Foot problems, functional impairment, and falls in older people

Contributions of age, gender, body mass index, and normalized arch height to hallux valgus: a decision tree approach

BACKGROUND

Hallux valgus (HV) is a common toe deformity with various contributory factors. The interactions between intrinsic risk factors of HV, such as arch height, sex, age, and body mass index (BMI) should be considered. The present study aimed to establish a predictive model for HV using intrinsic factors, such as sex, age, BMI, and arch height based on decision tree (DT) model.

METHODS

This is retrospective study. The study data were based on the fifth Size Korea survey, of the Korea Technology Standard Institute. Among 5,185 patients, 645 were excluded due to unsuitable age or missing data, and 4,540 (males = 2,236 and females = 2,304) were selected for inclusion in the study. Seven variables (i.e., sex, age, BMI, and four normalized arch height variables) were used to develop the prediction model for the presence of HV using a DT model.

RESULTS

The DT model correctly classified 68.79% (95% confidence interval [CI] = 67.25-70.29%) of the training data set (3,633 cases). The predicted presence of HV based on the DT was verified against the testing data set (907 cases) and showed an accuracy of 69.57% (95% CI = 66.46-72.55%).

CONCLUSIONS

The DT model predicted the presence of HV on the basis of sex, age, and normalized arch height. According to our model, women aged over 50 years and those with lower normalized arch height were at high risk of HV.

Comparison of the effects of progressive supervised and home program exercise therapy in mild-moderate hallux valgus

Aim: To compare the effects of progressive exercise therapy, performed under the supervision of a physiotherapist and given as a home program in individuals with hallux valgus. Methods: Participants were randomly divided into two groups. While one group performed the exercises under the supervision of a physiotherapist, the other group did the same program at home. Results: The amount of decrease in foot adduction angle, pain level while walking, and right foot navicular height of individuals receiving treatment under the supervision of a physiotherapist were significantly higher. Conclusion: The exercise program applied under the supervision of a physiotherapist was more effective in reducing the first toe adduction angle, medial longitudinal arc height, and pain, improving dynamic balance and functional capacity.

Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults?

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.

Reliability Study of Diagnostic Tests for Functional Hallux Limitus

BACKGROUND

Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL, and clarify the signs and symptoms associated with this pathology.

METHODS

Forty-four subjects were included in this reliability study. Subjects were divided into healthy control (non-FHL) and FHL groups according to the Buell first MPJ limitation values in addition to signs and symptoms derived from the literature. In both groups, we measured the mobility in the Buell, Dananberg, and Jack tests using a goniometer; their intraclass correlation coefficients (ICCs), sensitivities, and specificity indexes were also calculated.

RESULTS

All techniques showed high reliability across measurement trials with ICCs ranging from 0.928 to 0.999. The optimal mobility grades for predicting FHL were 68.6 ± 3.7 degrees, 21 ± 5.9 degrees, and 25.5 ± 6.5 degrees (mean±SD) (P < .05) for the Buell, Dananberg, and Jack tests, respectively.

CONCLUSION

Normal and limited mobility values were established for assessing FHL using each technique. The sensitivity and specificity data were perfect for the Dananberg and Jack tests, thus identifying these tests as specific and valid tools for use in FHL diagnosis. Pinch callus was the sign most associated with FHL.

LEVEL OF EVIDENCE

Level II, comparative series.

Heel Height as an Etiology of Hallux Abductus Valgus Development: An electromagnetic Static and Dynamic First Metatarsophalangeal Joint Study

