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D’Hondt L, De Groote F, Afschrift M. A dynamic foot model for predictive simulations of human gait reveals causal relations between foot structure and whole-body mechanics. PLoS Comput Biol 2024; 20:e1012219. [PMID: 38900787 PMCID: PMC11218950 DOI: 10.1371/journal.pcbi.1012219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 07/02/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024] Open
Abstract
The unique structure of the human foot is seen as a crucial adaptation for bipedalism. The foot's arched shape enables stiffening the foot to withstand high loads when pushing off, without compromising foot flexibility. Experimental studies demonstrated that manipulating foot stiffness has considerable effects on gait. In clinical practice, altered foot structure is associated with pathological gait. Yet, experimentally manipulating individual foot properties (e.g. arch height or tendon and ligament stiffness) is hard and therefore our understanding of how foot structure influences gait mechanics is still limited. Predictive simulations are a powerful tool to explore causal relationships between musculoskeletal properties and whole-body gait. However, musculoskeletal models used in three-dimensional predictive simulations assume a rigid foot arch, limiting their use for studying how foot structure influences three-dimensional gait mechanics. Here, we developed a four-segment foot model with a longitudinal arch for use in predictive simulations. We identified three properties of the ankle-foot complex that are important to capture ankle and knee kinematics, soleus activation, and ankle power of healthy adults: (1) compliant Achilles tendon, (2) stiff heel pad, (3) the ability to stiffen the foot. The latter requires sufficient arch height and contributions of plantar fascia, and intrinsic and extrinsic foot muscles. A reduced ability to stiffen the foot results in walking patterns with reduced push-off power. Simulations based on our model also captured the effects of walking with anaesthetised intrinsic foot muscles or an insole limiting arch compression. The ability to reproduce these different experiments indicates that our foot model captures the main mechanical properties of the foot. The presented four-segment foot model is a potentially powerful tool to study the relationship between foot properties and gait mechanics and energetics in health and disease.
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Affiliation(s)
- Lars D’Hondt
- Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Friedl De Groote
- Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maarten Afschrift
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Cao S, Ding N, Zan Q, Lu J, Li Y, Tian F, Xu J. Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38819934 DOI: 10.1002/ksa.12301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT). METHODS The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow-up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine-compartment partitioning method was used to partition the injury site. Preoperative and final follow-up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36-item Short-Form Health Survey (SF-36) to evaluate treatment efficacy and analyze prognostic factors. RESULTS Of the 31 patients with single cystic OLT with a complete set of follow-up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow-up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow-up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow-up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 scale showed significant improvement at the final postoperative follow-up when compared to preoperative scores (p < 0.001). No other complications were observed during follow-up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight-bearing or re-sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF-36 PCS and MCS scores. CONCLUSION Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- ShiHang Cao
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Ding
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiang Zan
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Jun Lu
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Li
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Feng Tian
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - JunKui Xu
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Cheng X, Su T, Li J, Parekh SG, Hu Y, Jiao C, Guo Q, Li N, Jiang D. Effect of Cigarette Smoking on Postoperative Outcomes After Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. Foot Ankle Int 2024:10711007241250007. [PMID: 38770767 DOI: 10.1177/10711007241250007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Bone marrow stimulation (BMS) is presently considered first-line surgical treatment for osteochondral lesions of the talus (OLTs); however, some patients still experience pain or dysfunction after surgery, and the reasons for success or failure remain somewhat unclear. This study aimed to investigate the effect of smoking on postoperative outcomes after arthroscopic BMS for OLTs. METHODS Consecutive patients with OLTs who underwent BMS between January 2017 and January 2020 were included. Smokers were defined as patients who actively consumed cigarettes before surgery and postoperatively, whereas nonsmokers were patients who never smoked. Visual analog scale (VAS), American Orthopaedic Foot & Ankle Society ankle hindfoot score (AOFAS), Karlsson-Peterson, and Tegner scores were assessed preoperatively and at follow-up. Additionally, a general linear model (GLM) was performed, followed by the interaction analysis to explore the potential influence of smoking. RESULTS The study enrolled 104 patients with a mean follow-up of 30.91 ± 7.03 months, including 28 smokers and 76 nonsmokers. There were no significant differences in patient age (35.2 ± 10.0 years vs 37.6 ± 9.7 years, P = .282) or OLT area (63.7 ± 38.7 mm2 vs 52.8 ± 37.0 mm2, P = .782). Both univariate analysis and GLM revealed that smoking was associated with worse postoperative pain levels, Karlsson-Peterson, and AOFAS scores (P < .05). The interaction analysis showed a significant interaction between smoking and OLT area for postoperative Karlsson-Peterson scores (general ankle function) (P = .031). Simple main effects analysis revealed that the negative effect of smoking on Tegner score significantly increased among patients >32 years old or with OLT area>50 mm2 (P < .05). CONCLUSION Smoking was associated with worse clinical outcomes following BMS of OLTs. As the size of OLTs increased, the difference in general ankle function between smokers and nonsmokers also increased. Furthermore, smokers who were older than 32 years or had larger OLTs were less likely to resume participation in high-level activities.
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Affiliation(s)
- Xiangyun Cheng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jian Li
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Selene G Parekh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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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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Lithgow MJ, Buldt AK, Munteanu SE, Marshall M, Thomas MJ, Peat G, Roddy E, Menz HB. Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Gait Posture 2024; 108:243-249. [PMID: 38141537 DOI: 10.1016/j.gaitpost.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Midfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition. RESEARCH QUESTION To compare plantar pressures between people with and without symptomatic radiographic midfoot OA. METHODS This was a cross-sectional study of adults aged ≥ 50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age ( ± 5 years) to controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen's d). RESULTS We included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p = <0.001) and pressure at the midfoot (d=0.70, medium effect size, p = <0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p = 0.13), and fifth MTP joint (d=0.37, small effect size, p = 0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p = 0.13). They also displayed lower force (d=0.40, small effect size, p = 0.02) and pressure at the hallux (d=0.50, medium effect size, p = <0.001) and lower force (d=0.54, medium effect size, p = <0.001) and pressure at the lesser toes (d=0.48, small effect size, p = <0.001) compared with controls. SIGNIFICANCE Midfoot OA appears to be associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships.
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Affiliation(s)
- Merridy J Lithgow
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Andrew K Buldt
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire ST6 7AG, United Kingdom
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom; Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield S10 2BP, United Kingdom
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire ST6 7AG, United Kingdom
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
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Mishra RK, Hamad A, Ibrahim R, Mathew M, Talal T, Al-Ali F, Park C, Davuluri V, Fernando ME, Najafi B. Objective assessment of mobility among adults with diabetes and end-stage renal disease using walking aid: A cross-sectional cohort study. Clin Biomech (Bristol, Avon) 2023; 107:106014. [PMID: 37290375 DOI: 10.1016/j.clinbiomech.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND This cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids. METHODS Sixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively. FINDINGS Participants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = -0.35, p = 0.034) and vibration perception threshold (R = -0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %). INTERPRETATION Those undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility.
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Affiliation(s)
- Ram Kinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abdullah Hamad
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Rania Ibrahim
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Mincy Mathew
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Talal Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Co, Doha, Qatar
| | - Fadwa Al-Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Vyshnavi Davuluri
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Malindu E Fernando
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Ulcer and wound Healing consortium, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Takahashi KZ, Krupenevich RL, Lenz AL, Kelly LA, Rainbow MJ, Franz JR. Mechanics and energetics of human feet: a contemporary perspective for understanding mobility impairments in older adults. BIOMECHANICS (BASEL, SWITZERLAND) 2022; 2:494-499. [PMID: 38249991 PMCID: PMC10798654 DOI: 10.3390/biomechanics2040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Much of our current understanding of age-related declines in mobility has been aided by decades of investigations on the role of muscle-tendon units spanning major lower extremity joints (e.g., hip, knee and ankle) for powering locomotion. Yet, mechanical contributions from foot structures are often neglected. This is despite the emerging evidence for their critical importance in youthful locomotion. With rapid growth in the field of human foot biomechanics over the last decade, our theoretical knowledge of young asymptomatic feet has transformed, from long-held views of a stiff lever and a shock-absorber to a versatile system that can modulate mechanical power and energy output to accommodate various locomotor task demands. In this perspective review, we predict that the next set of impactful discoveries related to locomotion in older adults will emerge by integrating the novel tools and approaches that are currently transforming the field of human foot biomechanics. By illuminating the functions of feet in older adults, we envision that future investigations will refine our mechanistic understanding of mobility deficits affecting our aging population, which may ultimately inspire targeted interventions to rejuvenate the mechanics and energetics of locomotion.
