Foot Pain, Plantar Pressures, and Falls in Older People

NewsBot · Sep 15, 2010

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Foot Pain, Plantar Pressures, and Falls in Older People: A Prospective Study.
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR.
J Am Geriatr Soc. 2010 Sep 9.

OBJECTIVES: To determine whether foot pain and plantar pressure are associated with falls in community-dwelling older adults.

DESIGN: Community-based cohort study with 12-month prospective falls follow-up.

SETTING: Sydney and Illawarra statistical regions of New South Wales, Australia.

PARTICIPANTS: Randomly recruited, community-dwelling adults (158 men and 154 women) aged 60 and older.

MEASUREMENTS: Manchester Foot Pain and Disability Index to establish baseline foot pain and dynamic plantar pressures. Participants were then classified as fallers (n=107) or nonfallers (n=196) based on their falls incidence over the following 12 months.

RESULTS: Fallers had a significantly higher prevalence of foot pain than nonfallers (57.9% vs 42.1%; chi-square=4.0; P=.04). Fallers also generated a significantly higher peak pressure and pressure-time integral under the foot than non-fallers. In addition, individuals with foot pain had a significantly higher peak pressure and pressure-time integral under the foot than those without foot pain.

CONCLUSION: High plantar pressures generated during gait may contribute to foot pain and risk of falls. Providing interventions to older people with foot pain and high plantar pressures may play a role in reducing their falls risk.
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NewsBot · Dec 28, 2012

The association between foot problems and falls in older adults -A covariance structure analysis-.
Sakurai R, Fujiwara Y, Fukaya T, Watanabe R, Saito K, Yasunaga M, Murayama Y, Yoshida H, Nishikawa T, Shinkai S, Watanabe S.
Nihon Ronen Igakkai Zasshi. 2012;49(4):468-75.

Aim: To investigate the manner in which community-dwelling older adults' foot problems affect their history of falls.

Methods: This study included 112 community-dwelling older adults. Foot problems (e.g., inflammation, ingrown nails, and pain while walking), self-rated physical ability (e.g., gait, tripping over, and balance), history of falls within a year, and physical ability (e.g., walking speed, Timed Up & Go test, and one leg balance test) were measured during a routine health checkup. Of these, five subjects were excluded due to incomplete all the measurement. Thus, the subjects eligible for analysis were 107 older adults (mean age±standard deviation=73.0±5.5 years). Covariance structure analysis was used to identify the inter-relationships among all measurements.

Results: The covariance structure analysis showed that foot problems negatively influenced participants' self-rated physical ability, and this relationship was also linked to history of falls. The overall fit of this model was judged to be statistically satisfactory (GFI=0.959, AGFI=0.912, CFI=0.981, RMSEA=0.043).

Conclusions: Our model indicated that the association between foot problems and history of falls was affected by self-rated physical ability. Furthermore, in order to prevent falls, the current results suggest that foot care could be an important intervention in older adults to prevent decline in their overall physical ability.
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Admin2 · Dec 28, 2012

Related threads:
Other threads tagged with Falls
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New falls guidelines
Podiatry Interventions can Prevent Falls
Foot characteristics and balance
Footwear and falls
Podiatry involvement in falls prevention

NewsBot · Jan 14, 2016

Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study
Angela Brenton-Rule, Nicola Dalbeth, Hylton B. Menz, Sandra Bassett and Keith Rome
BMC Musculoskeletal Disorders201617:22

Background
People with rheumatoid arthritis (RA) have an increased risk of falls. The foot is a common site of pathology in RA and foot problems are reported in up to 90 % of patients with established disease. The aim of this study was to determine whether foot and ankle characteristics are associated with falls in people with RA.

Methods
Adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Participants reported whether they had fallen in the preceding year, and the number of falls. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression analysis identified variables independently associated with falls.