Background: Hallux abductus valgus (HAV) is a forefoot condition produced by extrinsic and intrinsic factors. Shoes with a high heel height and a typical narrow tip toe box can induce deviations in both the proximal phalanx of the hallux (PPH) and the first metatarsal (IMTT) bones. Nevertheless, the isolated role of heel height remains unclear in the development of HAV pathology. Objectives: The goal was to determine if the heel height increase of shoes without a narrow box toe could augment the PPH and IMTT deviation in frontal, sagittal, and transverse planes toward the first metatarsophalangeal joint (MPJ) and the first metatarsocuneiform joint (MCJ), respectively, during static and dynamic conditions in relation to precursor movements of HAV. Methods: Women with an average age of 25.10 ± 4.67 years were recruited in this cross-sectional study to assess the three planes of motion of PPH and IMTT while wearing high heels with heights at 3, 6, 9 cm and unshod conditions via sandals. The measurements used an electromagnetic goniometer device with sensors placed on medial aspects of the PPH and IMTT bones under static and dynamic conditions. Results: Wearing shoes with a 6 cm heel in dynamic condition may increase the PPH valgus and abduction deviation from 3.15 ± 0.10° to 3.46 ± 0.05° (p < 0.05) and from 1.35 ± 0.28° to 1.69 ± 0.30° (p < 0.001), respectively. In addition, a PPH abduction increase from 1.01 ± 0.36° to 1.31 ± 0.46° (p < 0.05) after wearing shoes with a 6 cm heel height was observed under static conditions. Conclusions: Wearing shoes with a heel height of 6 cm without a narrow box toe interference may produce PPH abduction and valgus deviations related to HAV formation.

Relationship between forefoot structure, including the transverse arch, and forefoot pain in patients with hallux valgus

[Purpose] Hallux valgus occurs in the forefoot where the transverse arch is located and may be a factor involved in forefoot pain. The relationship between forefoot pain and forefoot structure is unknown. This study aimed to analyze the relationship between forefoot pain and the transverse arch in patients with hallux valgus. [Participants and Methods] In this study, 122 (197 feet) adult females (46 to 86 years old) with hallux valgus were studied. By using questionnaires, the females were divided into two groups depending on whether or not they had forefoot pain (a group with forefoot pain [P group] and a group without forefoot pain [NP group]). The hallux valgus angle was measured using a goniometer, and the transverse arch was measured using a weight-bearing plantar ultrasonography imaging device. The transverse arch measurements included the transverse arch height and length. [Results] Only the transverse arch length, even after adjustment, was significantly greater in the P group. No significant difference was found between the hallux valgus angle and the transverse arch height. [Conclusion] The greater transverse arch length in the P group was possibly due to the collapsing transverse arch support muscles. Increased width probably caused inadequate impact absorption which in turn led to forefoot pain.

Pilot Study of a 3-Dimensional Method for Analysis of Pronation of the First Metatarsal of Hallux Valgus Patients

BACKGROUND:

The current work sought to quantify pronation of the first metatarsal relative to the second metatarsal and of the proximal phalanx of the great toe relative to the first metatarsal.

METHODS:

Three-dimensional models were reconstructed from weightbearing computed tomography (CT) images (10 hallux valgus, 10 normal). The orientations of bones related to hallux valgus (HV) (ie, the phalanx, first and second metatarsals) were determined from coordinate systems established by selecting landmarks. After determining the hallux valgus and intermetatarsal angles, additional calculations geometrically determined the 3-dimensional (3D) angles using the aeronautical system of yaw-pitch-roll. The 3D geometrically determined angles were compared to the conventional plain radiographic angles.

RESULTS:

HV measurements taken with CT and 3D computer-aided design (3DCAD) geometric methods were the same as measurements taken from plain radiographs (P > .05). The average pronation of the first metatarsal relative to the second metatarsal was 8.2 degrees greater in the hallux valgus group (27.3 degrees) than in the normal group (19.1 degrees) (P = .044). A regression analysis of pronation vs intermetatarsal angle (IMA) was not found to be significant. There was also no correlation between pronation of the great toe and first metatarsal in the HV group.

CONCLUSIONS:

The pronation angle of the first metatarsal relative to the second metatarsal between normal and hallux valgus patients was larger in HV patients but was not well correlated with the IMA.

CLINICAL RELEVANCE:

The findings of this study indicate that pronation may need to be considered in the operative correction of hallux valgus for restoration of normal anatomy.

Foot problems as a risk factor for falls in community-dwelling older people: A systematic review and meta-analysis

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.

Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis

BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.

A cross-sectional observational study comparing foot and ankle characteristics in people with stroke and healthy controls

PURPOSE

The purpose of this study was to explore and compare foot and ankle characteristics in people with stroke and healthy controls; and between stroke fallers and non-fallers.