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Affiliation(s)
- Kota Z Takahashi
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L Krupenevich
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Luke A Kelly
- School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
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Miura S, Seko T, Himuro N, Koyama M, Saitoh S, Ohnishi H. Toe Grip strength declines earlier than hand grip strength and knee extension strength in community-dwelling older men: a cross sectional study. J Foot Ankle Res 2022; 15:79. [PMID: 36280859 PMCID: PMC9594870 DOI: 10.1186/s13047-022-00584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/13/2022] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study is to examine the age-related changes in the toe grip strength and its differences from hand grip strength and knee extension strength using cross-sectional data. Methods Of participants aged 65 years over who underwent health checkups for lifestyle-related diseases in 2018, 307 men and women met the criteria. Toe grip strength, hand grip strength, and knee extension strength were also measured as optional tests. The participants were divided into five groups categorized by every 5 years of age (Group 65–85). The data were analyzed with multiple comparisons using the linear mixed multilevel model to examine the following categories: association between age and muscle strength, differences in the pattern of change, and gender, using the 65–69 years group as a reference. Results In men, there were interaction effects between the factors of age and muscle, but in women there were not. Toe grip strength was significantly lower in Group 70, 75, 80, and 85 in men, lower in Group 85 than in 65 in women. Hand grip strength was significantly lower in Group 85 than in 65 in both men and women. There was no significant difference in knee extension strength among the age groups for both men and women. Conclusions The decline in toe grip strength may occur earlier and in a different pattern from hand grip strength and knee extension strength in men. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00584-x.
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Affiliation(s)
- Sayo Miura
- Department of Rehabilitation, Japan Health Care College, S-1, W-17, Chuo-ku, Sapporo, 060-8556 Japan ,grid.263171.00000 0001 0691 0855Department of Public Health, Sapporo Medical University School of Medicine, 3-11-1-50, Tsukisamu Higashi, Toyohira-ku, Sapporo, Hokkaido 062-0053 Japan
| | - Toshiaki Seko
- grid.263171.00000 0001 0691 0855Department of Public Health, Sapporo Medical University School of Medicine, 3-11-1-50, Tsukisamu Higashi, Toyohira-ku, Sapporo, Hokkaido 062-0053 Japan ,grid.505710.60000 0004 0628 9909Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, 066-0055 Japan
| | - Nobuaki Himuro
- grid.263171.00000 0001 0691 0855Department of Public Health, Sapporo Medical University School of Medicine, 3-11-1-50, Tsukisamu Higashi, Toyohira-ku, Sapporo, Hokkaido 062-0053 Japan
| | - Masayuki Koyama
- grid.263171.00000 0001 0691 0855Department of Public Health, Sapporo Medical University School of Medicine, 3-11-1-50, Tsukisamu Higashi, Toyohira-ku, Sapporo, Hokkaido 062-0053 Japan ,grid.263171.00000 0001 0691 0855Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-ku, Sapporo, 060-8556 Japan
| | - Shigeyuki Saitoh
- grid.263171.00000 0001 0691 0855Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-ku, Sapporo, 060-8556 Japan
| | - Hirofumi Ohnishi
- grid.263171.00000 0001 0691 0855Department of Public Health, Sapporo Medical University School of Medicine, 3-11-1-50, Tsukisamu Higashi, Toyohira-ku, Sapporo, Hokkaido 062-0053 Japan ,grid.263171.00000 0001 0691 0855Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-ku, Sapporo, 060-8556 Japan
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Manz WJ, Nash AE, Novak J, Fink J, Kadakia R, Coleman MM, Bariteau JT. Non-emergent Conditions of the Ankle, Hindfoot, and Midfoot in Elderly Patients Are as Mobility Limiting as Congestive Heart Failure. Foot Ankle Spec 2022:19386400221127836. [PMID: 36210764 DOI: 10.1177/19386400221127836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobility limitations are well linked to increased morbidity and mortality. Older patients with chronic pathologies of the foot and ankle can suffer from significant mobility limitations; however, the magnitude of limitation experienced by this cohort is not well characterized. Conversely, the effects of congestive heart failure (CHF) on patient mobility are routinely assessed via the New York Heart Association (NYHA) classification. New York Heart Association classification is determined by a patient's physical activity limitation and is strongly correlated to functional status. We hypothesized that non-emergent conditions of the foot and ankle would be as mobility limiting as CHF. METHODS Life-Space Mobility Assessments (LSAs) were prospectively collected from orthopaedic patients at their preoperative visits and from CHF patients at a cardiology clinic. Patients over the age of 50 years were included in this study. Congestive heart failure patients NYHA class II or greater were included. The non-emergent foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and LSA scores were analyzed using Mann-Whitney U and chi-squared tests. RESULTS A total of 96 elderly, non-emergent foot and ankle operative patients and 45 CHF patients met inclusion criteria. All medical comorbidities, except smoking status, were significantly more prevalent in the CHF cohort. No statistical difference was observed between CHF and preoperative foot and ankle LSA scores (56.1 vs 62.4, P = .320). Life-Space Mobility Assessment scores in the foot and ankle cohort were significantly improved relative to CHF patients, at 6-month and 1-year postoperative visits (P = .028, P < .0001, respectively). CONCLUSION Non-emergent ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III CHF. Older patients undergoing elective foot and ankle procedures exceeded the mobility of CHF patients at 6 months post-operation, and the mobility gains persisted at 1-year post-operation. LEVELS OF EVIDENCE Level II: Prospective cohort study.
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Affiliation(s)
- Wesley J Manz
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Amalie E Nash
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jack Novak
- Emory University School of Medicine, Atlanta, Georgia
| | - Juliet Fink
- Emory University School of Medicine, Atlanta, Georgia
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
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McNab B, Sadler S, Lanting S, Chuter V. The relationship between foot and ankle joint flexibility measures and barefoot plantar pressures in healthy older adults: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:729. [PMID: 35906599 PMCID: PMC9338503 DOI: 10.1186/s12891-022-05618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restriction in foot and ankle joint range of motion, such as an ankle equinus, has been associated with increased plantar pressure and its complications. However, previous research is limited by its scope of measures and study populations. The aim of this study was to investigate the relationship between foot and ankle joint range of motion on barefoot plantar pressures during walking in healthy older adults. METHODS This cross-sectional study recruited 49 older adults. Participants underwent measures of foot (first metatarsophalangeal dorsiflexion range of motion, and navicular drop and drift) and ankle joint range of motion, foot posture, body mass index, and plantar pressure during barefoot walking. Spearman Rank Order Correlations were used to explore the relationship between foot and ankle measures, body mass index, and plantar pressure, with significant correlations explored in a hierarchical regression analysis. A Mann-Whitney U test was performed to compare plantar pressure values between those with and without ankle equinus per region of the foot. RESULTS Mean (SD) age and BMI were 72.4 years (5.2) and 29.8 kg/m2 (5.9) respectively. A total of 32 of the 49 participants (65%) identified as female sex. Mean (SD) ankle joint range of motion was 32.7 (6.4) degrees with 17/49 (34.7%) participants classified as having an ankle equinus (defined as < 30 degrees of ankle joint dorsiflexion range of motion). We found that an ankle equinus predicted a statistically significant amount of peak forefoot plantar pressure (p = 0.03). Participants with an ankle equinus displayed significantly higher forefoot peak pressure 677.8 kPa (589.9 to 810.4) compared to those with no equinus 565.58 kPa (447.3 to 651.2), p = 0.02. A statistically significant correlation was found between body mass index and midfoot peak pressure (p < 0.01) and pressure-time integral (p < 0.01). No other significant correlations were found. CONCLUSION Clinicians should consider screening for an ankle equinus and body mass index as a simple way to identify which healthy older adults may be at risk of pressure-related complications in the mid- and forefoot.
