Canadian start-up PhysioBiometrics has developed a wearable to improve gait and reduce falls in older adults.

The Heel2Toe wearable therapeutic device can assess and train older adults to walk with a proper gait, which is essential to reduce strain on joints and muscles, help prevent falls, and make walking easier to stay active and independent.

The sensor attaches to the side of a shoe and beeps with each good step, one that begins with a strong heel strike. It has proven beneficial for older adults, including those with orthopaedic or neurological conditions such as Parkinson’s disease. It is believed to be the only wearable that provides real-time feedback for every step.

PhysioBiometrics, an Age-Well start-up affiliate, showed Heel2Toe at last week’s Age-Well Tenth Annual Conference in Montreal. The class-one medical device is available worldwide through Shopify.

“Many older adults do not walk well enough to gain health benefits from walking,” said Nancy Mayo, CEO of Montreal-based PhysioBiometrics. “Out of a fear of falling or low confidence in their walking, they often change their gait and take little shuffling steps that increase their fall risk. Heel2Toe is a game-changer for helping older adults age well because, when your gait is better, you can walk further. By intervening early enough to correct poor gait, older adults reduce fall risk, increase physical activity, improve joint and muscle health, and ultimately stay in their homes longer.”

An optimal gait starts with a strong heel strike, followed by placing the foot flat, pushing off, swinging the leg, and repeating the process with little stride variability. With poor gait, people tend to shuffle – they don’t put their heel down first, don’t lift their foot, and the foot scuffs, increasing the risk of tripping. Gait tends to deteriorate in older adults due to neurological or orthopaedic conditions, psychomotor slowing, and fear of falling.

As physiotherapists, Mayo and her co-founders set out to automate the encouragement therapists give people to walk heel-first. With support from McGill’s Biomedical Engineering Department, they developed the Heel2Toe sensor, which mimics the positive feedback by beeping each time a step begins with a strong heel strike. The beep works to improve the gait pattern by giving the brain a reward each time people take a good step. After repeated use, the brain anticipates the beep and automatically guides the body to keep walking in the improved way to get the reward.

“Essentially, Heel2Toe harnesses the power of the brain to change gait from the top down, so individuals re-learn to walk optimally,” said Mayo, a a professor at McGill University (www.mcgill.ca). “Clients say that once they start using the sensor, they continue to hear the beep even when not wearing it. They know which foot movement produces the sound.”

Heel2Toe is a therapy tool that can be used independently at home with instructional videos, an exercise book and a web-based dashboard showing walking analytics, or under a therapist’s supervision. Its three embedded inertial measurement units accurately assess walking patterns across the gait cycle. When a step begins with a strong heel strike, it provides positive, real-time auditory feedback, training an optimal gait. Focused practice – six minutes, twice a day – is recommended for best results.

Tamila Barab, an active 81-year-old retired nurse practitioner who now volunteers, recently had several falls, including one in her retirement residence hallway where she stepped toe-first and caught her foot on the flooring. She joined a PhysioBiometrics study in summer 2025 testing the independent use of Heel2Toe at home for one month. With the device, she learned to walk heel first.

“When I walk now, I’m conscious of going from heel to toe – I hear that voice in my head,” said Barab, who continues to practice with Heel2Toe. “I find walking much easier this way, and I have more confidence in my walking.”

A pilot study in individuals with Parkinson’s found greater gait improvements with home training with the Heel2Toe device as compared with exercise recommendations alone. Walking capacity was the primary outcome: 13 of 14 participants in the Heel2Toe group improved on the six-minute walk test, while none of seven in the exercise-only group did.

PhysioBiometrics is also using the Heel2Toe (physiobiometrics.com/products/heel2toe-walk-improvement-wearable/) as part of its Walk-Best programme, an in-person group training programme combined with at-home practice. The programme is offered to older adults in the Montreal area.

Brenda Hatch, 68, joined the programme because arthritis and plantar fasciitis made walking properly difficult and sometimes painful.

“When I started using the Heel2Toe device, I walked with my head down to watch for tripping hazards,” she said. “With Heel2Toe, I made steady improvement with my walking and it allowed me to go on my Italy trip without concerns about keeping up with five hours of daily walking.”

Age-Well (agewell-nce.ca), Canada’s technology and aging network, has funded Mayo’s work through several research programmes. In 2019, PhysioBiometrics – then Walk-Well Universe – won the Montreal regional competition of the Age-Well National Impact Challenge.

PhysioBiometrics (physiobiometrics.com) was co-founded by Mayo, Ted Hill, Helen Dawes, Ahmed Abou-Sharkh and Kedar Mate. The company has also received funding from McGill’s Healthy Brains, Healthy Lives, McGill Innovation Fund and Medtech.