With regard to the above press release and to the work of Dr Luke Kelly it strikes me that the governing bodies of world
golf could do a lot of good for older golfers ,and indeed
for the older community in general,
by putting some funding into looking at postural stability during dynamic tasks
such as the golf swing .
Dr Mickle has shown that toe strength is greatly reduced in older people but that this can be reversed whilst
Dr Kelly has shown how important the
intrinsic muscles of the foot are during posturally demanding tasks
.
The hypothesis of a study might be that if older golfers strengthen their feet then
their ability to swing a golf club in a consistent fashion
will improve .
The benefit for the older community in general would be that a study such as the one outlined
above would, if the results are positive ,indicate
that Mickles
strengthening protocol might help prevent falls among this older group during the performance
dynamic tasks in general .
Its one thing to come up with a way to strengthen the intrinsic foot musculature but another to get long term compliance outside of monitored trial .
If people can see or feel tangible results for their efforts things become much easier . Golfing improvement might be one area were improvement can be measured , and as you have indicate, bowls or ten pin bowling might be another .
Other areas might include things such as pain reduction .
I wonder why they stopped at toes? I wonder how much of the effect was due to things other than increased strength, such as, being the centre of attention, giving a purpose to life, simply focusing on the feet, improvement in proprioception, improvement in reflexes. The real measure of success will be the number still doing the exercises a year after the spotlight has gone off them.
Of course it will be subject to the law of diminishing returns. Exercising feet reduces the risk of falling by 50%, exercising legs reduced falls by 50% of the remaining 50% and so on but possibly in terms of quality of life 5% improvement comes from exercising the feet, 40% comes from including the legs and 100% comes from exercising the whole body.
Hi Bill
I don't think they so much stopped at the toes as were the first to get down that far and give toes serious consideration with regard to their possible role in falls prevention .
After showing an independent link between toe flexor strength and falls in the elderly the next question for
Dr Mickle
and her co workers to answer was -can toe flexor strength
in the elderly be increased to bring if back to the levels found in younger people ?
The answer to this question appears to be yes although the full details of the techniques used have yet to be made public .
So now we have an identified need (stronger toe flexors
may well help to prevent falls ) and we have an indication that a least one method of toe strengthening will satisfy the need .
In my opinion ,to have the necessary components for a podiatry driven ,health care initiative Mickle and her team now need an effective, easily available ,measurement tool
to identify those
who would benefit from a flexor strengthening programme and to keep track of their progress .
The development
of such a tool would be the clincher .
Would
the exercises be continued after the spotlight has moved away ?
Well in a care home setting ,were falls are more likely ,one would hope that activities that benefit the elderly residents
would be continually encouraged .
Mickle has shown there is a need and that the need can be met .
What concerns me is the very poor pass rate of the toe grip strength test with my diabetic patients [at any stratification level]. Combined with fasciculations in Abductor hallucis noted in routine care and which can precede the diagnosis of DMt2 up to 2 years [anecdotally I would see this a couple of times per year]any research and evidence based exercise regime is most welcome.
Hi Jo
I agree that research in this area is badly needed and my understanding is that a study investigating
the subject
has already been registered ,with the seemingly tireless Dr Mickle at the helm
.
If her exercise regime can produce in diabetic patients results
similar to those achieved in older patients then this might have a major impact on associated health care issues .
My observational investigation findings is that each part of the body has a balance reflex in the foot.
The greater toe balances the head. The lesser toe balances the arms.
The central toes respond to the position of the shoulders and chest.
Elderly clients that have always worn foot ware that restricts the lesser toe tend to have developed restricted reach of there arms. The normal reflex for holding an arm out to the side is to shift the weight to the opposite foot and spred the lesser toe laterly.
With regard to Dr Mickles
work on toe flexors
it might be said that strengthening these muscles gives the body more effective tools for foot related tasks .
Balance perturbation studies have shown that
balance perturbation training may have the potential to reduce falls in older people . That is , perturbation training may
improve the bodies ability to use the tools available to it to resist falls .
What would happen if you ran together Dr Mickles program for toe flexor strengthening and balance perturbation training
? That is ,improve the tools AND the ability to use them .
The
title of Dr Mickles present research is given as "Evaluating a foot strengthening exercise program to improve foot function in adults with diabetes " and it aims to look into restoring foot function in feet with diabetic neuropathy . My understanding is that Mickles toe flexion /theraband exercise will be used as part of the exercise protocol (which I assume will be conducted under close supervision to prevent any toenail induced injury )
. In my opinion this will effectively target the intrinsic foot muscles far more effectively than ,for example , toe curl type activities .
Whilst I
realise that there are only so many outcome measures than can be looked at in any one study
, I wonder if Dr Mickle might intend
collecting
some evidence ,even if only as subject comments , on the effects of the exercise program on neuropathic pain experience .
This study will make very
interesting reading .