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Affiliation(s)
- Bonnie McNab
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Central Coast Campus, 10 Chittaway Road, Ourimbah, Callaghan, NSW, 2258, Australia
| | - Sean Sadler
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Central Coast Campus, 10 Chittaway Road, Ourimbah, Callaghan, NSW, 2258, Australia.
| | - Sean Lanting
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Central Coast Campus, 10 Chittaway Road, Ourimbah, Callaghan, NSW, 2258, Australia
| | - Vivienne Chuter
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Central Coast Campus, 10 Chittaway Road, Ourimbah, Callaghan, NSW, 2258, Australia.,Discipline of Podiatry, School of Health Science, Western Sydney University, Campbelltown, NSW, Australia
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Jeong HJ, Cha B, Zellers JA, Chen L, Hastings MK. Midfoot and ankle movement coordination during heel rise is disrupted in people with diabetes and peripheral neuropathy. Clin Biomech (Bristol, Avon) 2022; 96:105662. [PMID: 35569256 PMCID: PMC9616002 DOI: 10.1016/j.clinbiomech.2022.105662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A heel rise task can be used to evaluate midfoot and ankle movement dysfunction in people with diabetes mellitus and peripheral neuropathy. Quantifying movement coordination during heel rise is important to better understand potentially detrimental movement strategies in people with foot pathologies; however, coordination and the impact of limited excursion on coordination is not well-understood in people with diabetes. METHODS Sixty patients with diabetes mellitus and peripheral neuropathy, and 22 older and 25 younger controls performed single-limb heel rise task. Midfoot (forefoot relative to hindfoot) sagittal and ankle (hindfoot relative to shank) sagittal and frontal kinematics were measured and normalized to time (0 to 100%). Cross-correlation coefficients were calculated across individuals in each group. A graphical illustration was used to interpret the relationship of midfoot and ankle excursion and cross-correlation coefficient during heel rise. FINDINGS People with diabetes mellitus and peripheral neuropathy showed significantly lower midfoot and ankle cross-correlation coefficients during heel rise compared to older controls (p = 0.003-0.007). There was no difference in the midfoot and ankle cross-correlation coefficients during heel rise for the older and younger controls (p = 0.059-0.425). The graphic data illustrated a trend of greater excursion of two joints and a higher cross-correlation coefficient. Some individuals with lower excursion showed a high cross-correlation coefficient. INTERPRETATION Foot pathologies, but not aging, impairs midfoot and ankle movement coordination during heel rise task. Investigating both movement coordination as well as joint excursion would better inform and characterize the dynamic movements of midfoot and ankle during heel rise task.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, 1515 W. Wisconsin Ave., Milwaukee, WI 53233, USA,Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, USA
| | - Baekdong Cha
- Gwangju Institute of Science and Technology 123, Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, South Korea
| | - Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri. 4444 Forest Park Ave., St. Louis, MO 63108, USA
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri. 4444 Forest Park Ave., St. Louis, MO 63108, USA
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Body mass index and maximum available midfoot motion are associated with midfoot angle at peak heel rise in people with type 2 diabetes mellitus and peripheral neuropathy. Foot (Edinb) 2022; 51:101912. [PMID: 35255403 PMCID: PMC9169461 DOI: 10.1016/j.foot.2022.101912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/04/2021] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Midfoot movement dysfunction, as measured by heel rise performance, is associated with midfoot deformity in people with diabetes and peripheral neuropathy. Understanding contributors of midfoot movement dysfunction may help clinicians understand deformity progression. The purpose of this study was to determine the factors associated with midfoot angle at peak heel rise. METHODS The outcomes of fifty-eight participants with type 2 diabetes mellitus and peripheral neuropathy were analyzed. Midfoot (forefoot on hindfoot) sagittal kinematics during unilateral heel rise task were measured using 3-dimensional motion analysis. A multivariate linear regression model was used to predict midfoot sagittal movements at peak heel rise. Independent variables that were entered in the model were (in order of entry): age, body mass index, intrinsic foot muscle volume, and maximum available midfoot plantarflexion range of motion. Intrinsic foot muscle volume was obtained from magnetic resonance imaging and maximum available midfoot motion was measured during non-weightbearing plantarflexion using 3-dimensional motion analysis. RESULTS Body mass index (R2 = 30.5%, p < 0.001) and maximum available midfoot plantarflexion range of motion (R2 = 10.9%, p = 0.001) were significant factors that accounted for 41.4% of variance of midfoot angle at peak heel rise, while age and intrinsic foot muscle volume were not significant predictors. CONCLUSIONS Greater body mass index and less available midfoot plantarflexion range of motion were associated with greater midfoot movement dysfunction. These two significant predictors are potentially modifiable, suggesting possible improvements in midfoot movements with reduction in body weight and increasing midfoot plantarflexion range of motion. Health care professionals should consider patient's weight and joint motion when prescribing foot exercise(s) to prevent excessive midfoot collapse during weightbearing tasks.
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Interventions to Improve Physical Capability of Older Adults with Mild Disabilities: A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052651. [PMID: 35270341 PMCID: PMC8910335 DOI: 10.3390/ijerph19052651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023]
Abstract
Ageing is related to changes in physical health, including loss of mobility and muscle function. It can lead to impaired physical capability and reduced quality of life. The purpose of this study was to investigate whether a physical activity rehabilitation program (PARP) could improve range of joint motion (ROM), grip strength, and gait speed of older adults with mild disabilities. Forty older adults in a long-term care center in Taiwan joined as human participants and were split into control and experimental groups. The participants in the experimental group joined a PARP for eight weeks. The ROM of bodily joints, grip strength, and gait speed of all participants were measured both before and after the eight-week period. The results showed that all the ROMs, grip strength, and gait speed of the participants in the experimental group increased significantly after attending the program. The improvement of the ROMs for male and female participants in the experimental group ranged from 3.8% to 71% and from 7.8% to 75%, respectively. Male participants had greater improvement on gait speed (50%) than their female counterparts (22.9%). Female participants, on the other hand, had greater improvement on grip strength (25.4%) than their male counterparts (20.3%). The ROM, grip strength, and gait speed of the control group, on the other hand, did not change significantly during the same period. The results showed that the PARP adopted in this study was effective in increasing the ROM, grip strength, and gait speed of those who had joined the PARP. This study shows that an eight-week PARP without the use of gym machines was beneficial in reducing sarcopenia in elderly people with mild disabilities.
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Willemse L, Wouters EJM, Bronts HM, Pisters MF, Vanwanseele B. The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review. J Foot Ankle Res 2022; 15:3. [PMID: 35057831 PMCID: PMC8772142 DOI: 10.1186/s13047-021-00509-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults. Methods A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence. Results Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics. Conclusions This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00509-0.
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Unver B, Bek N. Plantar sensation, plantar pressure, and postural stability alterations and effects of visual status in older adults. Somatosens Mot Res 2021; 39:55-61. [PMID: 34719316 DOI: 10.1080/08990220.2021.1994940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Ageing leads to plantar sensation and pressure alterations and poor postural control. The aim of this study was to compare the plantar sensation and static plantar pressure distribution between young and older adults. A secondary aim was to investigate the effect of ageing and visual status on postural stability. MATERIALS AND METHODS Forty older subjects and 43 young adult individuals participated in the study. Plantar light touch sensation was evaluated using Semmes-Weinstein monofilaments. Static plantar pressure and postural stability were assessed with the WinTrack® Pedobarography device. RESULTS Plantar sensation thresholds of the older individuals were higher compared to the young in all plantar regions (p < 0.001). The plantar contact area was greater in older individuals (p < 0.001). Maximum plantar pressure of midfoot was higher and maximum plantar pressure of the rearfoot and whole foot was less in older individuals during quiet stance (p < 0.05). The main effects of group and visual condition were significant for mean latero-lateral and antero-posterior sway speed with large effect sizes (p < 0.05). CONCLUSIONS The sensation of all plantar regions reduced, the rearfoot plantar pressure decreased, and the midfoot plantar pressure increased in older individuals compared to young. Postural stability was reduced in the older individuals, and their postural control was more affected by the eliminated visual information compared to the young. Increased plantar contact area and midfoot plantar pressure may be related to decreased MLA height in older individuals. Older individuals may need visual information more to maintain postural control because of reduced plantar sensation.
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Affiliation(s)
- Banu Unver
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | - Nilgun Bek
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
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Paillard T. Methods and Strategies for Reconditioning Motor Output and Postural Balance in Frail Older Subjects Prone to Falls. Front Physiol 2021; 12:700723. [PMID: 34712145 PMCID: PMC8546223 DOI: 10.3389/fphys.2021.700723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
In frail older subjects, the motor output of the antigravity muscles is fundamental in resisting falls. These muscles undergo accelerated involutions when they are inactive and the risk of falling increases during leisure and domestic physical activity. In order to reduce their risk of falling, frail older subjects limit their physical activities/exercises. The problem is that the less they exercise, the less they are able to exercise and the greater the risk in exercising. Hence, a vicious circle sets up and the antigravity muscles inevitably continue to deteriorate. This vicious circle must be broken by starting a reconditioning program based on developing the strength of antigravity muscles (especially lower-limb muscles). To begin with, for each increase in muscle strength, postural balance is improved. Once this increase reaches the threshold beyond which postural balance no longer improves, it seems appropriate to implement exercises aimed at concomitantly improving motor output and postural balance in order to counteract or even reverse the involution process of the postural balance system. Methods and strategies toward this end are proposed in this present communication. However, the transfer effects between strength increase and postural balance ability are not yet totally known and future research should evaluate the relationship between muscle strength and postural balance throughout rehabilitation programs (i.e., program follow-ups) in frail older subjects in order to advance knowledge of this relationship.
