Falls and slippery surfaces - effect of toe strength

NewsBot · Dec 11, 2007

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Greater toe grip and gentler heel strike are the strategies to adapt to slippery surface
Daniel Tik-Pui Fongab, De-Wei Maoac, Jing-Xian Liad, Youlian Honga
Journal of Biomechanics (Articles in Press)

This study investigated the plantar pressure distribution during gait on wooden surface with different slipperiness in the presence of contaminants. Fifteen Chinese males performed 10 walking trials on a 5-m wooden walkway wearing cloth shoe in four contaminated conditions (dry, sand, water, oil). A pressure insole system was employed to record the plantar pressure data at 50Hz. Peak pressure and time-normalized pressure-time integral were evaluated in nine regions. In comparing walking on slippery to non-slippery surfaces, results showed a 30% increase of peak pressure beneath the hallux (from 195.6 to 254.1kPa), with a dramatic 79% increase in the pressure time integral beneath the hallux (from 63.8 to 114.3kPa) and a 34% increase beneath the lateral toes (from 35.1 to 47.2kPa). In addition, the peak pressure beneath the medial and lateral heel showed significant 20–24% reductions, respectively (from 233.6–253.5 to 204.0–219.0kPa). These findings suggested that greater toe grip and gentler heel strike are the strategies to adapt to slippery surface. Such strategies plantarflexed the ankle and the metatarsals to achieve a flat foot contact with the ground, especially at heel strike, in order to shift the ground reaction force to a more vertical direction. As the vertical ground reaction force component increased, the available ground friction increased and the floor became less slippery. Therefore, human could walk without slip on slippery surfaces with greater toe grip and gentler heel strike as adaptation strategies.
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Admin2 · Dec 11, 2007

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NewsBot · Feb 26, 2019

The relationship between hallux grip force and balance in people with diabetes
Panagiotis E.ChatzistergosaAoifeHealyaRoozbehNaemiaLakshmiSundarbcAmbadyRamachandranbcNachiappanChockalingama
Gait & Posture; 23 February 2019

Highlights
•Accelerated muscle weakening in people with diabetes increases the risk for falling.
•Clinically viable methods to detect leg-muscle weakening/ poor balance are needed.
•The paper grip test was used to assess the strength of the foot-ankle complex.
•Decreasing hallux grip force was associated with weakening and worsened balance.
•Hallux grip force could enhance risk assessment for falls in people with diabetes.
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Background
Diabetes accelerates the decline in muscle strength in older people and substantially increases the risk for fall and injury. Weakening of lower extremity muscles, in particular, is a strong predictor for falls, but currently there is no established method for its assessment in clinics. The paper grip test (PGT) offers a qualitative assessment of hallux plantar flexor strength and its usefulness for predicting falls has been demonstrated in non-diabetic populations.

Research question
The aim of this study is to test whether the PGT can be used for a quantitative assessment of lower-extremity strength and to investigate its relationship with isometric muscle strength and balance in people with diabetes and peripheral neuropathy.

Methods
Isometric muscle strength of all muscle groups of the foot-ankle was assessed using a dynamometer in sixty-nine people with diabetes and neuropathy. Postural sway and the gripping force exerted by the participants during the PGT was measured for the same participants using a plantar pressure assessment system. These measurements were repeated in regular intervals for 18 months in a longitudinal observational cohort study.

Results
Cross-sectional analysis of baseline data showed that people who failed the PGT swayed more. Analysis of longitudinal data showed that increasing hallux grip force is significantly associated with reduced postural sway. No significant association was found between dynamometry-based measurements of strength and postural sway. Hallux grip force was significantly correlated to the strength of all muscle groups of the foot-ankle complex.

Significance
These results indicate that hallux grip force can assess the strength of the foot-ankle muscles and could potentially be used to identify people at risk of falling. This sets the basis for the development of new screening protocols to assess weakening of the muscles of the foot-ankle and to enhance risk assessment for falls in people with diabetes and peripheral neuropathy.
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NewsBot · Sep 1, 2019

The effects of toe grip training on physical performance and cognitive function of nursing home residents.
Tsuyuguchi R et al
J PhysiolAnthropol. 2019 Aug 28;38(1):11.

BACKGROUND:
Toe grip-related training requires individuals to actively exercise muscles that are not frequently used; therefore, it may improve not only toe grip strength but also cognitive function. The purpose of this study was to examine the effects of toe grip-related training on predictors of physical performance and cognitive function in nursing home residents.

METHODS:
A total of 35 nursing home residents (35 left and 35 right feet; mean age, 82.1 ± 7.9 years) were included in this study. The participants were divided into two groups: a training group and a control group. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the participants, and the Fall Risk Index (FRI) was used to evaluate the risk of falls. Toe grip-related physical function was also assessed. Baseline endpoints were evaluated and the effects of toe grip-related training were examined following a 12-week training intervention.

RESULTS:
The training group showed significant improvements in MMSE score, FRI score, toe grip strength, and the toe skill (TS) test; however, the control group did not show these changes. The training group showed significant increases in Δ MMSE, Δ toe grip strength, and Δ TS (right foot) than the control group. Stepwise regression analysis revealed that Δ toe grip strength is an independent factor of Δ MMSE.

CONCLUSIONS:
Toe grip training improves not only toe grip strength itself, but also cognitive function. Furthermore, change in toe grip strength was an independent factor of change in MMSE in those populations.
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