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Abstract

To determine whether foot pain and plantar pressure are associated with falls in community-dwelling older adults. Community-based cohort study with 12-month prospective falls follow-up. Sydney and Illawarra statistical regions of New South Wales, Australia. Randomly recruited, community-dwelling adults (158 men and 154 women) aged 60 and older. Manchester Foot Pain and Disability Index to establish baseline foot pain and dynamic plantar pressures. Participants were then classified as fallers (n=107) or nonfallers (n=196) based on their falls incidence over the following 12 months. Fallers had a significantly higher prevalence of foot pain than nonfallers (57.9% vs 42.1%; chi-square=4.0; P=.04). Fallers also generated a significantly higher peak pressure and pressure-time integral under the foot than non-fallers. In addition, individuals with foot pain had a significantly higher peak pressure and pressure-time integral under the foot than those without foot pain. High plantar pressures generated during gait may contribute to foot pain and risk of falls. Providing interventions to older people with foot pain and high plantar pressures may play a role in reducing their falls risk.

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... The incidence of falls has always been associated with gait abnormalities and disturbances [6]. During standing or walking, the foot represents the only contact with the ground and factors that can influence foot structure and function may increase the risk of falls [7]. In a community-based prospective study, Mickle et al. [7] showed that people who fell during the period of 12 months generated a significantly higher peak pressure and pressure-time integral under the foot, compared to non-fallers. ...
... During standing or walking, the foot represents the only contact with the ground and factors that can influence foot structure and function may increase the risk of falls [7]. In a community-based prospective study, Mickle et al. [7] showed that people who fell during the period of 12 months generated a significantly higher peak pressure and pressure-time integral under the foot, compared to non-fallers. Falls can also cause different spatiotemporal a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 disturbances of the foot, including slower gait velocity, shorter step and stride length, and longer contact time [8]. ...
... As mentioned in the 'Introduction' section, foot is the only body part that contacts the ground [7], making it the most essential structure and function. Foot structure and function in older adults are often characterized by flatter feet, intrinsic foot muscle weakness, altered plantar pressure loading patterns during walking, and reduced plantar tactile sensitivity [19]. ...
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Although previous evidence has shown that deviated foot structure and function are associated with falls, little is known of the association between foot rotations and falls in apparently healthy older adults. Therefore, the main purpose of the study was to determine the associations between foot rotation and falls. In this cross-sectional study, we recruited 120 older women (mean±SD; age 71.01±6.77 years; height 158.92±21.41 cm; weight 70.29±12.97 kg; body-mass index 26.79±4.42 kg/m2). Foot rotations were assessed by using pressure platform (Zebris manufacturer, Munich, Germany), while the risk of falls was assessed by using Downtown Fall Risk Index questionnaire. Correlations and multiple regression models were applied to calculate the associations. In unadjusted model, higher foot rotation was associated with higher risk of falls (β = 0.14, p<0.001 for both feet). In a model adjusted for age, body-mass index, foot pain and fitness index, higher foot rotation remained associated with higher risk of falls (β = 0.10, p<0.001 for both feet). Our study shows that older adults with higher foot rotation are at higher risk of falls. Special interventions aiming to correct for deviated foot function in older women are warranted.
... Biomechanically, the foot needs to perform diverse functions, especially during weight-bearing activities [6]. Such activities may lead to pain and discomfort and potentially discourage individuals from being physically active [7]. Foot pain has often been correlated with higher plantar pressures [7]. ...
... Such activities may lead to pain and discomfort and potentially discourage individuals from being physically active [7]. Foot pain has often been correlated with higher plantar pressures [7]. Studies conducted among children have shown that being sedentary is correlated with higher plantar pressures under 2-5 toes [6]. ...
... According to previous studies, only 25% of older adults meet the recommended levels of physical activity and the majority of them spend most of the time being sedentary [2]. Since older adults have deviated structure and function of the foot [7] and are physically inactive [5], it is necessary to explore whether such behaviors may be correlated with higher plantar pressures beneath different foot regions. Additionally, such associations may be able to help future strategies and policies for creating a set of activities designed for older individuals with higher plantar pressures and significant foot pain. ...
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Abstract: Background: Although obesity has been consistently correlated with higher plantar pressure during lifespan, to date little evidence has been provided regarding of how domain-specific and total sedentary behaviors may be correlated with plantar pressures. Moreover, high peak plantar pressures have been consistently associated with foot pain and discomfort, which unable individuals to be physically active. Therefore, the main purpose of the study was to explore the correlations between time spent in sedentary behaviors and plantar pressures. Methods: We recruited 120 older women aged ≥60 years. To assess the time spent in different domains of sedentary behavior, we used Measure of Older Adults’ Sedentary Time (MOST) questionnaire. Peak pressures beneath forefoot, midfoot and hindfoot were measured with Zebris pressure platform. Results: In unadjusted model, peak pressures were significantly correlated with almost all domain-specific sedentary behaviors (r = 0.15–0.41). Total time spent in sedentary behaviors was significantly correlated with forefoot (r = 0.40, p < 0.001), hindfoot (r = 0.31, p < 0.001) and total peak plantar pressure (r = 0.40, p < 0.001). In a model adjusted for age, the risk of falls, foot pain and gait velocity, similar significant correlations between sedentary behaviors and plantar pressures remained. Conclusions: Our study shows moderate correlation between domain-specific and total time spent in sedentary behaviors and plantar pressure beneath different foot regions in a sample of older women.
... Foot pain is a highly prevalent health problem, 29% of women and 19% of men suffer from it. (Awale et al., 2016) The existence of high plantar pressures in certain areas of the foot has been associated to pain and discomfort (Mickle et al., 2010) even leading to hyperkeratosis (Barlow et al., 1990) and, subsequently, metatarsal and heel pain, especially in older people. (Akdemir et al., 2011;Hill et al., 2008) In addition, alteration of foot function in one area can instigate unfavourable outcomes such as high pressure onto a new area, imbalance and/or injury when walking. ...
... (Akdemir et al., 2011;Hill et al., 2008) In addition, alteration of foot function in one area can instigate unfavourable outcomes such as high pressure onto a new area, imbalance and/or injury when walking. (Mickle et al., 2010) Foot pressure has different effects, thus depending on its magnitude the resulting sensation can vary from superficial touch to pain, previously passing through discomfort. (Hong et al., 2005) Whereas superficial touch provides the sensory feed-back necessary for balance and locomotion, discomfort and pain are mechanisms that warn of potentially harmful situations. ...
... (Kwan et al., 2010) Therefore, higher peak plantar pressures when walking have been found in older adults (775.7 kPa -699.1 kPa) compared to young ones (165.04 kPa) and have been associated with foot pain and falls. (Mickle et al., 2010) So, the existence of prior warning mechanisms such as discomfort becomes very important. Noticing pressure discomfort can be interpreted as an "alert mechanism" that would allow to make changes in gait biomechanics in order to reduce or avoid overpressures. ...
Article
Background Foot pain is a highly prevalent health problem for which measures such as a pattern of Pressure Discomfort Threshold of the foot plantar surface can provide valuable information for orthosis design. This study aimed to describe such pattern as a tool for the assessment of painful conditions of the feet and to analyse how it modifies according to age, gender and obesity. Methods A cross-sectional study was performed with participants allocated in: Group 1 people aged 20 to 35 years, Group 2 aged 50 to 65 years and Group 3 aged over 65. Pressure Discomfort Threshold on twelve points of the foot plantar surface was measured with an adapted manual dynamometer. Inferential analyses of the data were performed using one-way analysis of variance (ANOVA) considering foot areas, age group, gender and obesity. Findings 36 participants were analysed. The pattern of Pressure Discomfort Threshold for all individuals showed a significantly higher threshold on the heel and external foot (P < 0.001, η² = 0.124) and was statistical significantly influenced by age (P < 0.001, η² = 0.17), especially in participants aged over 65; by gender, with women having higher values (P < 0.001, η² = 0.13), and by obesity (P < 0.001, η² = 0.19). Interpretation A Pressure Discomfort Threshold pattern exists in the foot plantar surface. The characteristics of the discomfort pattern of the foot and its association with aging, gender and obesity may have considerable implications for orthosis and footwear design.
... 3,4 It is estimated that approximately 1/4 of adults suffer from foot pain, 5 increasing the costs of health care service. 6 Frequent foot pain also doubles the risk of falling, 7 which often leads to early institutionalization in nursery homes and premature death. 8 It has been well-documented that foot pain is a significant predictor of falls in older adults 7,9,10 and these two factors often coexist. ...
... 6 Frequent foot pain also doubles the risk of falling, 7 which often leads to early institutionalization in nursery homes and premature death. 8 It has been well-documented that foot pain is a significant predictor of falls in older adults 7,9,10 and these two factors often coexist. 7 In older adults, the most common way to engage in regular physical activity is by walking. ...