METHODS

Participants were recruited from community groups and completed standardized tests assessing sensation, foot posture, foot function, ankle dorsiflexion and first metatarsal phalangeal joint range of motion (1st MPJ ROM), hallux valgus presence and severity.

RESULTS

Twenty-three stroke participants (mean age 75.09 ± 7.57 years; 12 fallers) and 16 controls (mean age 73.44 ± 8.35 years) took part. Within the stroke group, reduced 1st MPJ sensation (p = 0.016) and 1st MPJ ROM (p = 0.025) were observed in the affected foot in comparison to the non-affected foot; no other differences were apparent. Pooled data (for both feet) was used to explore between stroke/control (n = 78 feet) and stroke faller/non-faller (n = 46 feet) group differences. In comparison to the control group, stroke participants exhibited reduced sensation of the 1st MPJ (p = 0.020), higher Foot Posture Index scores (indicating greater foot pronation, p = 0.008) and reduced foot function (p = 0.003). Stroke fallers exhibited significantly greater foot pronation in comparison to non-fallers (p = 0.027).

CONCLUSIONS

Results indicated differences in foot and ankle characteristics post stroke in comparison to healthy controls. These changes may negatively impact functional ability and the ability to preserve balance. Further research is warranted to explore the influence of foot problems on balance ability and falls in people with stroke. Implications for Rehabilitation Foot problems are common post stroke. As foot problems have been linked to increased fall risk among the general population we recommend that it would be beneficial to include foot and ankle assessments or a referral to a podiatrist for people with stroke who report foot problems. Further research is needed to explore if we can improve functional performance post stroke and reduce fall risk if treatment or prevention of foot problems can be included in stroke rehabilitation.

Effects of hallux valgus deformity on rear foot position, pain, function, and quality of life of women

[Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent.

Static Foot Posture and Mobility Associated With Postural Sway in Elderly Women Using a Three-dimensional Foot Scanner

BACKGROUND

Maintaining balance is a complex phenomenon that is influenced by a range of sensorimotor factors. Foot posture and mobility may also influence balance and postural sway. Recently, three-dimensional foot scanners have been used to assess foot posture. This tool allows many individuals to be scanned quickly and easily and helps eliminate patients' radiation exposure. The objective of this study was to determine whether static foot posture and mobility are independently associated with postural sway in a large community sample of older women using objective measures of balance status and the recently launched technology of three-dimensional foot scanning.

METHODS

This cross-sectional study included 140 community-dwelling elderly women (mean ± SD age, 73.9 ± 5.1 years) recruited in Kasama City, Japan. The postural sway variables were total path length and area and were measured by force plate. We measured static foot posture, sitting and standing navicular height, and mobility using a three-dimensional foot scanner. Foot mobility was determined as the amount of vertical navicular excursion between the positions of the subtalar joint, from neutral in sitting position to relaxed bilateral standing.

RESULTS

After adjusting for potential cofounders, analysis of covariance revealed that sitting navicular height was associated with total path length (P = .038) and area (P = .031). Foot mobility was associated with total path length (P = .018).

CONCLUSIONS

These findings suggest that sitting navicular height and foot mobility are associated with postural sway in elderly women and might be an important factor in defining balance control in older adults.

[A randomized controlled trial: effect of wearing high-heeled shoes on the lower appendicular skeleton]

Introduction

Véritable attribut de la féminité, le port de chaussures à talons est devenu une exigence professionnelle dans certaines structures des pays en développement comme le Bénin. L'objectif de ce travail est de déterminer les effets spécifiques du port de chaussures à talons hauts sur le squelette appendiculaire inférieur.

Méthodes

Des examens radiographiques de face et de profil de la cheville et du genou ont été effectués sur 122 femmes volontaires, âgées en moyenne de 25,09 ± 1,34 ans et ayant les genu varum qui ont participé à cette étude.

Résultats

Les résultats ont indiqué une augmentation significative de l’écart inter malléolaire, de l’écart inter condylien, de l'angle antérieur du pied et de l'angle fémoro-patellaire. Une diminution significative de l'angle postérieur du pied a été constatée.

Conclusion

Le port de chaussures à talons hauts est l'une des causes de la gonarthrose, des troubles des articulations de la cheville et du pied.

