Surface roughness has been shown to have substantial effects on the slip resistance between shoe heels and floor surfaces under various types of walking environments. This paper summarizes comprehensive views of the current understanding on the roles of surface roughness on the shoe and floor surfaces in the measurement of slipperiness and discusses promising directions for future research. Various techniques and instruments for surface roughness measurements and related roughness parameters are reviewed in depth. It is suggested that a stylus-type profilometer and a laser scanning confocal microscope are the preferred instruments for surface roughness measurements in the field and laboratory, respectively. The need for developing enhanced methods for reliably characterizing the slip resistance properties is highlighted. This could be based on the principal understanding of the nature of shoe and floor interface and surface analysis techniques for characterizing both surfaces of shoe and floor. Therefore, surface roughness on both shoe and floor surfaces should be measured and combined to arrive at the final assessment of slipperiness. While controversies around the friction measurement for slipperiness assessment still remain, surface roughness measurement may provide an objective alternative to overcoming the limitations of friction measurements.