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Affiliation(s)
- Thierry Paillard
- Laboratoire Mouvement, Equilibre, Performance et Santé (UPRES EA 4445), Département STAPS, Université de Pau et des Pays de l'Adour/E2S, Pau, France
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The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179351. [PMID: 34501940 PMCID: PMC8430807 DOI: 10.3390/ijerph18179351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. METHOD In this study, forty-eight participants aged 65-75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. RESULT After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions-front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only-front, back, and left (p < 0.05)-without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). CONCLUSION In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.
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Santos AD, Prado-Rico JM, Cirino NTDO, Perracini MR. Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults? Braz J Phys Ther 2021; 25:846-853. [PMID: 34535410 DOI: 10.1016/j.bjpt.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 01/02/2023] Open
Abstract
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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Affiliation(s)
- Aurélio Dias Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Janina Manzieri Prado-Rico
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | | | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil; Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, São Paulo, SP, Brazil.
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Ateş F, Coleman-Wood K, Litchy W, Kaufman KR. Intramuscular pressure of human tibialis anterior muscle detects age-related changes in muscle performance. J Electromyogr Kinesiol 2021; 60:102587. [PMID: 34428670 DOI: 10.1016/j.jelekin.2021.102587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023] Open
Abstract
Intramuscular pressure (IMP) reflects forces produced by a muscle. Age is one of the determinants of skeletal muscle performance. The present study aimed to test whether IMP mirrors known age-related muscular changes. We simultaneously measured the tibialis anterior (TA) IMP, compound muscle action potential (CMAP), and ankle torque in thirteen older adults (60-80 years old) in vivo by applying different stimulation intensities and frequencies. We found significant positive correlations between the stimulation intensity and IMP and CMAP. Increasing stimulation frequency caused ankle torque and IMP to increase. The electromechanical delay (EMD) (36 ms) was longer than the onset of IMP (IMPD) (29 ms). Compared to the previously published data collected from young adults (21-40 years old) in identical conditions, the TA CMAP and IMP of older adults at maximum intensity of stimulation were 23.8% and 39.6% lower, respectively. For different stimulation frequencies, CMAP, IMP, as well as ankle torque of older adults were 20.5%, 24.2%, and 13.2% lower, respectively. Surprisingly, the EMD did not exhibit any difference between young and older adults and the IMPD was consistent with the EMD. Data supporting the hypotheses suggest that IMP measurement is an indicator of muscle performance in older adults.
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Affiliation(s)
- Filiz Ateş
- Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany; Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Krista Coleman-Wood
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - William Litchy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Albano D, Bonifacini C, Zannoni S, Bernareggi S, Messina C, Galia M, Sconfienza LM. Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses. LA RADIOLOGIA MEDICA 2021; 126:963-970. [PMID: 33881714 PMCID: PMC8205886 DOI: 10.1007/s11547-021-01354-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses. METHODS Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes. RESULTS Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters. CONCLUSION Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy.
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122, Milan, Italy.
| | - Carlo Bonifacini
- Foot and Ankle Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stefania Zannoni
- Scuola di Specializzazione in Radiodiagnostica, Università Degli Studi di Milano, Milan, Italy
| | | | | | - Massimo Galia
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche Per la Salute, Università Degli Studi di Milano, Milano, Italy
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Cherry L, Gates L, Culliford D, Walker-Bone K, Portillo MC. COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study. J Foot Ankle Res 2021; 14:46. [PMID: 34193240 PMCID: PMC8243073 DOI: 10.1186/s13047-021-00486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living. METHODS A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation. RESULTS Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity. CONCLUSIONS Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.
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Affiliation(s)
- Lindsey Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ UK
- Department of Podiatry, Solent NHS Trust, St Mary’s Community Hospital Campus, Portsmouth, PO3 6DW UK
| | - Lucy Gates
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - David Culliford
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ UK
- NIHR Applied Research Collaboration for Wessex, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Mari Carmen Portillo
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ UK
- NIHR Applied Research Collaboration for Wessex, University of Southampton, University Road, Southampton, SO17 1BJ UK
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Age-based comparison of gait asymmetry using unilateral ankle weights. Gait Posture 2021; 87:11-18. [PMID: 33872954 DOI: 10.1016/j.gaitpost.2021.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 11/18/2020] [Accepted: 01/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The locomotor system is proposed to be able to adapt to asymmetric conditions, which reflects the interaction between interlimb control and task constraints. However, this adaptability may be confounded by intrinsic differences between age groups. RESEARCH QUESTION What are the effects of mechanical asymmetry on kinematic symmetry in healthy younger and older adults? METHODS Two groups of 10 participants (age 18-25 and 58-65 years) walked (3 km h -1) and ran (9 km h -1) on a treadmill normally, and with unilateral ankle weights (UW). Lower-body kinematic data was collected. Symmetry Index (SI) and bilateral cyclograms were used to evaluate spatiotemporal step-cycle characteristics and joint angles. RESULTS Step-cycle characteristics were not significantly different between all comparisons. In running gait, asymmetry in range of motion (SI_RoM) of the knee and bilateral cyclogram minimum bounding box length (L) of the ankle was greater with UW compared to the normal condition. Ankle angle characteristics (SI_RoM ankle and minimum ankle angle) were more asymmetrical for older compared to younger adults, regardless of the UW condition. Interaction effects between age and UW were observed. In running gait, L knee and SI_RoM hip were greater with UW for younger adults, and smaller with UW for older adults. In walking gait, ankle angle at touchdown was greater with UW for younger adults, but smaller with UW for older adults. SIGNIFICANCE For both age groups walking and running with UW, symmetry appears to be preserved in step-cycle characteristics, but not in joint angle measures. While adapting to unilateral perturbation, older adults show greater asymmetry in some ankle kinematic measures compared to younger adults while running, suggesting that some kinematic solutions are altered with age, while the majority of symmetry values about the lower limbs were not.
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James K, Baglini C, Wershof Schwartz A. From the ground up: recognising risk of frailty syndromes and functional decline through foot examination. BMJ Case Rep 2021; 14:14/5/e236229. [PMID: 34031059 DOI: 10.1136/bcr-2020-236229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Foot pathologies in older adults are associated with falls and complications such as amputations and ulcers. We report a case of an older man who presented to the geriatric medicine outpatient clinic. History taking revealed a fall, recent episode of delirium and decline in functional status with the patient reporting he was no longer able to cut his own toenails. Medical history included hypothyroidism, depression and hearing impairment. Physical examination detected very long, thickened toenails with bilateral bony deformities of the foot. Additionally, he had borderline slow gait speed and had difficulty completing a chair stand. Inability to maintain foot care suggested an early insight into a deterioration of overall function and emergence of frailty. An interprofessional team approach to the patient's care included a medication review, referrals to podiatry, orthotics, physiotherapy and occupational therapy. His toenails were debrided and orthopaedic shoes were prescribed with no further falls.
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Affiliation(s)
- Kirstyn James
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, USA .,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | | | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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24
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Lee HW, Beak HJ, Yoon EJ, Kim J. Effect of Instrument-Assisted Soft Tissue Mobilization on Ankle of Range of Motion and Balance in Older Women: A Preliminary Study. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) on ankle range of motion (ROM) and balance in older women.METHODS The 20 older women with a history of falls participated in the study, and the study subjects were randomly divided into the IASTM group (n=10) and control group (n=10).RESULTS There were no significant interactions between group and time for ankle ROM and functional reach after 8 weeks of IASTM on older women (P>0.05). Meanwhile, there were significant interactions between group and time for one-leg standing and star excursion balance (P<0.05), and in particular, the IASTM group had greater improvements compared to the control group.CONCLUSION In conclusion, the regular application of IASTM has been shown to improve the balance of older women with a history of falls.