Results
Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12-months was reported by 119 (59 %) participants. Univariate analysis showed that fallers had significantly longer mean disease duration, more co-morbid conditions, an increase in lower limb tender joints, higher midfoot peak plantar pressures and were more likely to have a history of vascular disease than non-fallers. Fallers also reported greater difficulty with activities of daily living, increased fear of falling and greater self-reported foot impairment. Logistic regression analysis revealed that increased midfoot peak plantar pressures (odds ratio (OR) 1.12 [for each 20 kPa increase], 95 % confidence interval (CI) 1.00-1.25), self-reported foot impairment (OR 1.17 [for each three point increase], 95 % CI 1.05-1.31) and history of vascular disease (OR 3.22, 95 % CI 1.17-8.88) were independently associated with a fall in the preceding 12 months.

Conclusions
Elevated midfoot peak plantar pressures, self-reported foot impairment and vascular disease are associated with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of benefit when considering falls prevention strategies in people with RA.
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NewsBot · Aug 31, 2017

Foot Problems in Older Adults: Associations with Incident Falls, Frailty Syndrome and Sensor-Derived Gait, Balance, and Physical Activity Measures.
Muchna A et al
J Am Podiatr Med Assoc. 2017 Aug 30. doi: 10.7547/15-186.

BACKGROUND:
Research on the relationship between foot problems and frailty is sparse and could be elucidated via advances in wearable sensor-based measures of gait, balance, and physical activity (PA). This study examined the impact of foot problems on likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.
METHODS:
Arizona Frailty Cohort Study participants (community-dwelling adults 65 years and older without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.
RESULTS:
Of 117 participants, 41 (35%) were non-frail, 56 (48%) pre-frail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem 63% in non-frail, 80% in pre-frail [OR=2.0], and 95% in frail [OR=8.3], p=.03 for trend), due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling, but not with fall history or incident falls over 6-months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased medial-lateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percent walking, percent standing and total steps per day.
CONCLUSIONS:
Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling among older adults, which may ultimately improve healthy aging and reduce risk of frailty.
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NewsBot · Sep 7, 2017

Feet deformities are correlated with impaired balance and postural stability in seniors over 75.
Puszczalowska-Lizis E et al
PLoS One. 2017 Sep 6;12(9):e0183227. doi: 10.1371/journal.pone.0183227. eCollection 2017.

OBJECTIVE:
Understanding the factors and mechanisms that determine balance in seniors appears vital in terms of their self-reliance and overall safety. The study aimed to determine the relationship between the features of feet structure and the indicators of postural stability in the elderly.
METHODS:
The study group comprised 80 seniors (41F, 39M; aged 75-85 years). CQ-ST podoscope and the CQ-Stab 2P two-platform posturograph were used as primary research tools. The data were analyzed based on Spearman's rank correlation and forward stepwise regression.
RESULTS:
Analysis of forward stepwise regression identified the left foot length in females and Clarke's angle of the left foot in men as significant and independent predictors of postural up to 30% of the variance of dependent variables.
CONCLUSIONS:
Longer feet provide older women with better stability, whereas in men, the lowering of the longitudinal arch results in postural deterioration. In the elderly, the left lower limb shows greater activity in the stabilizing processes in the standing position than the right one. In gerontological rehabilitation special attention should be paid to the individually tailored, gender-specific treatment, with a view to enhancing overall safety and quality of seniors' lives.
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NewsBot · Sep 20, 2017

The Semmes-Weinstein Monofilament Examination for predicting physical performance and the risk of falls in older people: results from the Pro.V.A. longitudinal study
Pamela Carrer et al
Arch Phy Med Rehab; Article in Press

Objectives
to investigate whether Semmes Weinstein Monofilament Examination (SWME) was associated with, and could predict measures of physical performance and the risk of fall in elderly subjects.

Design
prospective study (mean follow-up 4.4-years).

Setting
community.

Subjects
2826 older subjects enrolled in the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study. For longitudinal analyses, we considered a subsample of 1885 persons who did not report falls at baseline.

Interventions
not applicable.

Main outcome measures
falls reported in the year preceding the assessment and Short Physical Performance Battery (SPPB) were recorded at baseline and again after 4.4 years.