... 8 It has been well-documented that foot pain is a significant predictor of falls in older adults 7,9,10 and these two factors often coexist. 7 In older adults, the most common way to engage in regular physical activity is by walking. 11 Walking speed significantly decreases by age, steadily affecting the gait biomechanics and leading to all-cause mortality. ...
Article
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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 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 pressure platform (Zebris company, Munich, Germany). Results: Mean gait speed was 0.95 m/s. Of 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 for specificity 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: A 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.
... Associations between falls and decreased ROM [7], muscle strength [7,8] and pronated foot posture [7,9] have also been reported. The dynamic function of the foot, most commonly assessed using plantar pressure platforms, may also influence balance and risk of falls [9,10]. The center of pressure excursion index (CPEI), a measure of the medio-lateral shift in plantar loading while walking, was not found to discriminate between fallers and non-fallers by Awale and colleagues [9], although Mickle et al. reported that the total peak pressure and pressure-time integral was higher in fallers than non-fallers [10]. ...
... The dynamic function of the foot, most commonly assessed using plantar pressure platforms, may also influence balance and risk of falls [9,10]. The center of pressure excursion index (CPEI), a measure of the medio-lateral shift in plantar loading while walking, was not found to discriminate between fallers and non-fallers by Awale and colleagues [9], although Mickle et al. reported that the total peak pressure and pressure-time integral was higher in fallers than non-fallers [10]. ...
... We found fallers to have higher PTI at the medial column of the foot compared to non-fallers, with the odds of falling increasing by 2.65 for each unit increase of medial midfoot PTI. Despite evidence regarding the association between loading patterns and foot structure in older people [21], only two studies have compared the plantar pressure as foot function between older fallers and non-fallers [9,10]. Mickle and colleagues reported that fallers demonstrated higher peak pressure and pressure-time integral than non-fallers, but they only reported the total foot plantar numerical values [10]. ...
Article
Background Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors. Research question what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults? Method One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls. Results Seventy-four participants (39.9%) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95% CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95% CI 0.15-0.53), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95%CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95% CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95% CI 1.01-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors. Significance We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.
... Foot pain is a common complaint in older peopleit is estimated that between 20 and 29% of older people have foot pain [1][2][3]. Further, foot pain in older people can affect mobility, gait and balance [4,5]. One region of the foot that is commonly affected by pain is the forefoot [6], which is defined by pain in the region of the metatarsals heads [7,8]. ...
... Forefoot pain in older people is associated with many causes, including high plantar pressures under the forefoot [4,9]. Therefore, redistribution of high forefoot plantar pressures using forefoot pads may reduce forefoot pain [10]. ...
... It has been shown that redistributing plantar pressure in the forefoot can lead to a reduction in forefoot pain [4]. However, it is not known whether a difference of approximately 13 to 17%the reductions found in this studyis sufficient to reduce pressure-related forefoot pain. ...
Article
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Background: Forefoot pads such as metatarsal domes are commonly used in clinical practice for the treatment of pressure-related forefoot pain, however evidence for their effects is inconsistent. This study aimed to evaluate the effects on plantar pressures of metatarsal domes in different positions relative to the metatarsal heads. Methods: Participants in this study included 36 community-dwelling adults aged 65 or older with a history of forefoot pain. Standardised footwear was used and plantar pressures were measured using the pedar®-X in-shoe plantar pressure measurement system. Peak pressure, maximum force and contact area were analysed using an anatomically-based masking protocol that included three forefoot mask sub-areas (proximal to, beneath, and distal to the metatarsal heads). Data were collected for two different types of prefabricated metatarsal domes of different densities (Emsold metatarsal dome and Langer PPT metatarsal pad) in three different positions relative to the metatarsal heads. Seven conditions were tested in this study: (i) control (no pad) condition, (ii) Emsold metatarsal dome positioned 5 mm proximal to the metatarsal heads, (iii) Emsold metatarsal dome positioned in-line with the metatarsal heads, (iv), Emsold metatarsal dome positioned 5 mm distal to the metatarsal heads, (v) Langer PPT metatarsal pad positioned 5 mm proximal to the metatarsal heads, (vi) Langer PPT metatarsal pad positioned in-line with the metatarsal heads, and (vii) Langer PPT metatarsal pad positioned 5 mm distal to the metatarsal heads. Results: When analysed with the mask that was distal to the metatarsal heads, where the plantar pressure readings were at their highest, all metatarsal dome conditions led to significant reductions in plantar pressure at the forefoot compared to the control (no pad) condition (F3.9, 135.6 = 8.125, p < 0.001). The reductions in plantar pressure were in the order of 45-60 kPa. Both the Emsold metatarsal dome and the Langer PPT metatarsal pad, when positioned proximal to the metatarsal heads, managed to achieve this without adversely increasing plantar pressure proximally where the pad was positioned, however the Emsold metatarsal dome was most effective. Conclusions: Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5 mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. In this proximal position, the Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad and we cautiously recommend this forefoot pad for alleviating forefoot pressure in older people with forefoot pain.
... GRF parameters from sit-to-stand tasks have been a significant indicator of previous fall incidents [20], [21]. Foot plantar pressure (PP) measured with pressure-sensing mats and insoles has also been found to be higher in elderly fallers [22]. A combination of these parameters (COP, GRF, and PP) might result in increased accuracy of identifying elderly fallers. ...
... The mean pressure ranked 9 th (F-score = 0.16). Although previous studies have assessed GRF parameters [20], [21], COP displacement [17], [18], and peak PP [22], there is no existing comparison of these three categories of biomechanical parameters for elderly faller identification. ...
Article
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Accidental falls are a major health concern among older adults. Currently, fall prevention programs employ clinical assessment scores for identifying elderly fallers based on cut-off values. Biomechanical parameters provide crucial information differentiating pathological gait and posture and can be used to classify elderly fallers and non-fallers. Pattern recognition models based on biomechanical parameters may provide greater insight for such classification. The purpose of this study was to compare the classification accuracy of different pattern recognition models for identifying elderly fallers using biomechanical parameters measured during balance and gait tasks. Pattern recognition models were also developed using clinical assessment scores and compared to the models based on biomechanical parameters for accurately identifying elderly fallers. Participants included 58 non-fallers (age = 72.3 ± 5.7) and 41 fallers (age = 74.0 ± 12.3) who performed balance and gait tasks on a walkway with embedded force plates and pressure mats. The parameters included 2D ground reaction force (GRF), center of pressure (COP), and the plantar pressure (PP). Using this data as input, different classification algorithms were used to build models. Maximum accuracy of 86.02% for classifying faller/non-faller categories was obtained using a classifier based on biomechanical parameters from combined gait and balance tasks. The GRF parameters ranked higher than COP and PP parameters based on F-score ranking suggesting predictor importance of GRF parameters. The classification performance was further improved by adding GRF parameters to the more commonly used COP parameters. However, the classifiers based on clinical assessment scores resulted in a maximum accuracy of 92.93% suggesting that elderly fallers can be accurately classified using pattern recognition models based on clinical assessment scores.
... High forefoot plantar pressures are associated with pathologies such as plantar fasciitis, Achilles tendonitis, mid-foot arthritis [38][39][40]. It is well established that the incidence of foot complications and musculoskeletal injuries are associated with elevated plantar pressures [37]. ...
... 1st-5th metatarsal heads and or hallux (fi g. 4) [53]. Increases in plantar pressure can contribute to the development of callus and corn [54], which has been shown contribute to the development of foot ulceration in diabetic cohorts [38][39][40]. ...