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25
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Sadler SG, Lanting SM, Searle AT, Spink MJ, Chuter VH. Does a weight bearing equinus affect plantar pressure differently in older people with and without diabetes? A case control study. Clin Biomech (Bristol, Avon) 2021; 84:105324. [PMID: 33756401 DOI: 10.1016/j.clinbiomech.2021.105324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND A weight bearing ankle equinus has adverse effects on forefoot plantar pressure variables in older adults with diabetes, but it is unclear if this is also the case in older adults without diabetes. METHODS 40 older adults with diabetes (88% type 2, mean diabetes duration 17.6 ± 14.8 years) and 40 older adults without diabetes, matched for age (±3 years), sex and BMI (±2 BMI units) were included (63% female, mean age 72 ± 4 years, BMI 30 ± 4 kg/m2). Primary outcomes were prevalence of a weight bearing equinus and evaluation of barefoot forefoot plantar pressures in older adults with and without diabetes. FINDINGS A weight bearing equinus was present in 37.5% and 27.5% of the diabetes and non-diabetes group respectively with no significant difference between groups (p = 0.470). People with diabetes and equinus displayed higher peak pressure (808 versus 540 kPa, p = 0.065) and significantly higher pressure-time integral (86 versus 68 kPa/s, p = 0.030) than people with diabetes and no equinus group. The non-diabetes equinus group had significantly higher peak pressure (665 versus 567 kPa, p = 0.035) than those with no diabetes and no equinus, but no difference in pressure-time integral. INTERPRETATION A high prevalence of a weight bearing equinus was detected in older adults with and without diabetes, with associated increases in plantar pressures. As an equinus has been associated with many foot pathologies this study's findings suggest that clinicians should check for the presence of a weight bearing ankle equinus in all older adults.
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Affiliation(s)
- Sean G Sadler
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia.
| | - Sean M Lanting
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia
| | - Angela T Searle
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia
| | - Martin J Spink
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia
| | - Vivienne H Chuter
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia; Priority Research Centre for Physical activity and Nutrition, University of Newcastle, Australia
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Iseli RK, Duncan G, Lee EK, Lewis E, Maier AB. Incorporating foot assessment in the comprehensive geriatric assessment. BMC Geriatr 2021; 21:223. [PMID: 33794805 PMCID: PMC8015740 DOI: 10.1186/s12877-021-02164-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. Aims To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. Methods Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. Results Fifty-two patients (median age [inter-quartile range] 86.4 [79.2–90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a ‘high risk’ or ‘at risk’ foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 ‘at risk’ and 2 ‘low risk’ for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7–32.1] vs 15.2 [8–22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0–3] vs 0 [0–2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001). Conclusion Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02164-3.
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Affiliation(s)
- Rebecca K Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia. .,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.
| | - Gregory Duncan
- Eastern Health Clinical School, Monash University
- , Box Hill, Victoria, Australia
| | - Elton K Lee
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ellen Lewis
- Podiatry Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, 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; Centre for Healthy Longevity, National University Health System, Singapore, Singapore
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27
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Hernández-Guillén D, Tolsada-Velasco C, Roig-Casasús S, Costa-Moreno E, Borja-de-Fuentes I, Blasco JM. Association ankle function and balance in community-dwelling older adults. PLoS One 2021; 16:e0247885. [PMID: 33661991 PMCID: PMC7932177 DOI: 10.1371/journal.pone.0247885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength. Methods This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI. Results and discussion Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability ( Radj2 = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes ( Radj2 = [0.16–0.2]; β = [0.29–0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice. Conclusion This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.
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Affiliation(s)
- David Hernández-Guillén
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
- * E-mail:
| | | | - Sergio Roig-Casasús
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
- Hospital Politècnic i Universitari La Fe, Valencia, Spain
| | | | | | - José-María Blasco
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
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Choi M, Ahn N, Park J, Kim K. 12-Week Exercise Training of Knee Joint and Squat Movement Improves Gait Ability in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041515. [PMID: 33562705 PMCID: PMC7915473 DOI: 10.3390/ijerph18041515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
This study analyzed the effects of an exercise training program consisting of a knee joint complex exercise device (leg-link system) with digitally controlled active motion function and squat movement on physical fitness and gait ability of elderly women aged 70 or above. Fifty four (54) elderly women aged 70 or above were divided into three groups as control group (n = 18), aerobic training group (n = 18), and combined training group with resistance and aerobic exercise (n = 18). Health-related physical fitness, gait ability-related physical fitness, and the temporal and spatial parameters of gait ability were compared. The health-related physical fitness after the 12-week training was not significantly altered in control group, whereas combined training group showed significant increase in all factors (p < 0.05) and aerobic training group showed significant increase (p < 0.05) only in the physical efficiency index. The gait ability-related physical fitness and all items of the temporal and spatial parameters of gait were found to have significantly increased (p < 0.05) in combined training group after the 12-week exercise training; however, in aerobic training group, only the factors related to muscular endurance and balance showed significant increase (p < 0.05). This study suggested that the exercise training consisting of knee joint complex exercise with digitally controlled active motion function and squat exercise for strengthening lower extremities and core muscles had positive effects on enhancing the ambulatory competence in elderly women.
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James K, Orkaby AR, Schwartz AW. Foot Examination for Older Adults. Am J Med 2021; 134:30-35. [PMID: 32805226 PMCID: PMC9614715 DOI: 10.1016/j.amjmed.2020.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine assessment of older adults is imperative to detect foot problems. Foot pain and pathologies are common in older adults. Regular foot care is important to prevent these issues. However, some older adults may find it difficult to complete foot care, including cutting toenails. Regular foot examination can detect common foot problems, functional decline, and is recommended for preventing falls. We describe a technique for performing a focused examination of the feet for older adults. This review addresses current podiatric issues in older patient populations and describes a method for foot examination to address the needs of older adults that can be incorporated into patient assessments in any clinical setting.
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Affiliation(s)
- Kirstyn James
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Ariela R Orkaby
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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30
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Iseli RK, Lee EK, Lewis E, Duncan G, Maier AB. Foot disease and physical function in older adults: A systematic review and meta-analysis. Australas J Ageing 2020; 40:35-47. [PMID: 33314652 DOI: 10.1111/ajag.12892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically assess the literature examining the association between foot disease (foot ulceration, infection, critical ischaemia and/or Charcot neuroarthropathy) and physical function in older adults. METHODS Literature search of MEDLINE, Embase and CINAHL was performed. Studies were included if foot disease and physical function were assessed in participants of mean or median age ≥ 65 years. RESULTS Of 2,574 abstracts screened, 19 studies (13 longitudinal, 6 cross-sectional) reporting on 5634 participants, 43% female, were included. Diabetes-related foot disease and critical ischaemia were most studied (n = 5017, 40% female). In 8 studies with control groups, foot disease was associated with poorer physical function. Meta-analysis of 5 studies (n = 1503, 45% female) found an association between foot disease and poorer physical function (SMD (95% CI): 1.00 (0.40, 1.62), P < 0.001). CONCLUSION Foot disease is associated with poorer physical function in older adults. Future research should include broader study populations and intervention strategies.
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Affiliation(s)
- Rebecca K Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Elton K Lee
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia
| | - Ellen Lewis
- Podiatry Department, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Gregory Duncan
- Eastern Health Clinical School, Monash University, Box Hill, Vic., Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Foot Health Assessment and Problem Identification in a Dominican Batey Community: A Descriptive Study. J Wound Ostomy Continence Nurs 2020; 47:397-402. [PMID: 33290018 DOI: 10.1097/won.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Foot problems can adversely impact foot function and quality of life. Foot problems are often overlooked, particularly in populations with limited health care access. Little is known about the foot health of Haitian immigrants who live and work in the bateyes (rural sugarcane villages) of the Dominican Republic. These immigrant workers may experience foot problems that could affect foot function and the ability to work and provide for their families. DESIGN Cross-sectional, exploratory, descriptive study design. SUBJECTS AND SETTING A convenience sample of adults was recruited from an ongoing community-based participatory research project evaluating a mobile hypertension screening and treatment clinic program in 11 Dominican batey communities. METHODS Foot health was assessed using the Foot Problems Checklist, a 24-item survey instrument developed for this study based on a review of the literature and foot clinician expertise. A certified foot care nurse recorded foot health data on the Foot Problems Checklist via visual and physical inspection. RESULTS Study participants were 25 females and 16 males, aged 18 to 90 years, and all had at least one foot health problem. The most common foot problems were calluses (78%), dry skin (76%), thick nails (59%), jagged nails (29%), long/overgrown nails (17%), and skin fissures (12%). CONCLUSIONS While the foot problems we observed were not considered serious, they could become progressively debilitating and be prevented with proper self-management guided by appropriate knowledge and skills and available supplies. We recommend the development and testing of foot care self-management interventions deliverable via mobile clinics to increase access and improve foot health outcomes.
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Conde M, Hendry GJ, Woodburn J, Skelton DA. ´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study. J Foot Ankle Res 2020; 13:66. [PMID: 33176825 PMCID: PMC7659063 DOI: 10.1186/s13047-020-00434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.