The associations of leg lean mass with foot pain, posture and function in the Framingham foot study

Background

Foot disorders are common in older adults and associated with impaired lower extremity function. Reduced muscle mass may play a role in the etiology of foot disorders and consequent poor function.

Methods

We examined the association of leg lean mass with foot pain, posture and function among 1,795 individuals (mean age 67 years) from the population-based Framingham Foot Study (2002–2008). Pain was assessed via questionnaire, and a pressure mat classified foot posture (arch: high, low, referent) during standing and function (pronation, supination, referent) during gait. Leg lean mass was measured by whole body dual energy x-ray absorptiometry.

Results

In age- and body mass index-adjusted logistic (pain) and multinomial logistic (posture, function) regression models, a 1-standard deviation increase in leg lean mass was associated with lower odds of foot pain (OR = 0.76, 95% CI: 0.68, 0.86) and pronation (OR = 0.76, 95% CI: 0.67, 0.85), and higher odds of supination (OR = 1.17, 95% CI: 1.04, 1.31). Adjustment for sex attenuated these associations. Higher leg lean mass was associated with lower odds of high arch, even after adjustment for sex (OR = 0.73, 95% CI: 0.60, 0.89).

Conclusions

Though not related to foot pain or function, reduced leg lean mass was associated with extreme foot posture in older adults. Loss of muscle mass with aging may thus play a role in the etiology of functional impairment due to foot disorders.

Treatment of forefoot problems in older people: a randomized clinical trial comparing podiatric treatment with standardized shoe advice

PURPOSE

Consultations for forefoot pain are frequent in primary care, but scientific support of treatment options is scarce. The purpose of this study is to investigate the effect of podiatric treatment vs standardized advice on proper shoe characteristics and fit of shoes by means of an information leaflet for people aged 50 years and older with forefoot pain in primary care.

METHODS

In this randomized controlled trial, 205 participants aged 50 years and older with hindering nontraumatic forefoot pain have been recruited at their general practitioner's office. Exclusion criteria were treatment of forefoot problem of less than 6 months' duration before inclusion, rheumatoid arthritis, and diabetic neuropathy or having pain considered not to be musculoskeletal (eg, warts). Participants received shoe advice by means of an information leaflet or podiatric care. Foot pain, foot-related dysfunction, general health, and social participation were assessed by means of questionnaires every 3 months for 1 year. Using multilevel analysis, we analyzed results at the level of (1) outcome measures, (2) the individual, and (3) the general practitioner.

RESULTS

No differences were found between the 2 treatment groups. Both intervention groups showed an improvement over time in foot pain and foot-related dysfunction.

CONCLUSION

This study found that shoe advice provided to patients consulting their general practitioner for forefoot pain and symptom relief resulted in outcomes similar to treatment outcomes in patients consulting a podiatrist. Based on these results, primary care physicians should be cautious when referring a patient to a podiatrist; instead, they should start by providing advice on proper characteristics and fit of shoes.

The European, Japanese and US protective helmet, gloves and boots for firefighters: thermoregulatory and psychological evaluations

The purpose of this study was to investigate the physiological and subjective responses of the European, Japanese (JPN) and US firefighters' helmet, gloves and boots for international standardisation. Three experimental conditions were evaluated (clothing mass: 9.4, 8.2 and 10.1 kg for the three conditions, respectively) at the air temperature of 32°C and 60% relative humidity. The results showed that there was no significant difference among the three conditions in oxygen consumption, heart rate, total sweat rate, rectal temperature and mean skin temperature, whereas peripheral temperatures and subjective perceptions were lower in the JPN condition than in the other conditions (P < 0.05). These results indicate that a 0.5-kg reduction in helmet mass and a 1.1-kg reduction in boot mass during exercise resulted in a significant decrease in head and leg temperatures and subjective perceptions, while a 1.9-kg reduction in total clothing mass had insignificant influences on the metabolic burden and overall body temperature.