Article
Full-text available
Kinésithér Scient 2020;622:23-31 RÉSUMÉ I SUMMARY Il y a approximativement 800 000 Aborigènes en Australie. Ils représentent 3,3 % de la population australienne. Cette population présente une grande prévalence de maladies chroniques avec une morbidité et une mortalité précoce d'environ 60 %. Bien qu'il soit important pour les Aborigènes d'Australie de pra-tiquer des activités physiques, les recherches ont montré que les blessures des chevilles, des genoux et de la région lombale sont extrêmement nombreuses. Les études consacrées au genou et aux problèmes lombaires ont mis en évidence que les blessures musculosquelettiques sont prédominantes et associées à une durée d'appui majorée (Pres-sure Time Integrals, [PTI]). Cette durée exagérée est corrélée avec les blessures du genou et lombales. Les Aborigènes d'Australie ont un taux de diabète environ 3 fois plus élevé que celui de la population australienne standard. L'association entre le développement des ulcérations du pied et une augmentation de la pression plantaire chez les diabétiques a été abondamment documentée. On a mis en évidence chez les Aborigènes une augmentation de 4,8 des ulcérations et un taux de 38 fois plus élevé en ce qui concerne les amputations par rapport à la population australienne standard. Bien que l'équin a été associé aux complications du pied chez les Aborigènes, y compris les amputations, c'est aussi une considération à double aspect puisque l'équin est aussi liée à l'athlétisation musculaire. Les Aborigènes d'Australie sont puissamment athlétiques et cela depuis des milliers d'année. There are approximately 800,000 Aboriginal people in Australia, representing 3.3% of the Australian population, and su er with a high prevalence of chronic disease which accounts for approximately 60% of the premature morbidity and mortality occurring in this population. Although it is important for Aboriginal Australians to participate in physical activities, research has shown ankle, knee and back injuries are very high. Studies investigating knee and back injury for Aboriginal Austra-lians found that musculoskeletal injuries were predominately associated with Pressure Time Integrals (PTI), which is correlated with knee and back injury. Australian Aboriginal have diabetes approx. 3 times that of the non-Aboriginal Australians. The association between the development of foot ulceration and elevated plantar pressures in people with diabetes has been well established. Aboriginality has been shown to be associated with a 4.8 fold increase in foot ulceration and 38 times the rates of lower limb amputation compared to non-Aboriginal Australians. Although equinus has been associated with foot complications for Aboriginal Australians including amputation , it is a double-edged sword, as it is related to athleticism. Aboriginal Australians are very athletic, and they have been for many thousands of years. Paris Texte issu de la 4 e Conférence de l'École d'ASSAS « La marche et la locomotion humaine » Paris-26 février 2020 Les auteurs déclarent ne pas avoir un intérêt avec un organisme privé industriel ou commercial en relation avec le sujet présenté Kinésithérapie Scientifi que et l'École d'ASSAS sont particulièrement fi ers de vous présenter le travail de James Charles. Il est le premier pédicure-podologue Aborigène d'Australie et, de surcroît, Docteur-es-sciences. L'article ci-après, dont l'eff ort de le lire en anglais semble gratifi ant, met en évidence deux notions essentielles pour tous les rééducateurs. D'abord le pied, interface entre le corps et le sol, dont toute modifi cation de la bioméca-nique a des répercussions musculo-squelet-tiques sur l'ensemble du corps. Le pied et son utilisation dans la marche peut donc être à l'origine de nombreuses pathologies, rencon-trées dans nos cabinets de kinésithérapie. Deuxième enseignement de l'article ci-après : les populations marginales, ayant un accès aux soins insuffi sants et une autoprise en charge défectueuse, sont particulièrement fragiles. Elles méritent toute notre attention, au moyen d'un diagnostic kinésithérapique biopsychosocial. Bonne lecture.
... Moreover, increased foot pain on the MFPDI has been associated with increased risk of falling in older adults. 43 Unfortunately, current therapies provide limited and often ineffective symptomatic treatment without addressing the underlying problem. Offloading measures rely on patient compliance, can be cumbersome, and may even cause tissue breakdown at other locations on the foot due to changes in biomechanics or rubbing caused by thick inserts in shoes. ...
... 33 In other studies, heel pain has been associated with higher peak pressures and impaired force dissipation. 43 As such, we had hypothesized that heel pressures and forces would be reduced after fat grafting and that improved shock absorption may also confer lower pressures and forces to other regions of the foot. ...
Article
Background The shock-absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Heel fat pad atrophy (FPA) is common and can be painful and debilitating. In our previous work, autologous fat grafting (AFG) was effective for treating pain from forefoot FPA. Objectives We hypothesized that AFG to the heel would relieve pain and improve function in patients with heel FPA. Methods Patients with heel FPA and associated pain were recruited and randomized into two groups. Group 1 received AFG upon enrollment and was followed for 2yrs. Group 2 received offloading and activity modification for 1yr, then crossed over, underwent AFG, and was followed for 1yr afterward. Outcome measures included ultrasound-measured fat pad and dermal thickness, pedobarograph-measured foot pressures and forces, and patient-reported outcomes as measured by the Manchester Foot Pain and Disability Index (MFPDI). Results Thirteen subjects met inclusion criteria and completed the study. Seven (12 affected feet) were randomized into Group 1, and six (9 affected feet) were randomized into Group 2. Average age was 55yrs and BMI was 30.5kg/m 2. Demographics were not significantly different between groups. Heel fat pad thickness increased after AFG but returned to baseline at 6mo. However, AFG increased dermal thickness significantly and increased fat pad thickness under compressive load compared to controls at 6-12mo. Foot pain, function, and appearance were also significantly improved compared to controls at 6-12mo. Conclusions AFG improved patient-reported foot pain, function, and appearance and may rejuvenate local soft tissues in patients with heel FPA.
... However, the cushioning capacity of these tissues may be impaired because of aging [3][4][5], diabetes [6][7][8][9], and related foot structural deformities. These problems may eventually lead to increased plantar pressures, which may contribute to foot pain, tissue damage, and high risk of fall in elderly [10]. ...
... This study confirmed the influence of aging on the hardness of plantar soft tissues among healthy individuals. The hardness of plantar soft tissues appears to change with age in 10 healthy individuals, and there is a trend of increasing hardness of the plantar soft tissue with age. We have provided preliminary data demonstrating a positive relationship between the hardness of plantar soft tissues and the plantar pressure distribution at the rearfoot and midfoot. ...
Article
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Background: The plantar soft tissue plays a critical role in absorbing shocks and attenuating excessive stresses during walking. Plantar soft tissue property and plantar pressure are critical information for footwear design and clinical assessment. The aim of this study was to investigate the relationship between plantar soft tissue hardness and plantar pressure during walking. Methods: 59 healthy volunteers (27 males and 32 females, aged 20 to 82) participated in this study. The plantar surface was divided into five regions: lateral rearfoot, medial rearfoot, lateral midfoot, lateral forefoot, and medial forefoot, and the plantar tissue hardness was tested using Shore durometer in each region. Average dynamic pressures in each region were analyzed for the five regions corresponding to the hardness tests. The relationship between hardness and average dynamic pressure was analyzed in each region. Results: The average hardness of the plantar soft tissue in the above five regions is as follows: lateral rearfoot (34.49 ± 6.77), medial rearfoot (34.47 ± 6.64), lateral midfoot (27.95 ± 6.13), lateral forefoot (29.72 ± 5.47), and medial forefoot (28.58 ± 4.41). Differences of hardness were observed between age groups, and hardness of plantar soft tissues in forefoot regions increased with age (P < 0.05). A negative relationship was found between plantar soft tissue hardness and pressure reduction at lateral rearfoot, medial rearfoot, and lateral midfoot (P < 0.05). Conclusion: The hardness of plantar soft tissues changes with age in healthy individuals, and there is a trend of increasing hardness of the plantar soft tissue with age. The plantar soft tissue hardness increases with plantar pressure.
... GRF parameters from sit-to-stand tasks have been a significant indicator of previous fall incidents [20], [21]. Foot plantar pressure (PP) measured with pressure-sensing mats and insoles has also been found to be higher in elderly fallers [22]. A combination of these parameters (COP, GRF, and PP) might result in increased accuracy of identifying elderly fallers. ...
... The mean pressure ranked 9 th (F-score = 0.16). Although previous studies have assessed GRF parameters [20], [21], COP displacement [17], [18], and peak PP [22], there is no existing comparison of these three categories of biomechanical parameters for elderly faller identification. ...
Chapter
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Accidental falls are a major health concern among older adults, hence identifying biomechanical parameters from gait and balance tasks that differentiate between fallers and non-fallers are crucial. Limited studies using force platforms to assess postural control have used machine learning algorithms to classify older adult fallers. The results are diverse due to variation in task routines, biomechanical parameters and classification algorithms. Therefore, research analysing the performance of different classification algorithms is warranted. The purpose of this study was to compare the classification accuracy of different classification algorithms for identifying elderly fallers using force plate parameters measured during balance and gait tasks. Participants included 58 non-fallers (age = 72.3 ± 5.7) and 41 fallers (age = 74.0 ± 12.3) who performed balance and gait tasks on a walkway with embedded force plates (Kistler Instruments, Winterthur, Switzerland). The force plate parameters included 2D ground reaction force (GRF)-time data and centre of pressure (COP) displacement/velocity data. Using this data as input, five different classification algorithms were used to build models: Naïve Bayesian (NB), Artificial Neural Network (ANN), Linear Discriminant Analysis (LDA), Support Vector Machine (SVM) and k nearest neighbours (kNN). A maximum accuracy of 84.95% for classifying faller/non-faller categories was obtained using LDA classifier based on parameters from combined gait and balance tasks. Combining force plate parameters from gait and balance tasks resulted in higher classification accuracies of older adult fallers (>75%) for all the algorithms. The findings of this study suggest that high accuracy of classifying elderly fallers can be obtained using force plate parameters.
... Previous studies reported that patients with DPN showed higher overall dynamic plantar pressure especially below the forefoot compared to patients without DPN [7,8]. This high planter pressure could be due to foot pain [9,10], limited joint mobility [11] or muscle imbalance [12]. High plantar pressures produced during walking may cause an increased risk of falls [10,13]. ...
... This is consistent with Mickle et al., who concluded that high plantar pressures produced during walking may lead to an increased risk of fall. Reduction of falls risk could be accomplished through providing therapeutic interventions to people with high plantar pressures [9]. ...