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Affiliation(s)
- Monserrat Conde
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK.
| | - Gordon J Hendry
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Jim Woodburn
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Dawn A Skelton
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
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Bovonsunthonchai S, Thong-On S, Vachalathiti R, Intiravoranont W, Suwannarat S, Smith R. Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation. BMC Sports Sci Med Rehabil 2020; 12:56. [PMID: 32944253 PMCID: PMC7488097 DOI: 10.1186/s13102-020-00206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 09/01/2020] [Indexed: 11/11/2022]
Abstract
Background The study aimed to translate the foot function index (FFI) questionnaire to Thai and to determine psychometric properties of the questionnaire among individuals with plantar foot complaints. Methods The Thai version of the FFI (FFI-Th) was adapted according to a forward and backward translation protocol by two independent translators and analyzed by a linguist and a committee. The FFI-Th was administered among 49 individuals with plantar foot complaints to determine internal consistency, reliability, and validity. Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC3,1) were used to test the internal consistency and test-retest reliability. The Principal Component Analysis with varimax rotation method was used to test the factor structure and construct validity. Furthermore, the criterion validity was tested using Pearson’s correlation coefficient (rp) between the FFI-Th and the visual analogue pain scale (pain-VAS) as well as the EuroQol five-dimensional questionnaire (EQ-5D-5L). Results The FFI-Th showed good to excellent internal consistency and test-retest reliability in the total score, pain, disability, and activity limitation subscales. The Principal Component Analysis produced 4 principal factors from the FFI-Th items. Criterion validity of the FFI-Th total score showed moderate to strong correlations with pain-VAS and EQ-5D-5L, and EQ-VAS scores. Conclusion The FFI-Th was a reliable and valid questionnaire to assess the foot function in a Thai population. Trial registration NCT03161314 (08/05/2017).
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Affiliation(s)
- Sunee Bovonsunthonchai
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Rd., Salaya, Phuttamonthon, Nakhon Pathom, 73170 Thailand
| | - Suthasinee Thong-On
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Rd., Salaya, Phuttamonthon, Nakhon Pathom, 73170 Thailand
| | - Roongtiwa Vachalathiti
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Rd., Salaya, Phuttamonthon, Nakhon Pathom, 73170 Thailand
| | - Warinda Intiravoranont
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, 10700 Thailand
| | - Sarawut Suwannarat
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, 10700 Thailand
| | - Richard Smith
- Discipline of Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health Science, The University of Sydney, Sydney, NSW 2006 Australia
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Effects of age and speed on the ankle-foot system's power during walking. Sci Rep 2020; 10:14903. [PMID: 32913325 PMCID: PMC7484792 DOI: 10.1038/s41598-020-71763-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/31/2020] [Indexed: 11/08/2022] Open
Abstract
Structural and functional changes in the foot have been associated with age-related changes in gait mechanics, but walking speed may be a confounding factor in this relationship. The aim of this study was to investigate the effect of aging and speed on the ankle-foot power output during level walking. The effects of speed and aging on features of the mechanical power and work of the ankle and foot were quantified with a gait analysis of 24 young and 16 older individuals walking at different speeds. We observed gait speed having a significant effect on all the investigated features: peak power and positive and negative work of the ankle, foot, and sum of the ankle and foot (average effect size: 0.64 ± 0.22, from 0.26 to 0.87). We observed age having no effect on these same features (average effect size: 0.23 ± 0.12, from 0.03 to 0.39), with the exception of age's effect when combined with speed on the negative work of the foot. We performed additional analysis to illustrate how the speed can become a confounding factor to the understanding of the age effect on the gait biomechanics. Based on the influence of gait speed on the mechanical power of the ankle-foot system, it is essential that studies control for the effect of gait speed if there is interest in understanding age-related effects, particularly when studying frail older individuals.
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Štefan L, Kasović M, Zvonar M. Gait Speed as a Screening Tool for Foot Pain and the Risk of Falls in Community-Dwelling Older Women: A Cross-Sectional Study. Clin Interv Aging 2020; 15:1569-1574. [PMID: 32943857 PMCID: PMC7481277 DOI: 10.2147/cia.s260931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The main purpose of the study was to establish a gait speed cut-off value to predict foot pain and the risk of falls among community-dwelling older adults. Patients and Methods In this cross-sectional study, one-hundred and twenty White older women speaking Croatian (mean ± SD age 71.02 ± 6.78 years, height 161.77 ± 6.23 cm, weight 70.29 ± 12.97 kg, body mass index 26.79 ± 4.42 kg/m2) were recruited. The prevalence of foot pain was assessed by a single-item question and the risk of falls by the Downtown Fall Risk Index with a proposed cut-off value of "low risk" (<3 points) vs "high risk" (≥3 points) of falls. Self-selected gait speed (the independent variable) was estimated with a pressure platform (Zebris Company, Munich, Germany). Results Mean gait speed was 0.95 m/s. Of the total sample, 53.30% and 33.30% reported foot pain and had higher risk of falls. For foot pain and the risk of falls, gait speed cut-off values were 0.88 m/s and 0.85 m/s (area under the curve = 0.80 and 0.83, standard error = 0.043 and 0.043, p < 0.001). Sensitivity for foot pain and the risk of falls was 66.20% and 85.90% and specificity was 84.80% and 69.00%. Slower gait speed was associated with higher prevalence of foot pain (OR = 10.92, 95% CI 4.28 to 27.89, p < 0.001) and higher risk of falls (OR = 13.59, 95% CI 5.45 to 33.87, p < 0.001). Conclusion Proposed gait speed values of 0.88 m/s and 0.85 m/s may be used in clinical settings to predict foot pain and the risk of falls among community-dwelling older women.
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Affiliation(s)
- Lovro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Mario Kasović
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia.,Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic
| | - Martin Zvonar
- Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
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Hernández-Guillén D, Blasco JM. A Randomized Controlled Trial Assessing the Evolution of the Weight-Bearing Ankle Dorsiflexion Range of Motion Over 6 Sessions of Talus Mobilizations in Older Adults. Phys Ther 2020; 100:645-652. [PMID: 31944252 DOI: 10.1093/ptj/pzaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/19/2019] [Accepted: 11/17/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Ankle range of motion declines with age, affecting mobility and postural control. OBJECTIVE The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment. DESIGN This was a randomized clinical trial. SETTING This study was conducted in an outpatient clinic. PARTICIPANTS Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study. INTERVENTIONS The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment. MEASUREMENTS The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up. RESULTS A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention. LIMITATIONS Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown. CONCLUSIONS Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention.
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Affiliation(s)
- David Hernández-Guillén
- Group in Physiotherapy in the Ageing Process, Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain
| | - José-María Blasco
- Group in Physiotherapy in the Ageing Process, Social and Health Care Strategies, Department of Physiotherapy, University of Valencia
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Abstract
BACKGROUND Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain. METHODS A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat. RESULTS Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05). CONCLUSIONS Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Zeidan H, Ryo E, Suzuki Y, Iijima H, Kajiwara Y, Harada K, Nakai K, Shimoura K, Fujimoto K, Takahashi M, Aoyama T. Detailed analysis of the transverse arch of hallux valgus feet with and without pain using weightbearing ultrasound imaging and precise force sensors. PLoS One 2020; 15:e0226914. [PMID: 31917790 PMCID: PMC6952079 DOI: 10.1371/journal.pone.0226914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/06/2019] [Indexed: 12/28/2022] Open
Abstract
Background Hallux valgus is the most common forefoot deformity and affects the transverse arch structure and its force loading patterns. This study aims to clarify the differences in the transverse arch structure and the force under the metatarsal heads individually, between normal feet and hallux valgus feet, and between hallux valgus feet with pain and without pain. We further test the association between the parameters of the transverse arch and hallux valgus angle and between the parameters and pain in hallux valgus. Methods Women’s feet (105 feet) were divided into normal group (NORM) and hallux valgus group (HVG); and further into subgroups: hallux valgus without pain (HV Pain (-)) and hallux valgus with pain (HV Pain (+)). Transverse arch height and metatarsal heads height were measured using weight-bearing ultrasound imaging. Force under the metatarsal heads was measured using force sensors attached directly on the skin surface of the metatarsal heads. The measurements were taken in three loading positions: sitting, quiet standing and 90% weight shift on the tested foot. Differences between the groups were compared using Student t-test and Wilcoxon Exact test. Multivariate logistic analysis with adjustment for physical characteristics was also conducted. Results Transverse arch height was significantly higher in HVG than in NORM in all positions; there were no significant differences between HV Pain (+) and HV pain (-). Lateral sesamoid was significantly higher in HVG and HV Pain (+) than in NORM and HV Pain (-) respectively when bearing 90% of the body weight unilaterally. There was a trend of higher forces under the medial forefoot without significant difference. Transverse arch height and lateral sesamoid height were associated with the hallux valgus angle, while lateral sesamoid height was associated with forefoot pain in hallux valgus deformity. Conclusions This study shows the differences in the transverse arch structure between normal feet and feet with hallux valgus, and between hallux valgus feet with and without pain. This finding is noteworthy when considering future treatments of painful feet, notably the height of the lateral sesamoid which seems to play a role in forefoot pain.