Results
At baseline, 830 (29.4%) subjects had experienced falls in the previous year, with a higher prevalence of falls in those positive at SWME (SWME+) than in those negative at SWME (SWME-) (35.8% vs 28.0%, p=0.001). Using logistic regression, SWME+ subjects had a significant 66% higher risk of presenting worse SPPB score (95%CI: 1.51-1.83), and between 25% and 32% higher risks of having experienced at least one or recurrent falls, than those SWME-. The incidence of falls at follow-up was higher in the SWME+ compared with the SWME- group (42.2% vs 30.7%, p=0.001), and multinomial logistic regression showed that the former had a 13% higher risk of decline in SPPB scores (95%CI: 1.03-1.25), particularly for gait and balance, 48% higher risk of having had at least one fall and 77% higher risk of recurrent falls. At both baseline and follow-up, the larger the extension of neuropathy (SWME- vs unilateral vs bilateral SWME+), the greater its negative impact on falls and physical performance.

Conclusion
SMWE was associated with, and could predict lower-extremity physical performance and falls in older people.
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NewsBot · Apr 11, 2018

Foot Problems in Older Adults
Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures
Amy Muchna, Bijan Najafi, Christopher S. Wendel, Michael Schwenk, David G. Armstrong, and Jane Mohler
Journal of the American Podiatric Medical Association: March 2018, Vol. 108, No. 2, pp. 126-139.

Background: Research on foot problems and frailty is sparse and could advance using wearable sensor–based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.

Methods: Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.

Results: Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day.

Conclusions: Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty.
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NewsBot · Mar 18, 2019

Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan.
Yamashita T et al
BMC Geriatr. 2019 Mar 14;19(1):83. doi: 10.1186/s12877-019-1097-z.

BACKGROUND:
Abnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects' feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care.

METHODS:
The study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan's nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student's t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance.

RESULTS:
After intervention, abnormalities in the participants' feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated.

CONCLUSION:
In frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals' social participation increased, and their behavior improved.
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NewsBot · Oct 16, 2019

Foot Characteristics and Falls among Community-dwelling
Independent Elderly Women Who Can Walk Outdoors
Mieko Yokozuka et al
Progress in Rehabilitation Medicine 2019; Vol. 4, 20190017

Objective: We examined the toe flexor strength, foot morphology, and falls in community-dwelling elderly women who could walk outdoors independently without aids. Methods: The presence
or absence of falls in 1 year, the toe flexor strength, and foot morphology were recorded in 70
women. Hallux valgus was defined as a first phalangeal angle ≥16°. Falls were compared based
on the presence or absence of hallux valgus using the chi-squared test. The toe flexor strength,
arch height ratio (medial longitudinal arch), and spread ratio (lateral arch) were compared using
the Mann-Whitney U-test according to the presence or absence of hallux valgus. Spearman’s
correlation coefficient was used to compare toe flexor strength and foot morphology. Results:
No difference in the fall rate was noted between those with hallux valgus on at least one foot
and those without hallux valgus. No difference in toe flexor strength was noted between feet
with and without hallux valgus. Correlations were found between the hallux valgus angle and
the arch height (r=–0.228, P<0.01) and spread ratios (r=0.494, P<0.001). Conclusions: Among
community-dwelling elderly women who can walk independently outdoors without aids, the
presence or absence of hallux valgus does not affect the incidence of falls. The lack of correlation
between toe flexor strength and foot morphology may support this conclusion.
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scotfoot · Oct 18, 2019

Foot Characteristics and Falls among Community-dwelling
Independent Elderly Women Who Can Walk Outdoors
Mieko Yokozuka et al
Progress in Rehabilitation Medicine 2019; Vol. 4, 20190017

In my opinion , this paper can be summarize as follows . Quadratus plantae apart , toe grip dynamometers are more or less useless for looking at intrinsic toe flexor strength . However , many researchers persist .

NewsBot · May 13, 2021

Structural and functional foot and ankle characteristics associated with falls in older people
FatemePol et al
Gait & Posture; 12 May 2021

Highlights
•A novel foot and ankle risk factor model for falls in older people was developed.
•Less first metatarsophalangeal joint extension is associated with falls.
•Less plantarflexor muscle strength is associated with falls.
•Greater pressure in the medial forefoot is associated with falls.
•Greater center of pressure velocity in the forefoot is associated with falls.
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Background
Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors.