Article
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Objective: This study aimed at assessing the effectiveness of a task specific training guided by visual biofeedback in improving plantar pressure distribution to decrease risk of fall in individuals with Diabetic Peripheral Neuropathy (DPN). Methods: Thirty-four patients with DPN were included in the study and were randomly assigned into two equal groups. The study group received task specific training and 3-Dimensional terminal biofeedback. The control group received traditional strength training. Three sessions of assessments (pre, post and follow-up after a month) were done for all participants. Training was three times per week for 10 weeks. Berg Balance Scale (BBS) and Functional Reach Test (FRT) were used to assess the dynamic and anticipatory balance in addition to the risk of fall. E-med pedography was used to quantify the Planter Pressure (PP) beneath the hind and forefoot during walking. Results: Significant differences were noted in the BBS and FRT indicating a reduced risk of fall in the study groups. PP has been significantly changed in the study group and between the groups. Post-hoc test showed non-significant differences between the second and third measurements of the BBS, FRT and PP within the study group indicating along lasting effect of the applied treatments (p < 0.05). Conclusions: Task specific training and biofeedback may reduce the risk of fall by improving planter pressure distribution in individuals with DPN.
... While there are studies that evaluate this relationship in the older population, few studies are based on prospective primary data. Thus, the meta-analysis by Stubbs et al. [9] included 3 prospective studies [10][11][12], of which only the work by Leveille et al. [10] evaluated this relationship in a primary way in an exclusively female population with functional disability. Recently, a positive association was reported in an autonomous male population (unassisted ambulation) [13], as well as a positive relationship for lumbar pain specifically [14,15]. ...
... Anyway our sample had enough statistical power to exclude a difference proportions longer than 12.11% in this age group. Of the prospective studies performed previously [10][11][12][13][14][15], only the studies by Marshall et al. [14,15], who evaluated thoracolumbar pain as a risk factor for recurrent falls, analysed this association in a differentiated manner according to age group and found that the relationship was positive only in the group < 75 years, in both men and women. Although our results and those previously mentioned [14,15] cannot exclude chance, our summation results reinforce the hypothesis that the recurrent pain-fall relationship in this age group is at least less intense or that other risk factors are more prominent with respect to the group of 65-79 years older people. ...
Article
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Background Recurrent falls represent a priority in geriatric research. In this study we evaluated the influence of pain as a risk factor for recurrent falls (two or more in 1 year) in the older (65–79 years) and oldest-old (80 or more years) non-institutionalized population. Methods Prospective cohort study. 772 non-institutionalized individuals with ages of 65 years or older (with overrepresentation of people aged 80 years or older [n = 550]) were included through randomized and multistage sampling, stratified according to gender, geographic area and habitat size. Basal evaluation at participant’s home including pain evaluation by Face Pain Scale (FPS, range 0–6) and then telephonic contact every 3 months were performed until complete 12 months. Multivariate analysis by logistic regression (recurrent falls as outcome variable) for each age group (older and oldest-old group) were developed considering pain as a quantitative variable (according to FPS score). Models were adjusted for age, gender, balance, muscle strength, depressive symptoms, cognitive decline, number of drugs and number of drugs with risk of falls. Results 114 (51.35%) and 286 (52%) participants of older and oldest-old group, respectively, reported pain; and recurrent falls occurred in 6.93% (n = 12) of the older group and 12.06% (n = 51) of the oldest-old group. In the older group, pain was associated with recurrent falls, with an associated odds ratio (OR) of 1.47 (95% CI 1.08–2.00; beta 0.3864) for each unit increase in pain intensity (thus, participants with the most severe pain [FPS 6] had OR of 10.16 regarding to participants without pain [FPS 0]). In the oldest-old group, pain was not associated with recurrent falls. Conclusions Pain, a potentially modifiable and highly prevalent symptom, is a risk factor for recurrent falls in the older people (65–79 years). However, we have not been able to demonstrate that this relationship is maintained in the oldest-old population (80 or more years).
... Finally, we based our study on 120 older women (100%). Based on previous studies [20], the inclusion criteria were: (1) being ≥60 years old, (2) living independently in the community, (3) passing the Short Portable Mental Status Questionnaire [21], (4) being able to ambulate for at least 10 m with or without an aid, (5) being free from neurological diseases, and (6) could arrange their own transport to a testing venue in their community. All participants gave written informed consent before entering the study. ...
... To assess the level of plantar pressure under each participant's feet while walking, we used a Zebris plantar pressure platform (FDM; GmbH, Munich, Germany; number of sensors: 11.264; sampling rate: 100 Hz; sensor area: 149 cm × 54.2 cm). According to previous studies, the calibrated platform was placed on a firm, level surface, with a custom-designed dense walkway surrounding the plate to provide a level walking surface [20]. Each participant was instructed to walk at a comfortable speed across the platform without shoes and socks. ...
Article
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Although it has been well-documented that older adults spend a significant amount of time being sedentary and have slower gait velocity, little is known of how physical fitness mediates the association between them. The main purpose of the study was to explore whether objectively measured physical fitness mediates in the association between domain-specific and total sedentary behavior and gait velocity. We recruited 120 older adults aged ≥60 years. Sedentary behavior was assessed by the Measure of Older Adults’ Sedentary Time questionnaire. We used Zebris pressure platform to assess gait velocity. To assess the level of overall physical fitness, we summed z–scores of 7 tests: (1) waist circumference, (2) chair stand in 30 sec, (3) arm curl in 30 sec, (4) 2-minute step test, (5) chair sit–and–reach test, (6) back scratch test and (7) 8-feet up–and-go test. Overall physical fitness was obtained by summing up all physical test z-scores. Gait velocity was significantly associated with all domain-specific and total sedentary behavior (β = -0.04 to -0.35, p < 0.05). Overall physical fitness was significantly associated with all domain-specific and total sedentary behavior (β = -0.21 to -1.24, p < 0.001) and gait velocity (β = 0.23 to 0.24, p < 0.001). When physical fitness was put as the mediator, significant direct effects between sedentary behavior and gait velocity disappeared. Physical fitness fully mediates in the association between sedentary behavior and gait velocity in older adults.
... During regular gait, the foot is usually the only part of the body directly attached to the ground. Hence, any condition that can disturb the normal function of the foot during ambulation is likely to damage the stability of gait and increase the risk of falls (Mickle et al. 2010). ...
Article
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Fall is a very common injury, especially in older adults with foot deformities and other foot disorders. Even a small fall may cause fatal damage to this cohort. The purpose of this study was to conduct a review elucidating plantar pressure pattern under different foot deformities in the elderly. English-language search of the electronic databases in PubMed, ScienceDirect, Google Scholar, and Web of Science was conducted from 2000 to May 2020. Fifteen studies were found after literature searching and screening. Among them, 2 studies described the plantar pressure of plantar hyperkeratosis lesions in the elderly, 2 studies depicted the plantar pressure of pronated foot supinated foot in the elderly, 4 studies explored the plantar pressure distribution of hallux valgus and other foot deformities, and 7 studies focused on the plantar pressure of diabetic foot deformity in the elderly. Foot deformity appears to alter the plantar pressure in the elderly, and plantar pressure characteristics differ according to foot deformities.
... Furthermore, studies associated with arch height and arch stiffness receive increasing attention from footwear manufacturers, because arch height and arch stiffness may vary widely between individuals (37). Only footwear designs that are concordant with foot anthropometrics can guarantee the comfort of footwear for different groups of people (38,39). Through this research, we could discover which factors affect arch height and arch stiffness. ...
Article
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Arch structure and arch function play an important role in maintaining balance, bearing body weight, and absorbing ground reaction forces. However, arch structure and arch function are known to vary extensively and may be affected by factors such as gender, age, and obesity. Therefore, the purpose of this study was to examine the influence of gender, age, and body mass index (BMI) on arch height and arch stiffness. A total of 173 participants (aged 57.60 ± 11.19 years, mean BMI 25.12 ± 3.93 kg/m2) participated in this cross-sectional study. A 3-dimensional laser scanner was used to measure foot structure information in each subject, from which arch height and arch stiffness were calculated. The results showed that women had low-arched feet compared with men (p = .001), and no arch stiffness difference was found. Older individuals tended to have a stiffer arch than middle-aged and younger individuals (p < .05), and no arch height difference was found. BMI had an impact on arch height (p < .05) but not arch stiffness. Finally, a weak positive relationship existed between arch height and arch stiffness (r = 0.32, p < .01). The findings suggest that gender, age, and obesity have a certain impact on arch structure and arch stiffness. Figuring out the relationship between these factors and arch structure may be helpful in understanding the bases of foot deformity and foot dysfunction.
... These findings are consistent with previous reports, which have also identified higher foot loads in obese older adult [9]. It has been suggested that high foot loads contribute to foot pain, which as a consequence may cause balance disturbance, and thus predispose individuals to falls [25]. Also, the plantar mechanoreceptors hyperactivation due to continuous overload may reduce plantar sensitivity and affect postural stability [26]. ...