Tripod index: a new radiographic parameter assessing foot alignment

BACKGROUND

No single radiographic measurement takes into account complete foot alignment. We have created the Tripod Index (TI) to allow assessment of complex foot deformities using a standing anteroposterior (AP) radiograph of the foot. We hypothesized that TI would demonstrate good intraobserver and interobserver reliability and correlate with currently accepted radiographic parameters, in both flatfoot and cavovarus foot deformities.

METHODS

Three groups of patients were studied: 26 patients (30 feet) with flatfoot, 29 patients (30 feet) with cavovarus foot, and 51 patients (60 feet) without foot deformity as controls. Weight-bearing radiographs were obtained: foot AP with a hemispherical marker around the heel plus standard lateral and hindfoot alignment views. Radiographic measurements were made by 2 blinded investigators. Statistical analysis included intraclass correlation coefficients (ICCs), correlation of the TI with existing radiographic measurements using Pearson coefficients, and comparison between patient groups using analysis of variance.

RESULTS

Intraobserver and interobserver ICCs of TI (0.99 and 0.98, respectively) were excellent. In the flatfoot group, TI significantly correlated with AP talonavicular coverage angle (r = 0.43), medial cuneiform-fifth metatarsal height (r = -0.59), coronal plane hindfoot alignment (r = 0.53), and clinical hindfoot alignment (r = 0.39). In the cavovarus foot group, TI correlated significantly with AP talonavicular coverage angle (r = 0.77), calcaneal pitch angle (r = 0.39), medial cuneiform-fifth metatarsal height (r = -0.65), coronal plane hindfoot alignment (r = 0.55), and clinical hindfoot alignment (r = 0.61). Statistically significant differences between flatfoot-control and cavovarus foot-control were found in TI, AP talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height, coronal plane hindfoot alignment, and clinical assessment of hindfoot alignment (all with P < .001).

CONCLUSION

The TI was demonstrated to be a valid and reliable radiographic measurement to quantify the magnitude of complex foot deformities when evaluating flatfoot and cavovarus foot.

CLINICAL RELEVANCE

The TI may be helpful as an integrated assessment of complex foot deformities. Further clinical studies are recommended.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Gait parameters associated with hallux valgus: a systematic review

Background

Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.

Methods

Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.

Results

Nine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD −0.61, CI −1.19 to −0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD −0.81 to −0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD −0.73, -1.25 to −0.20), step length (SMD −0.66 to −0.59) and less stable gait patterns (SMD −0.86 to −0.78) in older adults with HV.

Conclusions

HV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.

Center of pressure progression characteristics under the plantar region for elderly adults

This investigation identifies the center of pressure (COP) progression characteristics under the plantar region for elderly adults during barefoot walking. A total of 60 healthy adults (30 young and 30 old) were recruited. The young and elderly participants had average ages of 23.6 (SD=2.7) and 70.8 (SD=4.1) years old, respectively. All subjects had normal foot arch and no relevant musculoskeletal disease in the lower extremities. The foot pressure measurement system (RS-scan(®) system) was used to measure the center of pressure coordinates (COP), progression angle and COP velocity. Four sub-phases of the stance phase were calculated. The initial contact (ICP) and forefoot contact phase (FFCP) corresponded to the loading response. The foot flat phase (FFP) coincided with the mid-stance. The forefoot push-off phase (FFPOP) corresponded to the terminal stance and pre-swing phases. The analytical results revealed that age effects were found in the relative time percentages for the initial contact, foot flat and forefoot push-off phases during foot movement. The elderly subjects exhibited significant medial COP curve and faster COP velocity during the initial contact phase and more pronated mid-foot posture and slower COP velocity during the mid-stance. The older adults tended to have a more pronated foot and displayed a significant medial COP curve compared to young adults. These COP progression characteristics can provide further insight into relevant foot function and gait performance evaluations for older adults.

The effect of aging on the hardness of foot sole skin: a preliminary study

BACKGROUND

Foot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin.

METHODS

Twenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups.

RESULTS

From the result we observe statistical significant (p<0.05; p<0.01; p<0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd & 5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r=0.57; p<0.005), 1st metatarsal head (r=0.567; p<0.00001), 3rd metatarsal head (r=0.565; p<0.00001), 5th metatarsal head (r=0.55; p<0.00001), and heel (r=0.59; p<0.0001).