Research question
what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults?

Method
One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls.

Results
Seventy-four participants (39.9%) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95% CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95% CI 0.15-0.53), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95%CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95% CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95% CI 1.01-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors.

Significance
We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.
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NewsBot · Aug 4, 2021

The relationship between common foot problems with falls and quality of life in older people
Maryam Jalali PhD, Parviz Mojgani MD, Hassan Saeedi PhD, Fatemeh Azadinia PhD, Maryam Niksolat MD, Faezeh Ghorbani PhD candidate
31 July 2021

Objectives
To evaluate the relationship between a number of prevalent foot problems in older people and their history of falls and quality of life. To examine the relationship between timed up and go (TUG) test time and ankle muscles’ strength.

Method
In this cross-sectional observational study on a convenient sample of 350 people 65 years and older, direct logistic and hierarchical regressions were used to assess the relation of self-reported falls and quality of life with hallux valgus, oedema, sensory loss and callus. The correlation coefficients were calculated to measure the relationship between TUG test time and ankle muscle strength.

Results
Moderate negative correlations were measured between ankle muscles’ strength and TUG time (rDorsiflexors = −0.42 p = 0.000, rPlantar flexors = −0.45 p = 0.000). The odds ratio extracted from logistic regression for foot pain was 3.05 (p = 0.000, 95% CI: 1.8–5.1). The results of the hierarchical regression showed that oedema had the highest contribution to depicting the quality of life (standardised B = −0.22, p = 0.001), followed by foot pain (beta = −0.178, p = 0.004) and plantar sensory loss (beta = −0.143, p = 0.019).

Conclusion
The results of this study highlight the importance of foot problems in older people. Foot pain showed relationship with self-reported fall experience. Oedema and foot pain had negative impact on quality of life. Ankle muscles’ strength may affect balance in older people. However, because of the small effects sizes and wide confidence intervals, the results should be interpreted cautiously.
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NewsBot · Sep 8, 2021

Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults?
Aurélio DiasSantos et al
Brazilian Journal of Physical Therapy; 3 September 2021

Highlights
•Foot deformity and plantar sensitivity in elderly adults were evaluated.
•Hallux valgus was the most prevalent deformity among elderly individuals.
•Reduced foot sensitivity and hallux valgus impair physical function of older adults.
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Background
Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear.

Objective
To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults.

Methods
We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function.

Results
Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function.

Conclusion
Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.
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NewsBot · Apr 15, 2022

Fall Risk Assessment for the Elderly Based on Weak Foot Features of Wearable Plantar Pressure
Zhen Song, Jianlin Ou, Lin Shu, Guo Hua Hu, Shibin Wu, Xiangmin Xu, Zhuoming Chen
IEEE Trans Neural Syst Rehabil Eng. 2022 Apr 14

The high fall rate of the elderly brings enormous challenges to families and the medical system; therefore, early risk assessment and intervention are quite necessary. Compared to other sensor-based technologies, in-shoe plantar pressure sensors, effectiveness and low obtrusiveness are widely used for long-term fall risk assessments because of their portability. While frequently-used bipedal center-of-pressure (COP) features are derived from a pressure sensing platform, they are not suitable for the shoe system or pressure insole owing to the lack of relative position information. Therefore, in this study, a definition of "weak foot" was proposed to solve the sensitivity problem of single foot features and facilitate the extraction of temporal consistency related features. Forty-four multi-dimensional weak foot features based on single foot COP were correspondingly extracted; notably, the relationship between the fall risk and temporal inconsistency in the weak foot were discussed in this study, and probability distribution method was used to analyze the symmetry and temporal consistency of gait lines. Though experiments, foot pressure data were collected from 48 subjects with 24 high risk (HR) and 24 low risk (LR) ones obtained by the smart footwear system. The final models with 87.5% accuracy and 100% sensitivity on test data outperformed the base line models using bipedal COP. The results and feature space shown the novel features of wearable plantar pressure could comprehensively evaluate the difference between HR and LR groups. Our fall risk assessment models based on these features had good generalization performance, and showed practicability and reliability in real-life monitoring situations.
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NewsBot · May 1, 2022