Article
Background: Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk. Research question: Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older? Methods: At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month followup period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05. Results: 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39–3.27). Using the counterfactual approach, only specific torque (NIE:1.11, 95 % CI: 1.01–1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01–1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively. Significance: Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.
... There is a proven relationship between high plantar pressure and metatarsalgia [7], ulceration [2], and falls [8] in OAs and so reducing these values is a useful goal in this population. Plantar pressure distribution during gait has been widely studied in elderly populations by analysing different variables including barefoot versus shoe wearing [2], shoe sole hardness [9], or the use of accommodative insoles [7]. ...
Article
Background: Improving gait is in exercise programs for older adults (OAs) but little is known about how different gait-training approaches affect spatiotemporal parameters and plantar pressure distributions in OAs. High plantar pressures are linked to tissue injury risk, ulceration, and pain in OAs, but no studies have yet compared how they affect podobarometric variables. Research question: The effect of changing plantar pressure on absolute and mean maximum pressure, the pressure-time integral, stride time, stance time, and gait speed in OAs following either a multicomponent training program (EG) or interval-walking training (WG). Methods: Comfortable gait speed, strength (seat-to-stand test), and plantar pressure (Pedar-X mobile in-shoe system), were evaluated in 23 OAs (EG: n=12, 7 female, 71.58 ± 4.56 years; WG: n=11, 6 female, 69.64 ± 3.56 years), by dividing the plantar area into 9 regions. Results: After 14 weeks, the maximum pressure in medial and central metatarsus areas in the dominant leg were reduced in the EG (p=0.01 & p=0.04, respectively), but increased in the non-dominant leg lateral heel in the WG (p=0.03). The mean maximum pressure also increased in the WG in medial heel in the dominant leg (p=0.02) and lateral heel in the non-dominant leg (p=0.03). The overall pressure-time integral reduced in the whole plantar area in both legs in both groups. WG reduced stride time (dominant: p=0.01; non-dominant: p=0.01) and stance time (dominant: p < 0.005; non-dominant: p < 0.005). Gait speed did not change in any group. As expected, lower limb strength improved after both exercise programs (EG: p=0.02; WG: p=0.01). Significance: Although these training interventions were short, they indicate the importance of exercise types. Our results suggest that OAs might benefit from periodized training, especially when multicomponent programs are introduced prior to the walking goals. Future, larger studies should explore situations in which special populations with specific foot problems might benefit from these interventions.
... However, no study to date has systematically established significant factors associated with several foot functions in children and adolescents and apparently healthy individuals. Indeed, previous studies conducted among older adults have shown, that fallers had a significant higher prevalence of foot pain and generated a significantly higher peak pressure and pressure-time integral under the foot, compared to non-fallers 25 , leading to risks of chronic degenerative diseases, disabled range of motion and premature death. ...
Article
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The main purpose of the study was to establish foot characteristics during walking in children. In this cross-sectional study, we recruited 1 284 primary-school students aged 6-14 years (714 boys and 570 girls) randomly selected from five schools in the city of Brno, Czech Republic. Children walked across a pressure platform (EMED-xl; NovelGmbH, Munich, Germany) to collect the data for both left and right foot during three trials. After the procedure, the software generated several foot characteristic variables: (1) force-time integral, (2) pressure-time integral, (3) contact area, (4) contact time, (5) peak pressure and (6) average pressure for the total foot. Curves for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were calculated using the Lambda, Mu and Sigma (LMS) Chartmaker software. Our results showed that boys had longer force-time integral, higher contact area and contact time values, and higher peak plantar pressure, while no significant differences in pressure-time integral and average plantar pressure between sexes were observed. Older boys and girls had higher values in all measured variables. Our results provide for the first-time sex- and age-specific foot characteristics during walking in 6-14-year-old children.
... As with many assessment tools, feasible and repeatable protocols that can be implemented in clinical practice are essential to collect robust data to inform clinical decision making. Plantar pressure assessment has advanced understanding of the foot in healthy older populations [14][15][16], in people with diabetes [17,18] and rheumatoid arthritis [19,20]. Earlier work with a neurological population [21] evaluated dynamic plantar pressures in people with spastic and non-spastic hemiparesis of mixed aetiology. ...
Article
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Purpose: Stroke-related changes in foot structure and function affect balance and mobility and quantifying foot function following stroke could offer clinically useful information to inform rehabilitation. The aim of this work was to explore the feasibility of undertaking plantar pressure assessment during barefoot walking in people with stroke, and evaluate the repeatability of the assessment protocol and regional footprint analysis as a measure of dynamic foot characteristics. Materials & methods: Plantar pressure analysis was undertaken using a pressure platform (Tekscan HR Mat) on two test sessions, approximately two weeks apart (mean = 15.64 ± 11.64 days). Peak plantar pressure (kPa) and contact area (cm2) for foot regions were extracted and repeatability analysis undertaken. Descriptive evaluation of field notes and experiences of the participants was undertaken to inform the feasibility of the data collection protocol. Results: Twenty-one participants (61.8 ± 9.2 years; 11 male, 10 female; 8 right-sided, 13 left-sided stroke) were recruited and 18 returned for retesting. Full data capture was achieved from 14 participants. Peak pressure and contact area demonstrated moderate to good repeatability for at the toes (ICC 0.76 and 0.58 respectively) and good to excellent repeatability for the other foot regions (ICC ≥ 0.82). Conclusion: The protocol adopted in this study was feasible and yielded good to excellent repeatability for the foot regions, except the toes. The challenges with data collection in our study cohort could help inform future studies adopting similar protocols. This work also has relevance for use of pressure technology in clinical practice for assessing and monitoring foot function following stroke.
... usuário que não desenvolve complicações e o gestor que minimiza gastos e quando a promoção em saúde está inserida em conjunto com diferentes categorias atuantes essa comunidade diminui consideravelmente seus agravos, pois atua em diferentes frentes com um único objetivo que é promover a saúde da população.REFERÊNCIASACIOLE, G. G.; BATISTA, L. H. Promoção da saúde e prevenção de incapacidades funcionais dos idosos na estratégia de saúde da família: a contribuição da fisioterapia. Saúde em Debate, Rio de Janeiro, v. 37, n. 96, p.[10][11][12][13][14][15][16][17][18][19] 2013 BAENA, C.P; SOARES, M.C.F. Subsídios reunidos junto à equipe de saúde para a inserção da fisioterapia na Estratégia Saúde da Família.Fisioter Mov. ...
... These findings are consistent with previous reports, which have also identified higher foot loads in obese older adult [9]. It has been suggested that high foot loads contribute to foot pain, which as a consequence may cause balance disturbance, and thus predispose individuals to falls [25]. Also, the plantar mechanoreceptors hyperactivation due to continuous overload may reduce plantar sensitivity and affect postural stability [26]. ...
... To assess the spatiotemporal and kinetic gait parameters, we used a Zebris plantar pressure platform (FDM; GmbH, Munich, Germany; number of sensors: 11.264; sampling rate: 100 Hz; sensor area: 149 cm × 54.2 cm). We followed the methodology of collecting data from previous studies [12,13]. In brief, each participant was instructed to walk at a comfortable speed across the platform without shoes and socks. ...
Article
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The main purpose of the study was to explore the effects of carrying police equipment on gait spatiotemporal and kinetic parameters. Two - hundred and seventy - five healthy men and women attending police academy (32% women) were randomly recruited. Gait analysis without and with police equipment load (≈ 3.5 kg) was analyzed using Zebris pressure platform. Differences and effect sizes were calculated using Student t – test and Wilcoxon test for dependent samples and Cohen’s D statistics. In both men and women, carrying police equipment significantly increased foot rotation (effect size 0.13 – 0.25), step width (0.13 – 0.33), step time (0.25), stride time (0.13 – 0.25) and peak plantar pressure beneath the forefoot (0.16 – 0.30), midfoot (0.15 – 0.32) and hindfoot (0.13 – 0.25) region of the foot. Significant reductions in step length (0.12 – 0.25), stride length (0.14 – 0.23), cadence (0.15 – 0.28) and walking speed (0.20 – 0.22) were observed in both sexes. Although significant, effect sizes were mostly trivial in men and small in women. Our study shows significant changes in gait spatiotemporal and kinetic parameters while carrying police equipment in both men and women. Although effect sizes are trivial to small, carrying police equipment of ≈ 3.5 kg may have negative impact on gait characteristics in first year police officers.
... 6, 8 Özellikle yüksek VKİ değerlerinin ayak arkları üzerine etkisini araştıran çalışmalar VKİ değerleri ile ayak ağrısı ve düz tabanlık arasında yakın ilişki olduğunu, VKİ değerlerindeki artışın ayak plantar basıncında artmayla sonuçlandığını ve bu yüksek plantar basınç oranlarının yaşlı bireylerde ayak ağrısı ve yüksek düşme oranlarıyla ilişkili olduğu göstermiştir. 8,10,12,18 Alt ekstremite kinematik zincirinin en uzak kısmı olan ayağın biyomekaniksel özellikleri, ayakta durma, yürüme ve birçok fiziksel aktivitede önemli bir role sahiptir. 19 Yürüyüş döngüsü sırasında talocrural, subtalar, talonavikular, kalkaneokuboid ve navikulaküboid eklemlerde belirgin hareketler meydana gelir. ...