CONCLUSION

The loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.

[The association between foot problems and falls in older adults -a covariance structure analysis-]

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Ingrown nails and pachyonychia of the great toes impair lower limb functions: improvement of limb dysfunction by medical foot care

BACKGROUND

Painful feet and lower limb dysfunction are risk factors for falling. Toenail deformities are common disorders in elderly people, but the relationship between nail deformities and lower limb function remains unclear. The aims of the present study were to assess the impairment of lower limb function in patients with deformities of the great toe and to determine whether foot care treatment is beneficial in reducing the risk of falling.

METHODS

  Functional tests of the lower extremities were performed in 263 adults, including patients with any of hallux valgus, ingrown nail, or pachyonychia, and volunteers. Fifty-five subjects with nail disorders of the great toe received medical foot care treatment.

RESULTS

The presence of ingrown nail, pachyonychia, or tenderness of the great toe was significantly correlated with impaired postural performance and reduced muscular strength as assessed by functional tests. Medical foot care markedly reduced pain levels in the great toe and improved scores on functional tests of the lower extremities.

CONCLUSIONS

Toenail disorders of the great toe cause dysfunction of the lower extremities and are likely to increase the risk of falling in daily life. Foot care management of toenail disorders has the potential to improve functional abilities in daily life, particularly in elderly individuals.

Radiographic correlates of hallux valgus severity in older people

Background

The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people.

Methods

This study utilised 402 x-rays of 201 participants (74 men and 127 women) aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores.

Results

Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed.

Conclusions

Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may be a contributing factor to the development and/or progression of hallux valgus.

The effect of aging on the biomechanical properties of plantar soft tissues

BACKGROUND

Foot problems are common in elderly people and stiffened plantar soft tissues may lead to ulceration in people with Diabetes Mellitus. It is unclear how the biomechanical properties of plantar soft tissues change with advancing age. Therefore, this study examined the age-related differences in the biomechanical properties of plantar soft tissues.

METHODS

Sixty healthy volunteers without foot problems, aged from 41 to 83 years, were examined using tissue ultrasound palpation system. The thickness and stiffness of the plantar soft tissues under the big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and heel were measured. The load-deformation curve of the plantar soft tissues was plotted. The correlation between age and biomechanical properties was examined and comparisons were made between four age groups.

FINDINGS

The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age (P<0.001). The plantar soft tissues at the heel were the thickest (P<0.001), with the plantar soft tissue tending to be increasingly thicker with age, although there was no statistical significance. Strong positive correlations between age and stiffness of the plantar soft tissues were found at the big toe (r=0.608), first metatarsal head (r=0.549), third metatarsal head (r=0.657), fifth metatarsal head (r=0.633), and heel (r=0.584) (all P<0.001).

INTERPRETATION

The loss of compliance in the plantar soft tissues may be one of the factors responsible for the higher incidence of foot problems in elderly individuals.

Physical and psychological factors associated with stair negotiation performance in older people

BACKGROUND

An inability to negotiate stairs is a marker of disability and functional decline and can be a critical factor in loss of independence in older people. There is limited research on the underlying factors that impair performance in this important activity of daily living. We examined which physical and psychological factors are associated with stair climbing and stair descending performance in older people.

METHODS

Six hundred sixty-four community-dwelling people aged 75-98 years (mean age = 80.1 years, standard deviation (SD) = 4.4 years) underwent stair negotiation tests as well as tests of lower limb strength, vision, peripheral sensation, reaction time, and balance and completed questionnaires measuring psychological and health status.

RESULTS

Many physiological and psychological factors were significantly associated with stair negotiation speed. Multiple regression analyses revealed that knee extension and knee flexor strength, lower limb proprioception, edge contrast sensitivity, reaction time involving a foot-press response, leaning balance, fear of falling, and the Short-Form 12 Health Status Questionnaire (SF-12) pain and vitality scores were significant and independent predictors of stair ascent and descent performance. The combined set of variables explained 47% of the variance in stair ascent performance and 50% of the variance in stair descent performance. Measures of strength, balance, vision, fear, and vitality also significantly discriminated between persons who did and did not require the use of the handrail when performing the tests. Discussion. In community-dwelling older people, impaired stair negotiation is associated not only with reduced strength but also with impaired sensation, strength, and balance; reduced vitality; presence of pain; and increased fear of falling.