Foot Anatomical Structural Variations Increase the
Risk of Falls
Almudena Sánchez-Sanjuan et al
Research Square

Falls are common among older adults. The purpose of this study was to demonstrate the relationship
between foot anatomical structural variations and balance in older adults and quantify foot posture and
stabilometry as predictors of falls risk. Case-control study in older adults, classified as cases or controls
according to falls in the last five years. All the subjects were healthy women and men and > 65 years old
(n = 164), who were divided into two groups: 83 individuals who had suffered from a fall in the previous
five years (case group) and 81 individuals who had not suffered from a fall (control group). There were
found strong correlations among the variables, specifically gender, Hallux abductus valgus (HAV) and
tailor’s bunion. Women have a higher probability to suffer from falls. HAV and tailor’s bunion also
increased fall probability (p = .042, p = .069 respectively). Foot anatomical structural variations (HAV and
tailor’s bunion) linked to gender and age, in-crease falls risk among older adults. In women fallers with
HAV, there were a higher possibility of risk of falling (63.89%). In older than 70 with HAV, the percentage of
falls is high (62%). Fall-ers with tailor´s bunion (60.66%) are more numerous than fallers without this
pathology. Older adults with HAV and tailor´s bunion had twice probability to suffer a fall than older
people without foot anatomical structural. Foot anatomical structural variations (HAV and tailor´s
bunion) are risk factors of falls.
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NewsBot · Jun 12, 2022

Knowledge about foot-specific foot falls risk factors and exercise among physiotherapists in the UK and Portugal: A cross-sectional survey
Monserrat Conde, Gordon J Hendry, Jim Woodburn, Dawn A Skelton
Physiother Res Int. 2022 Jun 11

Background and purpose: Foot-related falls risk factors and specific foot and ankle exercise interventions are within the scope of Physiotherapy, yet little is known about United Kingdom (UK) and Portugal-based (PT) physiotherapists' self-perceived knowledge, confidence and practice of such interventions, or perceptions of patients' falls prevention knowledge. The purpose of this study was to assess levels of self-reported knowledge, confidence, and practices surrounding foot-specific falls risk and exercise for fall prevention in physiotherapists working in the UK and in Portugal. It also aimed to explore physiotherapists' views about their participants' falls prevention knowledge.

Methods: A self-report online survey was developed, and pilot tested in both nations. Registered Physiotherapists were invited to participate through their professional associations, social media and snowballing. Mann-Whitney tests were used to compare mean ranks of ordinal variables between nations and Chi-square test to assess the independency between pairs of variables. Spearman's correlation coefficient (rs) was used to measure the association between pairs of variables (p < 0.05).

Results: 682 physiotherapists participated in the survey [UK n = 229 (mean (SD) age = 43(10) years, 86.9% female]; PT n = 453 (mean (SD) age = 33(9) years, 78.3% female]. Among physiotherapists with a caseload of ≥70% older adults, more PT-based physiotherapists held postgraduate qualifications (p = 0.01). Most physiotherapists correctly identified generic and foot-specific risk factors (≥70% of participants for each item). More UK-based physiotherapists reported always prescribing ankle and foot exercises (42.6% vs. 33%, p =< 0.001) and displayed higher levels of self-reported confidence surrounding exercise-based interventions.

Discussion: Our sample of UK and Portugal-based physiotherapists are aware of the contribution of foot-specific risk factors and exercise to falls prevention, with the former group being more confident in exercise-based interventions. Both groups of physiotherapists perceived that their older patients had little knowledge about these topics, with UK older adults having slightly better knowledge on generic falls risk factors at first contact. Future studies and strategies for knowledge translation and education in foot health and foot function screening and management for physiotherapists, within a falls prevention scope, may be informed by this study.
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NewsBot · Mar 21, 2023

Plantar pressure and falling risk in older individuals: a cross-sectional study
Yifeng Yan et al
J Foot Ankle Res. 2023 Mar 21;16(1):14

Background: Falls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined.

Methods: Twenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis.

Results: The foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05).