Article
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Z Çalışmanın amacı farklı vücut kitle indeksi (VKİ) düzeyinde olan bireylerde statik yük altındaki ayağın pronasyon cevabının araştırılmasıydı. Demografik veriler, VKİ değerleri (kg/m 2) kaydedildi ve naviküler düşme miktarı (%) değerlendirildi. Değerlendirme tamamlandıktan sonra, katılımcılar üç gruba ayrıldı: düşük kilolu bireyler (VKİ <18,5 kg/m 2), normal kilolu bireyler (VKİ=18,5-24,9 kg/m 2), preobezite düzeyinde olan bireyler (25-29,9 kg/m 2). İkili karşılaştırmalar, düşük kilolu grup ile normal kilolu grup (p = 0,012) arasında ve preobez grup ile normal kilolu grup arasında fark olduğunu gösterdi (p = 0,046). Düşük kilolu grup ile preobez grup arasında olmadığı görüldü (p=0,854). Çalışma, düşük kilolu ve preobez bireylerin ayağının pronasyon cevabının benzer olduğunu ve her iki grubun da normal kilolu bireylerden daha yüksek bir pronasyon cevabı oluşturduğunu gösterdi. Normal kiloda olmanın, statik yüklenme altında uygun ayak pronasyonu açısından önemli olduğu sonucuna varılmıştır. ABSTRACT Investigating the pronation response of the foot under static loading in individuals with different body mass index (BMI) level was the aim of the study. Demographic data, BMI values (kg/m 2) were recorded and navicular drop (%) was assessed. After the evaluation period was completed, the participants were allocated to the three group: individuals with underweight (BMI<18.5 kg/m 2), individuals with normal weight (BMI = 18.5-24.9 kg/m 2), individuals who were at preobesity level (25-29.9 kg/m 2). Pairwise analyses showed that there was a difference between the underweight group and normal weight group (p=0.012), the preobese group and normal weight group (p=0.046). There was a similarity between the underweight group and preobese group (p=0.854). The study showed that the pronation response of the foot of individuals with underweight and overweight were similar and also both of the two groups showed a higher pronation response than the individuals with normal weight. It has been concluded that the normal weight levels were important in terms of the reasonably foot pronation under static loading.
... In childhood, the foot structure tends to have a flattened appearance, mostly due to incomplete foot development [4], while in elderly, the decline in foot function due to aging makes the foot muscles and ligaments unable to maintain the shape of the arch, which results in flatfoot [5]. It is believed that abnormal foot structure can affect the walking stability of the elderly and become a potential risk for falls [6]. During standing, patients with flatfoot have a higher magnitude and speed of plantar center-of-pressure trajectory sway than normal foot people and exhibit poorer static postural control [7,8], and Harrison's team showed that as the severity of flatfoot deformity increases, static postural stability decreases [7]. ...
Article
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Flatfoot is a common foot deformity, and the collapse of the arch structure affects the foot cushioning during walking. A growing number of scholars have found that the analysis of the impact force should be combined with both the magnitude and the frequency of the impact force. Therefore, the aim of this study is to investigate the plantar impact characteristics of flatfoot patients and normal foot people at different load-bearing buffer stage from the time and frequency domains. Sixteen males with flatfoot and sixteen males with normal foot were recruited to walk on the plantar pressure test system at the same step speed, and the vertical ground reaction force data were collected from the heel contact stage and the arch support stage. The differences in the frequency domain of the ground reaction force between the flatfoot and the normal foot in the two stages were analyzed according to the basic mechanical characteristics and the continuous wavelet transform. Independent sample t-test was used to compare the baseline data of subjects, and the differences in foot impact force characteristics at different stages of foot type and weight-bearing cushion phase were compared by two-factor repeated measures Analysis of Variance. 1) In terms of basic mechanical characteristics, In both groups for flatfoot patients and normal foot people, the peak ground reaction force was higher in the arch support stage compared to the heel contact stage (Pflatfoot<0.001, Pnormal foot<0.001), and the load rate of force change was smaller in this stage (Pflatfoot<0.001, Pnormal foot<0.001). However, no differences in peak ground reaction force and time of occurrence were found between flatfoot and normal foot in the two stages (p > 0.05), in the arch support stage, the force change load rate of patients with flatfoot was lower than that of normal foot people (p = 0.021). 2) The results of time and frequency domain characteristics showed that during the heel contact and the arch support stage, no significant differences in the maximum signal power as well as the corresponding time and the frequency of the main impact force between the normal foot and the flatfoot were found. In both flatfoot and normal foot types, compared with the foot heel contact stage, the maximum signal power in the arch support stage was higher (Pflatfoot < 0.001, Pnormal foot<0.001), and the corresponding impact frequency was smaller (Pflatfoot = 0.002, Pnormal foot = 0.004). Once the step speed was controlled, the flatfoot patients only showed a smaller impact force load rate in the arch support stage, which may be related to their lower arch rigidity. The characteristics of the impact force in different stages of walking support period were different in time and frequency domain, suggesting that there may be differences in the function of various parts of the foot.
... Reportedly, 30% of the foot deformities in community-dwelling elderly people [3][4][5] are associated with reduced walking speed [1,6], di culty in daily living activities, and increased risk of falls [6,7]. Recent studies emphasize the link between increased health risks such as frailty syndrome and falls in the elderly and foot problems [1,[8][9][10]. ...
Preprint
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Background Foot deformity can cause walking difficulty and posture problems in all age groups and lead to even more serious health problems in the elderly. This cross-sectional study aimed to investigate the effects of foot arch deformation on physical characteristics, muscular strength, and motor function in the community-dwelling elderly. We also assessed the reliability of the foot measurement method used in this study. Methods Overall, 204 community-dwelling elderly participants, of whom 159 were women, aged 65 to 90 years old, were included in this study. This study measured and analyzed the feet arch height ratio (AHR, dorsal height/truncated foot length). Participants were classified based on the AHR values above, below, or within 1.5 SD into the High-Arched Group (HAG), Low-Arched Group (LAG), or Normal-Arched Group (NAG), respectively. Furthermore, the reliability of the foot arch measurement method was examined in 17 university students. The survey items compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and foot intrinsic strength), and locomotive function (two-step value and gait speed) among the three groups based on AHR. The foot measurements and sex differences were measured using the Mann-Whitney test. The associations among the three groups were analyzed using the Kruskal-Wallis test. Results There were significant differences in BMI and walking speed among the three groups categorized according to AHR. The HAG had the highest BMI and the lowest walking speed among all groups. The foot measurements demonstrated high or moderate reliability. Conclusions The decreased walking speed of elderly people was found to be associated with high-arched feet. Additionally, the BMI could be associated with high-arched feet. Longitudinal studies are needed to confirm whether obesity increases the incidence of high-arched feet.
... Up to 20% of the elderly consider foot pain as the reason for not leaving home. Additionally, it has been associated with reduced balance and risk of falls [14]. ...
Conference Paper
Chronic foot pain is a disease that progresses with age and has a high prevalence. Therapeutic procedures include the utilization of orthoses or insoles that are placed inside the footwear. Design of personalized insoles is a process that includes several stages. An important stage is the acquisition and analysis of footprint images. Their segmentation enables quantification of the footprint shape by estimating several indices that allow classification and diagnosis of foot morphology abnormalities. A segmentation method for footprint images using Level-Set algorithms is reported. Two area based Level-Set segmentation algorithms were applied. The first is the Chan-Vese algorithm using a global minimizer. The second is the Lankton algorithm that implements the Chan-Vese energy function using a localized minimizer and the Sparse Field Method for reducing the computational cost. Algorithms tested are accurate for segmenting the footprint images, providing an average Dice coefficient higher than 0.93. The Lankton algorithm is robust with respect to spatial variation in intensities within the footprint shape. It is also fast as the average time for segmenting one image is only 6.4 seconds.
... A six-level scale has shown that the higher prevalence of discomfort occurred at the right ankle at the end of the driving process. Reported foot or lower limb pain/discomfort might change the comfortable walking rhythm and cause variation in gait (Mickle et al. 2010). Increasing the walking speed will result in an increase in plantar pressure under a specific surface of the foot (Burnfield et al. 2004;Segal et al. 2004. ...