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Affiliation(s)
- Hala Zeidan
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Eguchi Ryo
- Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Yusuke Suzuki
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
| | - Hirotaka Iijima
- Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
- Department of Physical Therapy, Kio University, Nara, Japan
| | - Keiko Harada
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
| | - Kengo Nakai
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
| | - Koji Fujimoto
- Human Brain Research Center, Kyoto University, Kyoto, Japan
| | - Masaki Takahashi
- Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Kyoto University, Kyoto, Japan
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Hernández-Guillén D, Sanoguera-Torres A, Martínez-Pérez C, Igual-Camacho C, Blasco JM. Balance training versus balance training and foot and ankle mobilization: a pilot randomized trial in community-dwelling older adults. Physiother Theory Pract 2019; 36:1097-1106. [PMID: 30652944 DOI: 10.1080/09593985.2018.1563931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Balance limitations and foot and ankle problems are common in older adults. Objective: To determine the impact of augmented balance training with foot and ankle mobilizations (FAMs) on balance in older adults. Methods: Two-arm pilot randomized trial. Both groups underwent a 4-week conventional balance training. Additionally, the experimental group received four sessions of FAM. Balance measurement, as assessed by the Berg Balance Scale, was the primary outcome. The secondary outcome was the ankle range of movement (ROM). Outcomes were evaluated 1 day before and after intervention, and at 3 months' post-intervention (midterm). Results: Twenty-eight participants completed the study (14 control, 14 experimental). No between-group differences were observed in terms of balance. Similarly, both groups significantly improved the ankle ROM, but the effects persisted at 3 months only in the FAM group. Conclusion: Augmented balance training with FAM does not improve balance of older adults over conventional methods, but may help to correct ankle mobility limitations at midterm. As this was a pilot study, further studies with adequate sample size are warranted to validate our findings, and elucidate the dose-response relationship of FAM with improvement of balance and ROM in older adults.
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Affiliation(s)
| | | | - Carlos Martínez-Pérez
- Department of Developmental and Educational Psychology, University of Valencia , Valencia, Spain
| | - Celedonia Igual-Camacho
- Department of Physiotherapy, University of Valencia , Valencia, Spain.,Group in Physiotherapy in the Ageing Process, University of Valencia , Valencia, Spain.,Clinic and University Hospital of Valencia, University of Valencia , Valencia, Spain
| | - José-María Blasco
- Department of Physiotherapy, University of Valencia , Valencia, Spain.,Group in Physiotherapy in the Ageing Process, University of Valencia , Valencia, Spain.,Joint Research Unit La Fe-UV (IRIMED) , Valencia, Spain
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Miikkola M, Lantta T, Suhonen R, Stolt M. Challenges of foot self-care in older people: a qualitative focus-group study. J Foot Ankle Res 2019; 12:5. [PMID: 30675187 PMCID: PMC6339366 DOI: 10.1186/s13047-019-0315-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Foot health is an important aspect of general health, and it can be maintained and promoted through foot self-care. However, little is known about older people’s experiences of caring for their feet. The aim of this study was to gather knowledge about experiences of foot self-care from the perspective of healthy older people in order to improve their welfare and their management of foot health. Methods A qualitative descriptive design with focus groups was used. Seventeen older people recruited from daytime activity centres participated in the focus groups (n = 4). The data were analysed using inductive content analysis. Results The participants described their foot self-care as including various activities, but they were hindered by the following factors: physical (e.g. changes in nail structure), external (e.g. seeking help from multi-level professionals) and internal (e.g. related to ageing). Foot self-care was considered to be important, but it was not systematically carried out. The participants thought that health-care professionals neglected patients’ feet. Conclusions Older people use a variety of methods to care for their feet. However, several factors hinder their ability to do so. Older people need advice, education and support to maintain their foot health. Future research is needed to identify effective ways to support older people in foot self-care and improve their welfare as active citizens.
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Affiliation(s)
- Maija Miikkola
- 1Department of Nursing Science, University of Turku, Turku, Finland
| | - Tella Lantta
- 1Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- 1Department of Nursing Science, University of Turku, Turku, Finland.,2Turku University Hospital, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Minna Stolt
- 1Department of Nursing Science, University of Turku, Turku, Finland.,2Turku University Hospital, Turku, Finland
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Telfer S, Bigham JJ. The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis. Gait Posture 2019; 67:269-276. [PMID: 30391749 DOI: 10.1016/j.gaitpost.2018.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results. METHODS A systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI. RESULTS 115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns. CONCLUSIONS At the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.
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Affiliation(s)
- S Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States.
| | - J J Bigham
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
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Wang C, Goel R, Rahemi H, Zhang Q, Lepow B, Najafi B. Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial. Gerontology 2018; 65:299-307. [PMID: 30504728 DOI: 10.1159/000494114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Foot problems are prevalent in older adults, which may increase the risk and concern for falls. Ankle-foot orthoses (AFO) have been shown to be effective in the stabilization of lower extremities, but their long-term effectiveness in improving balance and their potential to encourage older adults to become more physically active are still debated. OBJECTIVE This randomized controlled trial investigated the effectiveness of daily use of a custom-made AFO on balance, fear of falling, and physical activity in older adults. STUDY DESIGN Forty-four older adults with concern about or at risk for falling were randomly allocated to either the control group (CG; 77.3% female, age 75.6 ± 6.5 years, BMI 29.3 ± 6.4) or the intervention group (IG; 63.6% female, age 73.7 ± 6.3 years, BMI = 27.8 ± 4.8). The IG received walking shoes and bilateral custom-made AFO. The CG received only walking shoes. At the baseline and 6-month follow-ups, balance and physical activity were assessed using validated wearable instrumentation and fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Adherence and acceptability toward wearing the AFO were assessed using self-reported questionnaires at the 6-month follow-up. RESULTS No significant between-group difference was observed at baseline (p = 0.144-0.882). Compared to baseline and the CG, hip, ankle, and center-of-mass (COM) sways were significantly reduced at the 6-month follow-up in the IG while standing with the feet together during the eyes-open condition (p = 0.005-0.040). Within the IG, the FES-I was reduced significantly (p = 0.036) and there was an increasing trend in the number of walking bouts with a medium effect size (d = 0.52, p = 0.440) compared to baseline. However, there were no significant changes in FES-I and physical activity measures in the CG (p = 0.122-0.894). The reduction in COM sway in the IG was moderately correlated with adherence (r = -0.484, p = 0.047) and strongly correlated with baseline COM sway (r = -0.903, p < 0.001). CONCLUSION Results suggest that bilateral custom-made AFO plus walking shoes is effective in improving balance compared to walking shoes alone, and it significantly reduces the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, compared to baseline. The results also suggest that older adults with poor balance at baseline and higher daily adherence to using the AFO will gain more benefit from the AFO intervention.
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Affiliation(s)
- Changhong Wang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Rahul Goel
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Hadi Rahemi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Circulation Concepts Inc., Houston, Texas, USA
| | - Qianzi Zhang
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Brian Lepow
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA,
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Menz HB, Auhl M, Spink MJ. Foot problems as a risk factor for falls in community-dwelling older people: A systematic review and meta-analysis. Maturitas 2018; 118:7-14. [PMID: 30415759 DOI: 10.1016/j.maturitas.2018.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Foot problems are common in older people. The objective of this systematic review was to determine whether foot problems increase the risk of falling in community-dwelling older people. METHODS Electronic databases were searched from inception to May 2018. To be eligible for inclusion, papers needed to (i) include community-dwelling older participants, (ii) document falls either retrospectively or prospectively, and (iii) document or assess the presence of foot problems. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS A total of 146 papers were screened by title and abstract, and nine met the inclusion criteria. An additional six eligible papers were identified by searching the reference lists of included papers, resulting in a total of 15 papers. Quantitative synthesis indicated that older people who fell were more likely to have foot pain, hallux valgus, lesser toe deformity, plantar fasciitis, reduced ankle dorsiflexion range of motion, reduced toe plantarflexion strength, impaired tactile sensitivity and increased plantar pressures when walking. Meta-analysis indicated that fallers were more likely to have foot pain (pooled odds ratio [OR] 1.95, 95% CI 1.38-2.76, p < 0.001), hallux valgus (pooled OR 1.89, 95% CI 1.19-3.00, p = 0.007) and lesser toe deformity (pooled OR 1.67, 95% CI 1.07-2.59, p = 0.020). CONCLUSION Foot problems, particularly foot pain, hallux valgus and lesser toe deformity, are associated with falls in older people. Documentation of foot problems and referral to foot care specialists should therefore be a routine component of falls risk assessment and prevention.
