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White J, Maier AB, Iacobaccio L, Iseli R. Foot Problems in Older Adults Presenting to a Falls and Balance Clinic. Gerontology 2024; 70:732-740. [PMID: 38697042 DOI: 10.1159/000539160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with an increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aimed to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. METHODS Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems, and footwear were assessed in the clinic. RESULTS One-hundred and two patients were included; median age 79.3 (73-84.3) years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p < 0.001). CONCLUSION The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.
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Affiliation(s)
- Josephine White
- Department of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Laura Iacobaccio
- Department of Podiatry, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rebecca Iseli
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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Kunkel D, Mamode L, Burnett M, Pickering R, Bader D, Donovan-Hall M, Cole M, Ashburn A, Bowen C. Footwear characteristics and foot problems in community dwelling people with stroke: a cross-sectional observational study. Disabil Rehabil 2023; 45:2630-2637. [PMID: 35968548 PMCID: PMC9612931 DOI: 10.1080/09638288.2022.2102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/04/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population. METHODS Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments. RESULTS Most participants wore slippers indoors (n = 17, 57%) and walking shoes outdoors (n = 11, 37%). Over half wore unsupportive ill-fitting shoes indoors and 47% of outdoor shoes fitted badly. All participants had foot problems (mean 6.5 (3.1), 95% CI: 5.4-7.7), including impaired single limb heel raise (93%), reduced range of movement (77%), sensation (47%), and muscle strength (43%). Many had foot-pain, hallux valgus (both 50%), or swollen feet (40%). Foot problems were associated with reduced balance confidence, activity, and community participation (all p < 0.05). A greater proportion of fallers (13/16) than non-fallers (4/14) reported foot problems (p = 0.029). CONCLUSIONS Many community-dwelling people with stroke wore poorly fitting shoes; all had foot problems. Foot problems were linked to reduced mobility. Finding more effective pathways to support people with stroke to select supportive, well-fitting indoor and outdoor footwear is indicated.Implications for rehabilitationPeople with stroke often wear unsupportive ill-fitting shoes and experience foot problems.Assessment of foot problems and footwear advice should be considered during stroke rehabilitation particularly when interventions target fall prevention or improvements in balance and mobility.Information on appropriate footwear and signposting that new shoe purchases should include measuring feet to ensure a good fit is recommended.
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Affiliation(s)
- Dorit Kunkel
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Louis Mamode
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Malcolm Burnett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dan Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Mark Cole
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ann Ashburn
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Bowen
- School of Health Sciences, University of Southampton, Southampton, UK
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Yu B, Xie Q, Xu J, Chen L, Zhang J, Yin H, Jia J, Qiu Y, Xu W. Impairments and Compensations of Static Balance and Plantar Load Distribution in Patients With Chronic Stroke: An Observational Study. J Manipulative Physiol Ther 2022; 44:734-742. [PMID: 35752501 DOI: 10.1016/j.jmpt.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to explore impairment and compensation characteristics of static balance and plantar load distribution in patients with chronic stroke. METHODS We recruited 68 patients who had chronic stroke who could stand independently (stroke group) and 30 healthy individuals (control group) with the Zebris FDM platform. Static balance parameters, including center of pressure (COP) ellipse sway area, COP path length, and angle-θ between y and major axis, were compared between 2 groups under standard standing posture. In the stroke group, balance parameters were re-tested under their preferring standing posture. Plantar load distribution was also assessed. Another 8 patients with chronic stroke who could not stand independently and had to rely on a crutch were enrolled to analyze the characteristics of balance compensation. RESULTS In the stroke group, the ellipse sway area, COP path length, and angle-θ were significantly larger than those of the control group. Sixty-one (89.7%) patients preferred standing with the affected foot outward-forward supporting, and their preferring standing balance was better than that of standard standing. All patients who could not stand independently tended to compensate for balance with a crutch supporting laterally and also preferred standing with a typical posture- the affected foot was outward-forward. CONCLUSIONS In patients post stroke, static balance is impaired mainly at the lateral direction, and patients commonly locate the crutch laterally for compensation of lateral balance. Patients preferred standing with the affected foot outward-forward supporting, and their preferring standing balance was better than that of standard standing, which challenged the necessity of training standing symmetrically.