Chapter
Background: The development of driving discomfort caused by prolonged driving is a multifunctional problem. It has been the subject of interest of several articles. After prolonged exposure to driving discomfort, performing gait on different ground levels contributes to a high prevalence of occupational injuries. Objective: This study investigates whether the developed discomfort during prolonged driving might trigger changes in gait plantar pressure. Method: The study includes data based on forty-four subjects aged between 20 and 40 years old. The plantar pressure variable was collected into two periods, before and after steering the driving simulator. Subjects’ groups were defined using the Hierarchical clustering method based on walking speed difference performed at post- and pre-steering gait. Results: The results uncover significant changes in the forefoot (central and lateral) area among faster walking participants. The exception was for the hallux. Participants with the fastest walking speed shifted plantar pressure from the hallux to the central forefoot area with a post-steering gait. Conclusions: The time spent driving influenced the plantar pressure distribution among subgroups, suggesting that discomfort occurred at the end of the driving process. Adopting faster walking speed with uneven plantar pressure might explain physiological and psychophysical responses to the driving process.
... Inclusion criteria were as follows: (1) no history of foot and ankle injuries in the past 1 year; (2) no history of lower leg, ankle, and foot surgery or fracture; (3) no observed radiographic features of deformity on simple radiographs of the hip, knee, ankle, or foot; (4) no subjective symptoms such as pain or discomfort during gait. Two male adults with too small feet to fit the shoes and 3 male adults with flat feet (based on radiologic Meary's angle, talonavicular coverage angle, calcaneal pitch angle, and talocalcaneal angle) were excluded following the protocol. ...
... Noteworthy is that none of this research considers the effect of hole size on the integrity of different footwear types (e.g., minimal versus maximal shoes) or shoe size. Given that foot anthropometry is highly individualised (Mickle et al., 2010;Redmond et al., 2008;Tomassoni et al., 2014), holes cut in footwear on the basis of one participant's foot anatomy are likely unsuitable for another participant. Furthermore, researchers and clinicians often examine biomechanics of runners wearing their own shoes Lussiana et al., 2017;Soares et al., 2018), wherein it becomes inappropriate to cut holes in shoes. ...
... Similarly, a reduction in motion in the first metatarsophalangeal joint, which is associated with a loss of high-gear propulsion, has been linked to increased plantar pressures within the hallux region [6]. Increased plantar pressures within these regions of the foot have been linked to pressure-related complications such as foot pain and ulceration [1,2,7,8]. ...
Article
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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.
... This information when paired with inertial measurements can provide further insight into an individual's fall risk and gait. In fact, fallers and stumblers have shown to exert different pressure values and PPD than non-fallers (55,56). By recognizing characteristic PPD and gait patterns while walking and standing, further insight into an individual's fall risk can be obtained. ...
Article
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Fall risk assessment and fall detection are crucial for the prevention of adverse and long-term health outcomes. Wearable sensor systems have been used to assess fall risk and detect falls while providing additional meaningful information regarding gait characteristics. Commonly used wearable systems for this purpose are inertial measurement units (IMUs), which acquire data from accelerometers and gyroscopes. IMUs can be placed at various locations on the body to acquire motion data that can be further analyzed and interpreted. Insole-based devices are wearable systems that were also developed for fall risk assessment and fall detection. Insole-based systems are placed beneath the sole of the foot and typically obtain plantar pressure distribution data. Fall-related parameters have been investigated using inertial sensor-based and insole-based devices include, but are not limited to, center of pressure trajectory, postural stability, plantar pressure distribution and gait characteristics such as cadence, step length, single/double support ratio and stance/swing phase duration. The acquired data from inertial and insole-based systems can undergo various analysis techniques to provide meaningful information regarding an individual's fall risk or fall status. By assessing the merits and limitations of existing systems, future wearable sensors can be improved to allow for more accurate and convenient fall risk assessment. This article reviews inertial sensor-based and insole-based wearable devices that were developed for applications related to falls. This review identifies key points including spatiotemporal parameters, biomechanical gait parameters, physical activities and data analysis methods pertaining to recently developed systems, current challenges, and future perspectives.
... Çalışmamıza dahil edilen kadınların WOMAC tutukluk, fonksiyon ve total skorları erkeklere göre daha yüksek bulunmuştur. Literatürde çalışmalar, kadınlarda radyografik ve semptomatik diz OA'sının prevalansı ve insidansının daha yüksek olduğunu ortaya koyarken kadın cinsiyetinin OA progresyonu ile ilişkili olduğu tartışmalıdır (22,24,25,35,36). Raynauld ve ark. ...
... In a one-year follow-up study of elderly people by Menz et al. 4) , individuals in the fallen group had significantly lower ankle mobility and toe grip strength than those in the non-fallen group; in addition, more of the former had decreased plantar sensation, as well as foot pain and hallux valgus. Notably, decreased toe grip strength and foot pain were associated with falls 4,5) . Therefore, previous studies suggest that toe grip strength is important in balance assessment and treatment of the elderly. ...
Article
[Purpose] This study aimed to compare the inter- and intra-examiner reliabilities of toe grip strength measurements obtained just above the first interphalangeal joint with those of toe grip strength measurements obtained in the most comfortable position for the participant. The study also aimed to calculate the minimal detectable change for the more reliable method. [Participants and Methods] The participants for each test included 20 healthy adult males and females. Intra-class correlation coefficient (1,1) and (2,1) values were calculated for both tests. Bland-Altman analysis was used to determine the systematic error and calculate the minimal detectable change. [Results] The intra- and inter-examiner reliabilities of measurements obtained by setting the position of the toe-grasping bar to the first interphalangeal joint were better than those obtained in the most comfortable position for the participant. Measurement of the minimal detectable change showed a random error of 4.97 kg. [Conclusion] We considered that toe grip strength measurements just above the first interphalangeal joint were better. The minimal detectable change was 4.97 in healthy adults.
... The factors influencing the distribution of the foot sole pressure are weight, age, and sex [10]. For this reason, we needed to establish functional parameters in the design of the system in order to have a homogeneous distribution of the foot's weight without the use of shoes or insoles, which can introduce errors into the dataset [31]. ...
Article
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The analysis of plantar pressure through podometry has allowed analyzing and detecting different types of disorders and treatments in child patients. Early detection of an inadequate distribution of the patient’s weight can prevent serious injuries to the knees and lower spine. In this paper, an embedded system capable of detecting the presence of normal, flat, or arched footprints using resistive pressure sensors was proposed. For this purpose, both hardware- and software-related criteria were studied for an improved data acquisition through signal coupling and filtering processes. Subsequently, learning algorithms allowed us to estimate the type of footprint biomechanics in preschool and school children volunteers. As a result, the proposed algorithm achieved an overall classification accuracy of 97.2%. A flat feet share of 60% was encountered in a sample of 1000 preschool children. Similarly, flat feet were observed in 52% of a sample of 600 school children.
... Mickle et al. reported that reduced toe flexor strength and the presence of hallux and toe deformities increase the risk of falling in older people. 39 Furthermore, Menz et al. reported that fallers were more likely to fail the paper grip test using the lesser toe. 20 In our study, because we did not investigate toe deformity, we do not know the detail of its association or incidence with foot arch morphology. ...
Article
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Purpose This cross-sectional study aimed to investigate the effects of foot arch deformities on physical characteristics, muscular strength, and motor function in older women depending on the presence or absence of pain. Methods Overall, 145 community-dwelling women aged 65 to 90 years were included in this study. We measured the foot arch height ratio (AHR, dorsal height/truncated foot length) and classified participants with AHR values above, below, or within 1.5 standard deviations into the high-arched group (HAG), Low-Arched Group (LAG), or normal-arched group (NAG), respectively. We also compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and intrinsic foot strength (IFS)), and locomotive function (two-step value and gait speed) among the three groups. Results Locomotive examination and muscle strength showed significant differences among the three groups only in the presence of pain; in the two-step test, HAG, NAG, and LAG values were 0.98 cm/cm, 1.19 cm/cm, and 1.18 cm/cm, respectively. The IFS measured 19.2 N, 24.2 N, 31.0 N, respectively, in the HAG, NAG, and LAG. Conclusion This study suggests that decreased IFS affects the mobility function of high-arched feet in older women. Although there was no significant difference in the evaluation of pain, HAG showed the highest average value, which is considered to contribute to the decreased two-step value. It has been suggested that a high-arched foot in the presence of pain is associated with IFS weakness and may affect the decline of mobility function in older women.
... Also, gait patterns can be changed by compensatory strategies that alleviate the pain, and those altered patterns can increase risk of injury at another foot region ( Van der Leeden et al., 2006). Changes of pressure on the foot can elicit unfavorable outcomes by overburdening metatarsal region of the foot, placing the individual at a greater risk of plantar stress in rheumatoid arthritis or diabetic foot, and fall-related injury affected by higher pressure in forefoot and heel (Hodge et al., 1999;Mickle et al., 2010; Rao and Carter, 2012). Therefore, understanding of the region affected pressure change and imbalance in the soles of the feet on stairs could be significant biomechanically, because stair walking could have different pressure mechanisms from level walking as described earlier. ...