What tools help make "whole-of-patient" practices happen?: a Tasmanian falls prevention project

The development of "whole-of-patient" approaches is explored using transcripts of 10 interviews with registered nurses implementing the Quickscreen Clinical Falls Risk Assessment Tool in general practices in northern Tasmania. These data suggest that while the tool helped develop holistic nursing practices, the development of multidisciplinary practices requires different tools and strategies.

Foot and leg problems are important determinants of functional status in community dwelling older people

PURPOSE

To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors.

METHOD

Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65 - 94 years (533 females, 467 males, mean age 73.4 years +/- 5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed 'Up & Go' test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors.

RESULTS

Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed 'Up & Go' performance (OR = 2.15, 95%CI 1.55 - 2.97), difficulty climbing stairs (OR = 3.33, 95%CI 1.98 - 5.61), difficulty walking one kilometer (OR = 3.13, 95%CI 2.09 - 4.69), and history of falling (OR = 1.73, 95%CI 1.26 - 2.37).

CONCLUSIONS

Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.

Gait instability in older people with hallux valgus

BACKGROUND

Hallux valgus is a common condition that may lead to considerable pain and disability. There is also evidence that hallux valgus may impair balance and increase the risk of falling in older people. Although a number of plantar pressure studies have been undertaken in people with and without hallux valgus, little is known about how hallux valgus affects basic gait patterns or the movement of the upper body when walking.

METHODS

Measurements of temporospatial parameters of gait and acceleration patterns of the head and pelvis were obtained in 71 people (24 men, 47 women) between 75 and 93 (mean 80 +/- 4) years of age when walking on both a level surface and a specially designed irregular walkway. Foot problems, vision, peripheral sensation, strength, and reaction time also were evaluated.

RESULTS

After adjusting for potential confounders, subjects with moderate to severe hallux valgus were found to exhibit significantly reduced velocity and step length on both walking surfaces and less rhythmic acceleration patterns in the vertical plane when walking on the irregular surface compared to subjects with no or mild hallux valgus.

CONCLUSION

These findings indicate that hallux valgus has a significant detrimental impact on gait patterns that may contribute to instability and risk of falling in older people, particularly when walking on irregular terrain.

Experimental gerontological research in Australia

Recently there has been recognition in Australia of the importance of experimental gerontological research. To date, the major areas of research into the biology of ageing have been oxidative stress and mitochondrial dysfunction. Future directions for gerontological research in Australia are likely to place more emphasis on comprehensive studies that integrate basic biological research, with clinical studies and the behavioural and social domains of ageing. Priority will be given to studies incorporating biological markers that are population based and longitudinal. The growing interest in experimental gerontological research complements Australian research strengths in other domains such as disease-based research, social gerontology, population studies and health policy research.

Health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders

This exploratory study attempted to estimate the severity of health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders in the Netherlands. Information on the severity and the distribution of the complaints in these patients is important to acquire insight in the problems which these patients experience, and moreover is essential for further research, especially for evaluating effects of patients undergoing foot orthosis treatment. Patients with degenerative foot disorders aged 18 years and over were recruited from nine orthopaedic workshops over a period of three months in 2000. One hundred and twenty-two (122) patients were included in the study. Two approaches were used to obtain data. Firstly, shoe technicians and orthotists inspected patients' feet and legs and interviewed them at their initial visit. Data on gender, age, height, weight, existing and prescribed orthotic devices were recorded on a report form. Secondly, patients were asked to fill in a questionnaire assessing type, location, frequency, intensity and duration of health complaints, and disability. Data indicate that females with degenerative foot disorders and foot orthoses are twice as common as men. Patients supplied with foot orthoses are twice as often overweight compared to subjects in the general population. Besides frequent and protracted pain there are also fatigue complaints, particularly in the feet and lower leg. Duration and frequency of the complaints suggest that these patients suffer from a chronic pain syndrome. In addition, the results indicate that the functional level of these patients is below that of the general population, in particular regarding physical activities.