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Maria Auhl
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Martin J Spink
- School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, New South Wales, 2258, Australia
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D'Ambrosi R, Maccario C, Serra N, Ursino C, Usuelli FG. Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location. Foot Ankle Surg 2018; 24:365-372. [PMID: 29409207 DOI: 10.1016/j.fas.2017.04.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/03/2017] [Accepted: 04/11/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of the study was to assess the relationship between symptomatic osteochondral lesions of the talus (OLTs) and age, body mass index (BMI), quality of life (QOL), size and anatomic location. METHODS Fifty-two patients with chronic OLTs were analyzed including BMI, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Health Survey (SF-12 divided into Mental (MCS) and Physical (PCS) score) and the 12-Item General Health Questionnaire (GHQ-12). Every patient underwent magnetic resonance imaging (MRI) and computed tomography (CT) examinations. We carried out a sub-analysis by dividing the talus into 6 areas, 3 vertical (medial, central and lateral group) and 3 horizontal (anterior, middle and posterior group). RESULTS There were 31 (60%) male and 21 (40%) female patients. Mean MCS and PCS resulted respectively 43.9 and 35.2. OLTs were located as follows: medial 20 (38.50%); central 13 (24.0%); and lateral 19 (36.50%); anterior 24 (46.15%); middle 16 (30.77%); and posterior 12 (23.08%). No significant differences were found among different groups with the exception of the anterior and posterior group for MCS (p=0.021). In the central group we identified a negative correlation (R=-0.672) between aging and AOFAS and a positive correlation between BMI and lesion size. We found a positive correlation between CT and MRI in each group. CONCLUSIONS OLTs impact patients' quality of life particularly in the physical component. Additionally, in patients with central lesions we found a positive linear correlation between lesion size and BMI and a worsening of the ankle with increasing age.
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Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, U.O. CASCO - Piede e Caviglia, Milan, Italy.
| | - Camilla Maccario
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, U.O. CASCO - Piede e Caviglia, Milan, Italy
| | - Nicola Serra
- Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy
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Shivaprasad C, Amit G, Anish K, Rakesh B, Anupam B, Aiswarya Y. Clinical correlates of sudomotor dysfunction in patients with type 2 diabetes and peripheral neuropathy. Diabetes Res Clin Pract 2018. [PMID: 29524484 DOI: 10.1016/j.diabres.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To investigate the factors associated with abnormal electrochemical skin conductance (ESC) in patients with type 2 diabetes mellitus (T2D) and early diabetic peripheral neuropathy (DPN). METHODS We recruited 523 consecutive patients with T2D (median age: 50 [interquartile range: 16] years; median T2D duration: 4 [5] years). Sudomotor dysfunction was defined as an ESC <60 µS, and DPN as a neuropathy disability score (NDS) ≥6. Logistic regression was performed to determine the predictors of sudomotor dysfunction in patients with DPN. RESULTS The prevalence of sudomotor dysfunction was 29% for all patients and 84.5% for patients with DPN. A significant negative correlation was observed between the NDS and ESC measurements (r = -0.52, p < 0.0001). In the univariate analysis, abnormal ESC measures were associated with age, diabetes duration, glycated hemoglobin, diabetic retinopathy, insulin therapy, and foot abnormalities. In the multivariate analysis, ESC abnormalities were associated with age, diabetes duration, glycated hemoglobin levels, insulin therapy, and foot deformities. There was a robust association between foot deformities and abnormal ESC (p = 0.049; odds ratio = 16.02) in patients with DPN. CONCLUSION Sudomotor dysfunction is highly prevalent in patients with T2D, especially in those with DPN. Various diabetes-related factors were linked to lower ESC values, indicating an association between chronic hyperglycemia and sudomotor function. We also observed a strong relationship between foot deformities and ESC abnormalities. We conclude that the factors associated with DPN are also relevant to sudomotor dysfunction.
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Affiliation(s)
- Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
| | - Goel Amit
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kolly Anish
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Boppana Rakesh
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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Ramalho F, Santos-Rocha R, Branco M, Moniz-Pereira V, André HI, Veloso AP, Carnide F. Effect of 6-month community-based exercise interventions on gait and functional fitness of an older population: a quasi-experimental study. Clin Interv Aging 2018; 13:595-606. [PMID: 29670343 PMCID: PMC5896669 DOI: 10.2147/cia.s157224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Gait ability in older adults has been associated with independent living, increased survival rates, fall prevention, and quality of life. There are inconsistent findings regarding the effects of exercise interventions in the maintenance of gait parameters. Objectives The aim of the study was to analyze the effects of a community-based periodized exercise intervention on the improvement of gait parameters and functional fitness in an older adult group compared with a non-periodized program. Methods A quasi-experimental study with follow-up was performed in a periodized exercise group (N=15) and in a non-periodized exercise group (N=13). The primary outcomes were plantar pressure gait parameters, and the secondary outcomes were physical activity, aerobic endurance, lower limb strength, agility, and balance. These variables were recorded at baseline and after 6 months of intervention. Results Both programs were tailored to older adults’ functional fitness level and proved to be effective in reducing the age-related decline regarding functional fitness and gait parameters. Gait parameters were sensitive to both the exercise interventions. Conclusion These exercise protocols can be used by exercise professionals in prescribing community exercise programs, as well as by health professionals in promoting active aging.
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Affiliation(s)
- Fátima Ramalho
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Rita Santos-Rocha
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Marco Branco
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Vera Moniz-Pereira
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Helô-Isa André
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - António P Veloso
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Filomena Carnide
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
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Muchna A, Najafi B, Wendel CS, Schwenk M, Armstrong DG, Mohler J. Foot Problems in Older Adults Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures. J Am Podiatr Med Assoc 2018; 108:126-139. [PMID: 28853612 PMCID: PMC6647839 DOI: 10.7547/15-186] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Amy Muchna
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Christopher S. Wendel
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Jane Mohler
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
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Tan JM, Crossley KM, Vicenzino B, Menz HB, Munteanu SE, Collins NJ. Age-related differences in foot mobility in individuals with patellofemoral pain. J Foot Ankle Res 2018; 11:5. [PMID: 29467828 PMCID: PMC5815185 DOI: 10.1186/s13047-018-0249-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Age-related changes in midfoot mobility have the potential to influence success with foot orthoses intervention in people with patellofemoral pain (PFP). The aim of this study was to determine whether older people with PFP demonstrate less foot mobility than younger adults with PFP. Methods One hundred ninety four participants (113 (58%) women, age 32 ± 7 years, BMI 25 ± 4.9 kg/m2) with PFP (≥ 6 weeks duration) were included, with foot mobility quantified using reliable and valid methods. K-means cluster analysis classified participants into three homogenous groups based on age. After cluster formation, univariate analyses of co-variance (covariates: sex, weight) were used to compare midfoot height mobility, midfoot width mobility, and foot mobility magnitude between age groups (significance level 0.05). Results Cluster analysis revealed three distinct age groups: 18–29 years (n = 70); 30–39 years (n = 101); and 40–50 years (n = 23). There was a significant main effect for age for midfoot height mobility (p < 0.001) and foot mobility magnitude (p = 0.006). Post-hoc analyses revealed that midfoot height mobility differed across all three groups (moderate to large effect sizes), and that foot mobility magnitude was significantly less in those aged 40–50 years compared to those aged 18–25 years (moderate effect size). There were no significant main effects for age for midfoot width mobility (p > 0.05). Conclusion Individuals with PFP aged 40–50 years have less foot mobility than younger adults with PFP. These findings may have implications for evaluation and treatment of older individuals with PFP.
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Affiliation(s)
- Jade M Tan
- 1Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086 Australia.,2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Kay M Crossley
- 2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Bill Vicenzino
- 3School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD 4072 Australia
| | - Hylton B Menz
- 1Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086 Australia.,2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Shannon E Munteanu
- 1Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086 Australia.,2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Natalie J Collins
- 2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia.,3School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD 4072 Australia.,4Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Parkville, VIC 3010 Australia
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McKay MJ, Baldwin JN, Ferreira P, Simic M, Vanicek N, Wojciechowski E, Mudge A, Burns J. Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years. Gait Posture 2017; 58:78-87. [PMID: 28763713 DOI: 10.1016/j.gaitpost.2017.07.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/07/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. METHODS In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years. RESULTS A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. CONCLUSION This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan.
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Affiliation(s)
- Marnee J McKay
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Jennifer N Baldwin
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Paulo Ferreira
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Milena Simic
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, United Kingdom.
| | - Elizabeth Wojciechowski
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
| | - Anita Mudge
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
| | - Joshua Burns
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
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