conduct

Beyond physical condition, a person’s conduct at the time of the fall is one of the most aggressively examined elements in slip and fall litigation. Defendants and insurance companies routinely scrutinize whether the injured person was distracted, behaving recklessly, or failed to take reasonable precautions available to them.

The Restatement (Second) of Torts § 303(i) provides that a possessor of land is not liable for harm caused by a condition whose danger is known or obvious to the person — unless the possessor should anticipate the harm despite such knowledge. This means that if a person knowingly walks into a hazard they have already perceived, their own conduct may substantially limit or eliminate the property owner’s liability.

Under comparative negligence — the majority rule in the United States — the finder of fact apportions fault between the plaintiff and the defendant. Common plaintiff conduct that leads to findings of comparative fault includes:

Using a cell phone or being otherwise distracted while walking
Running or moving hastily through an area with posted warnings
Ignoring visible warning signs, barriers, or cones
Deliberately entering a restricted or hazardous area
Wearing footwear obviously unsuitable for the environment

Under modified comparative negligence rules, a plaintiff who is found 50% or 51% at fault (depending on the state) may be barred from recovering any damages at all. In pure comparative negligence states, the plaintiff may recover even if 99% at fault, though their recovery is reduced proportionately.

The stricter contributory negligence doctrine — still applied in Alabama, Maryland, North Carolina, Virginia, and Washington D.C. — can bar a plaintiff entirely from recovery if they are found even 1% at fault. As noted in Maryland premises liability law, courts have recognized that a plaintiff who ignores a clearly visible hazard, wears inappropriate footwear, or fails to exercise basic caution in a known hazardous environment may face a complete bar to recovery under this doctrine.

In Maryland, Chalmers v. Great Atlantic & Pacific Tea Co., 172 Md. at 558–559, held that it is not contributory negligence as a matter of law for a store patron to fail to observe and trip over a substance obstructing the passage of a store aisle — but the determination depends heavily on the specific facts of each case. The Restatement and case law in this area consistently emphasize that the reasonableness of the plaintiff’s conduct is evaluated in context, not in the abstract.

Mental Health, Cognitive Impairment, and Fall Risk

In nursing home and hospital contexts, cognitive impairment is a particularly important personal factor. Residents with dementia may lack the judgment to recognize hazardous conditions or to use assistive devices properly. Courts and regulators have increasingly scrutinized whether facilities provided adequate supervision and environmental modifications for cognitively impaired residents who are at elevated fall risk.

The Interaction of All Three Factors

These three factors rarely operate in isolation. The most common real-world slip and fall scenario involves an interaction of all three: a person with reduced balance or distracted attention walks across a wet or slippery floor while wearing footwear with low traction. Each individual factor might not be sufficient to cause a fall on its own, but their combination creates conditions under which a fall becomes likely or even inevitable.

The NFSI and safety researchers describe this as a “multi-factorial” causation model. Forensic slip resistance experts are frequently retained in litigation to test the COF of the actual floor surface (or a materially comparable surface) and the footwear, and to offer opinions on how the combination of these elements compared to established ANSI/NFSI B101 safety standards at the time of the incident.

Legal Framework: Pulling It All Together

When a slip and fall claim reaches the courthouse, the interplay of all three factors shapes the litigation from investigation through verdict. Counsel for both sides typically investigate the following questions:

On the Floor: What was the COF of the surface at the time of the fall, both dry and wet? Were warning signs posted? How long had the hazardous condition existed? Had the property owner received prior complaints or notice of the danger? What inspection procedures were in place?

On the Footwear: What was the COF performance of the plaintiff’s footwear on the relevant surface? Was the footwear worn or damaged? Was the footwear appropriate for the environment? Had the plaintiff been warned about the floor conditions in advance?

On the Person: What was the plaintiff’s physical condition, including any balance issues, medication use, or prior history of falls? What was the plaintiff doing at the moment of the fall — looking at a phone, carrying items, moving quickly? Did the plaintiff have a legitimate reason to be on the premises? Did the plaintiff have knowledge of the hazard beforehand?

The answers to these questions, layered against the controlling legal standard in the applicable jurisdiction — whether comparative or contributory negligence, and whether the plaintiff was an invitee, licensee, or trespasser under the Restatement (Second) of Torts §§ 329, 330, and 332 — determine both liability and the amount of recoverable damages.

What to Do After a Slip and Fall Injury

If you or someone you know has suffered a slip and fall injury, the steps taken in the immediate aftermath can significantly affect the viability of any legal claim:

Seek immediate medical attention. Document your injuries with a qualified medical provider as close in time to the incident as possible.
Preserve your footwear. Do not discard, wash, or repair the shoes worn at the time of the fall. They are physical evidence.
Photograph the scene. Capture the floor surface, any warning signs (or lack thereof), the surrounding area, and any visible hazard such as a spill or uneven surface.
Report the incident. File an incident report with the property owner or manager and obtain a copy.
Identify witnesses. Gather names and contact information of anyone who witnessed the fall or who can speak to the condition of the floor before or after the incident.
Consult an attorney. Premises liability law involves complex notice requirements, comparative fault rules, and statutes of limitations that vary by state. Prompt legal consultation ensures that evidence is preserved and deadlines are met.

Slip and fall injuries are not simple accidents. They are the product of an interaction between the walking surface, the footwear, and the individual — each of which carries its own legal and scientific significance. Whether you are a property owner trying to prevent accidents and minimize liability, an injured person evaluating a potential claim, or a legal professional building a case, understanding all three factors is essential.

With 47,026 fall-related deaths in 2023 alone, and $70 billion in annual costs attributable to workplace slip and fall injuries, the stakes could not be higher. The law — from OSHA 29 CFR 1910.22 to the Restatement (Second) of Torts §§ 332 and 343 — reflects society’s recognition that these injuries are, in the vast majority of cases, preventable. Property owners who maintain their premises, monitor for hazards, and exercise reasonable care can substantially reduce both the incidence of falls and their exposure to liability.