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Affiliation(s)
- Baofu Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; The Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian Xie
- Department of Radiology, Jing'an District Center Hospital, Fudan University, Shanghai, China
| | - Jing Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jionghao Zhang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Department of Orthopaedic Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China
| | - Huawei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jie Jia
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China
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Mandiroglu S, Firat M. Foot and ankle deformities in stroke: relationship with ambulation, balance, and daily living activities: a cross-sectional study. Somatosens Mot Res 2022; 39:106-110. [PMID: 34930085 DOI: 10.1080/08990220.2021.2018294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ankle-foot deformities play a critical role in functional capacity and therefore activities of daily living in stroke patients. AIM This is the first study to evaluate all foot deformities in stroke patients together. The primary aim of this study is to determine the frequency of ankle-foot deformities in stroke patients. The secondary aim is to investigate the relationships between ankle-foot deformities and ambulation, postural control, balance, spasticity, and activities of daily living. MATERIAL AND METHODS The Functional Ambulation Classification was used to assess ambulation status, Postural Assessment Scale for Stroke Patients was used to assess postural control and balance. Lower extremity spasticity was evaluated with Modified Ashworth Scale. Activities of daily living were evaluated with Barthel Index. RESULTS Ankle-foot deformity was detected in 77 (42%) of 184 cases. The incidence of pes equinovarus was 48%, pes equinus was seen in 22%, claw toe in 19.5%, and pes varus in 10.4%. Pes equinovarus and claw toe were seen together in 8 cases. In the group with ankle-foot deformity, the disease duration was longer and the rate of spasticity in the lower extremity was statistically higher (p = 0.29, p = 0.023). There was no difference in Functional Ambulation Classification, Barthel Index, and Postural Assessment Scale for Stroke Patients scores between patients with or without ankle-foot deformity (p = 0.811, 0.321, 0.385). CONCLUSION It is important to detect ankle-foot deformities in stroke patients. Ankle-foot deformities are associated with spasticity in patients with stroke and are an important factor to be considered when determining the rehabilitation program.
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Affiliation(s)
- Sibel Mandiroglu
- Physical Medicine and Rehabilitation Division, Ankara Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Mehpare Firat
- Physical Medicine and Rehabilitation Division, Ankara Etimesgut Government Hospital, Ankara, Turkey
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Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
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Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
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Berezutsky VI. [The application of kinesiotaping for the rehabilitation of the post-stroke patients]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2018; 95:58-64. [PMID: 29786683 DOI: 10.17116/kurort201895258-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 03/14/2017] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
This review of the scientific literature was designed to consider the prospects for the application of kinesiotaping for the rehabilitation of the post-stroke patients. The relevance of the work arises from the absence of a systemic analysis of the large number of investigations that have been carried out during the past two years. The objective of the present review article was to evaluate the influence of kinesiotaping on the health status of the post-stroke patients and the course of their rehabilitative treatment based on the results of analysis of the scientific reports published during the period from 2015 to 2017. The analysis has demonstrated that the method under consideration makes it possible to effectively reduce spasticity, increase the paretic limb power, improve the static and dynamic balance, and alleviate the pain syndrome by virtue of the ability to improve the articulation proprioception and to regulate the muscle tone. Such effects are known to promote the reduction of muscle tone asymmetry in the patients suffering from hemiparesis and articulation instability which in its turn improves the patients' gait and walking ability, hightens their living standards, and allows to tolerate enhanced physical exertion. Kinesiotaping actually improves the locomotor function in the post-stroke patients Taken together, the advantages of the approach in question give reason to recommend kinesiotaping for the wide application for the combined rehabilitative treatment of the post-stroke patients.
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Affiliation(s)
- V I Berezutsky
- State establishment is the Dnepropetrovsk medical academy
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