Conclusions: The differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.
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NewsBot · Sep 12, 2023

Foot characteristics of the daily-life gait in postmenopausal females with distal radius fractures: a cross-sectional study
Akiko Yamamoto et al
BMC Musculoskelet Disord. 2023 Sep 5;24(1):706

Background: Gait decline in older adults is related to falling risk, some of which contribute to injurious falls requiring medical attention or restriction of activity of daily living. Among injurious falls, distal radius fracture (DRF) is a common initial fragility fracture associated with the subsequent fracture risk in postmenopausal females. The recent invention of an inertial measurement unit (IMU) facilitates the assessment of free-living gait; however, little is known about the daily gait characteristics related to the risk of subsequent fractures. We hypothesized that females with DRF might have early changes in foot kinematics in daily gait. The aim of this study was to evaluate the daily-life gait characteristics related to the risk of falls and fracture.

Methods: In this cross-sectional study, we recruited 27 postmenopausal females with DRF as their first fragility fracture and 28 age-matched females without a history of fragility fractures. The participants underwent daily gait assessments for several weeks using in-shoe IMU sensors. Eight gait parameters and each coefficient of variance were calculated. Some physical tests, such as hand grip strength and Timed Up and Go tests, were performed to check the baseline functional ability.

Results: The fracture group showed lower foot angles of dorsiflexion and plantarflexion in the swing phase. The receiver operating characteristic curve analyses revealed that a total foot movement angle (TFMA) < 99.0 degrees was the risk of subsequent fracture.

Conclusions: We extracted the daily-life gait characteristics of patients with DRF using in-shoe IMU sensors. A lower foot angle in the swing phase, TFMA, may be associated with the risk of subsequent fractures, which may be effective in evaluating future fracture risk. Further studies to predict and prevent subsequent fractures from daily-life gait are warranted.
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NewsBot · Jan 12, 2024

Correlation Of Medial Longitudinal Arch Height With Postural Stability, Sensory Integration, Balance And Fall Risk Among Healthy Young Adults
Sameera Gul et al
J Pak Med Assoc. 2023 Nov;73(11):2242-2246

A cross-sectional analytical study was conducted on 165 healthy young adults. With pes rectus and pes planus to correlate the medial longitudinal arch height with postural stability, sensory integration of balance and fall risk. Persons with pes cavus, congenital foot anomalies other than pes planus, leg length discrepancies, recent history of trauma, lower limb amputations, history of serious foot injury, ligamentous laxity, or an active inflammatory disorder were excluded. Outcome measurements included normalised truncated navicular height (NTNH), Chippaux Smirak index (CSI), athletic single leg stability (ASLS) index, fall risk (FR) index, postural stability (PS), clinical test of sensory integration of balance (CTSIB), and balance error scoring system (BESS). Spearman correlation and Mann Whitney U test were used for data analysis. CSI and NTNH were noted to have no significant correlation (p<0.05) with PS, FR, CTSIB, ASLS and BESS among healthy young adults. Males were observed to have poorer balance and fall risk as compared to females.
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NewsBot · Apr 11, 2024

Improvement of postural control in the frail older adults through foot care: A pre- and post-intervention study
Tomoko Yamashita et al
Med Eng Phys. 2024 Mar:125:104115

Frailty in older adults often leads to foot issues, increasing fall-related fracture risk. Mechanoreceptors, the pressure receptors in the foot sole, are pivotal for postural control. Foot problems can impair mechanoreceptor function, compromising balance. This study aimed to examine the effect of foot care on postural control in frail older adults. Forty-eight participants underwent a five-month monthly foot care intervention. Measurements were taken before and after this intervention. Participants stood for 45 s in a static, open-eyed position on a stabilometer. Center-of-pressure (CoP) analysis included total trajectory length, integrated triangle area, rectangular area, and range of motion in anterior-posterior and medio-lateral directions. Results indicated that foot care significantly increased toe ground contact area by 1.3 times and improved anterior-posterior motion control during static standing. Enhanced postural control resulted from improved skin condition due to foot care that intensified mechanoreceptor signal input and improved postural control output. These findings underscore the potential for reducing fracture risks in older adults through proactive foot care. The study highlights the vital role of foot care in enhancing postural control, with broader implications for aging population well-being and safety.
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