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Foot characteristics and balance

Discussion in 'Gerontology' started by Hylton Menz, Jan 19, 2006.

  1. Hylton Menz

    Hylton Menz Guest


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    From the December issue of the Journal of Gerontology:

    Foot and Ankle Characteristics Associated With Impaired Balance and Functional Ability in Older People

    Hylton B. Menz, Meg E. Morris, and Stephen R. Lord

    J Gerontol A Biol Sci Med Sci 2005 60: 1546-1552

    Background. Ageing is associated with changes to the structure and function of the foot and ankle, and there is preliminary evidence that foot problems impair balance and increase the risk of falls. To explore this in more detail, we conducted a study to determine the relative contribution of several foot and ankle characteristics to performance on a range of balance and functional tests.

    Methods. One hundred seventy-six people (56 men and 120 women, mean age 80.1 years, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity), sensorimotor function (including vision, sensation, strength, and reaction time), and balance and functional ability (including tests of standing balance, leaning balance, stepping, sit-to-stand, and walking speed).

    Results. Many foot and ankle characteristics and sensorimotor measures were associated with performance on the balance and functional tests in univariate analyses. Multiple regression analysis consistently revealed that ankle flexibility, plantar tactile sensitivity, and toe plantarflexor strength were significant and independent predictors of balance and functional test performance, explaining up to 59% of the variance in these test scores.

    Conclusions. Foot and ankle characteristics, particularly ankle flexibility, plantar tactile sensation, and strength of toe plantarflexor muscles, are significant independent predictors of balance and functional ability in older people. Programs to improve the strength and flexibility of the foot and interventions to augment plantar sensation may be beneficial in improving mobility and reducing the risk of falls.​

    One of the surprising results of this study was that foot posture (measured using the FPI, arch index and navicular height) was not associated with balance ability in older people.

    If anyone would like a copy, please email me.

    Cheers,

    Hylton
     
  2. Hylton Menz

    Hylton Menz Guest

    The 12-month follow-up of this study has been completed, and confirms that foot problems are a falls risk factor:

    Foot and Ankle Risk Factors for Falls in Older People: A Prospective Study

    Hylton B. Menz, Meg E. Morris and Stephen R. Lord

    The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61:866-870 (2006) - link

    Background. Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls.

    Methods. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls.

    Results. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age.

    Conclusions. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.
     
  3. Ian Linane

    Ian Linane Well-Known Member

    Hi Hylton

    Thank you for the information.

    I am curious, as gentle mobilisations (even a long time after injury) of the ankle and other foot joints appear to improve joint and muscle function in a good number of people, possibly including awareness of where the feet are, have studies been done to show any efficacy of this as part of treatment for the aging population. Or indeed as a profilactic approach?

    Ian
     
  4. Hylton Menz

    Hylton Menz Guest

    Ian,

    To my knowledge there are no published studies that have addressed this. However, at the ISPGR conference in 2003, a paper was presented by a British osteopath (Mark Goss-Sampson) in which postural sway parameters were measured before and after manual ankle manipulations were applied to young and elderly women. The results indicated that a greater "dynamic safety margin" was evident in both groups following the intervention. I've been unable to track down a published manuscript on the study.

    Kind regards,

    Hylton
     
  5. Ian Linane

    Ian Linane Well-Known Member

    Thank you Hylton.

    Could be an interesting study for a pod to do using mobilsation techniques (based around Maitlands approach) as opposed to possible osteopathic manipulation techniques.

    Again thanks

    Ian
     
  6. NewsBot

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  7. krome

    krome Active Member

    Hi Hylton

    Great to see the follow-up. What type of strategies would you and your team consider?
     
  8. Freeman

    Freeman Active Member

    Greetings all.

    I recognize that balance is very complicated as a component of "fitness" and see a direct relationship between gastroc/soleous flexibility and ankle dorsiflexion. If yuo don't have adequate ankle dorsiflexion when moving forward one is more inclined to compensate in frontal and transverse planes. The more birthdays a person spends having short calves, the greater the effects of frontal and transverse compensation will have on balance through muscular imbalance.

    I am also very curious, as a pedorthist, as to the effects of poor fitting footwear on balance. I would guess that about 80% of the population will have some significant error in sizing and fitting them,selves with footwear suitable for their daily activities. I would say that msot pople will short fit themselves. However, the concern I have with fitting elderly people in footwear too large, or in a sloppy manner is that they are not getting enough sensory info from sloppy fitting and would be at a greater risk for falling. This also applies to footwear which is unstable and distorted.

    Sincerely,

    Freeman Churchill
     
  9. Hylton Menz

    Hylton Menz Guest

    J Biomech. 2008;41(4):838-44.

    Greater toe grip and gentler heel strike are the strategies to adapt to slippery surface.

    Fong DT, Mao DW, Li JX, Hong Y.

    Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China.

    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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    Unnikrishnan R, Deghidi A N, Babu A
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  22. scotfoot

    scotfoot Well-Known Member

    With regard to the above , consider a man on a bicycle . The man cycles along the road fully in control of the bike . Then he gets to a set of traffic lights and tries to balance on the bicycle whilst stationary . It's much more difficult .
    In my opinion ,with standing human subjects , the difficult task of standing still is greatly aided by the intrinsic foot muscles .
     
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