Article
Stair walking is more demanding locomotion than level walking and can aggravate discomfort of the foot. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking. Thirty-five healthy males with 23.4±2 years old were included in this study after examining normality. They performed level walking, stair ascending, and descending in same type of shoes. Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral were done by Pedar-X system, masked 7 regions. Also, pressures in each region throughout the gait cycle were analyzed from each type of walking. Statistical analysis was performed using repeated measure one way analysis of variance. Peak pressure in all regions except for the midfoot was higher during level walking than stair walking. Pressure-time integral in the forefoot, midfoot during stair ascending, and the forefoot during stair descending was higher than level walking. In gait cycle, first peak was produced in the heel and the second peak was produced in the hallux during level walking, whereas during stair ascent, the heel and midfoot were in first peak, and the second peak was in the hallux. During stair descent, the first peak were in the forefoot and the midfoot, and the second peak was in the forefoot. In healthy young male adults, forefoot and midfoot are significant regions in the way that they have higher pressure burdens than other foot regions during stair walking.
... Düşmenin ve düşme endişesinin birçok farklı nedeni olmakla birlikte son yıllarda ayak ağrısının düşme ile ilişkisinin incelendiği çalışmalar dikkat çekmektedir. Ağrının eşlik ettiği ayak problemlerinin yaşlıların yaklaşık %24'ünde görüldüğü (6) ve denge bozukluklarına neden olarak düşme riskini arttığı bildirilmiştir (7)(8)(9). Bu durum 65 yaş üstü bireylerin %28-35'inin, 75 yaş üstü bireylerin ise %32-42'sinin yılda en az bir kez düşme deneyimi (10) ve toplumda yaşayan yaşlıların yaklaşık %50'sinin de düşme endişesi yaşadığı (11,12) göz önüne alındığında önemli bir problemdir. ...
Article
ÖZET Amaç: Bu çalışmanın amacı toplumda yaşayan yaşlılarda ayak fonksiyonunun denge, düşme ve düşme endişesi ile ilişkisini belirlemektir. Gereç ve Yöntem: Denizli merkezde yaşayan 47 yaşlı (13 kadın, 34 erkek) çalışmaya dahil edildi. Ayak fonksiyonları Ayak Fonksiyon İndeksiyle (FFI), düşme endişesi Uluslararası Düşme Etkinliği Ölçeğiyle (FES-I), dinamik denge ve düşme riski Süreli Kalk-Yürü Testiyle (SKYT) değerlendirildi. Ayrıca yaşlıların son bir yıldaki düşme deneyimleri de sorgulandı. Bulgular: Çalışmaya katılan yaşlıların yaş ortalaması 75.34±7.81 yıldı. FFI skoruna göre yaşlılarda hafif derecede ayak ağrısı (21.19±19.87) ve aktivite kısıtlılığı (15.34±12.20), orta derecede yetersizlik (32.72±26.00) bulundu. Yaşlıların %76.7'sinin düşme endişesi yaşadığı, %57.4'ünün düşme riski taşıdığı saptandı. FES-I ile FFI'nin ağrı (r=0.538 p=0.000), yetersizlik (r=0.417 p=0.004) ve aktivite kısıtlılığı (r=0.532 p=0.000) alt grupları arasında pozitif yönde orta düzeyde anlamlı ilişki saptandı. SKYT ile FFI'nin ağrı (r=0.367 p=0.011) ve yetersizlik (r=0.352 p=0.015) alt grupları arasında pozitif yönde hafif düzeyde anlamlı ilişki gözlenirken aktivite kısıtlılığı (r=0.602 p=0.000) alt grubu ile yüksek düzeyde anlamlı ilişki bulundu. Sonuç: Çalışmamız sonucunda ayak ağrısının ve ayak problemlerinden kaynaklanan günlük yaşam aktivitelerindeki yetersizlik ve aktivite kısıtlılığının denge kaybını, düşme riski ve endişesini arttırabileceği saptandı. Ayak problemleri nedeniyle fiziksel aktivite kısıtlaması veya fiziksel aktiviteden kaçınma kısa vadede yaşlıyı düşmelere karşı korusa da, uzun vadede yaşlının fiziksel ve zihinsel sağlığına zarar vermekte, sosyal katılımını kısıtlanmakta, yaşam kalitesini azaltmakta ve gelecekteki düşme riskini arttırmaktadır. Bu sebeple yaşlıların ayak sağlığıyla ilgili farkındalıklarının artırılmasının, ayak problemlerinin belirlenip gerekli önlemlerin alınmasının tüm bu risklerin ortadan kaldırılması açısından önemli olduğunu düşünmekteyiz. Anahtar Kelimeler: Ayak ağrısı, ayak fonksiyonu, düşme, düşme endişesi, yaşlılık Balance, Falls, Fear of Falling, and Foot Function in Elderly People in Community-Dwelling Older Adults ABSTRACT Purpose: The aim of this study was to determine whether foot function is associated with balance, falls, fear of falls in community-dwelling older adults. Materials and Methods: A total of 47 older adults (13 women, 34 men) residing in Denizli were included. Foot functions, fear of falling, dynamic balance and fall risk were evaluated by the Foot Function Index (FFI), Falls Efficacy Scale International (FES-I), Timed Up and Go test (TUG), respectively. The number of fall experience in the previous year was questioned. Results: The mean age was 75.34±7.81 years. According to the FFI score, mild foot pain (21.19±19.87) and activity limitation (15.34±12.20), moderate disability (32.72±26.00) were found. 76.7% of the participants had fear of falling and 57.4% had a risk of falling. There was a moderate positive correlation between FES-I and FFI-pain (r=0.538,p=0.000), FFI-disability (r=0.417,p=0.004), FFI-activity limitation (r=0.532,p=0.000). There was a weak positive correlation between TUG and FFI-pain (r=0.367,p=0.011) and FFI-disability (r=0.352,p=0.015), while a strong positive correlation in FFI-activity limitation (r=0.602,p=0.000). Conclusion: As a result of our study, activity limitation and disability of daily living activities due to foot pain and foot problems may increase the loss of balance, fall risk and fear of falling. Although in the short term, restriction or avoidance of physical activity due to foot problems protects the elderly against falls, in the long term it deteriorates the physical and mental health, restricts social participation, reduces the quality of life, increases the risk of future falls. Therefore, we think that it is important to increase the awareness of the elderly about foot health, to identify foot problems and to take necessary precautions in order to eliminate all these risks. Keywords: Foot pain, foot function, fall, fear of falling, elderly
... Whilst previous studies have investigated the contribution of foot-related impairments to greater falls risk in RA [3] and older adults [4], there is limited falls research in PsA, and the younger age of this PsA cohort should be noted. Distinct gait impairments have previously been demonstrated in those with PsA-related rearfoot enthesial pain [5], and indeed patient-reported problems Rheumatology in the rearfoot were a common finding in those who reported falls (n ¼ 197, 74%). ...
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The authors examined sex-specific relationships between fat mass index (FMI), android/gynoid (A/G) fat ratio, relative skeletal muscle mass index, and Bone-Specific Physical Activity Questionnaire derived bone-loading scores (BLSs) in middle-aged and older adults (men, n = 27; women, n = 33; age = 55–75 years). The FMI, A/G fat ratio, and relative skeletal muscle mass index were estimated by dual-energy X-ray absorptiometry. The Bone-Specific Physical Activity Questionnaire was used to assess: (a) BLS past (age 1 until 12 months before the study visit), (b) BLS current (last 12 months), and (c) BLS total (average of [a] and [b]) scores. Separate multiple linear regression analysis of (a) age, FMI, and relative skeletal muscle mass index and (b) age, height, and A/G fat ratio versus BLS revealed that FMI and A/G fat ratio were negatively associated with BLS past and BLS total ( p < .05) in women only. Adiposity and, specifically, central adiposity is negatively related to bone-loading physical activity in middle-aged and older women.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
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Background Valgus hindfoot is a very common postural deviation, and the associated foot pronation can be a triggering factor for diseases such as tarsal tunnel syndrome. Research question This work compares two techniques for hindfoot valgus correction: GPR (Global Postural Reeducation) and PIMT (Postural Integration by Manual Therapy). Methods Sixty young adult subjects from the Brazilian Army with unilateral hindfoot valgus were selected and divided into two groups of 30 subjects, one treated with GPR and the other treated with PIMT. Differences between normal and valgus hindfeet (plantar surface and body weight load) for each subject were measured and analysed, using a baropodometer with subjects in static standing position for 5 seconds. Measurements were performed before and after each treatment session (4 weeks, once a week), and 4 weeks after the end of treatment. Results These data showed that both treatments were equally effective for improving symmetry in body weight load between feet and plantar surface. After 4 weeks from the end of treatment, both treatments were equally effective for body weight load symmetry, but plantar surface symmetry was better in PIMT treated subjects. Significance This study shows that PIMT technique can be validated as a physical therapy procedure, at least for valgus hindfoot.
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Holding an asymmetrical load, like a rucksack, grocery bag, or travel backpack, is a part of daily and occupational activities. This pilot study was aimed to determine the effects of light, asymmetrical, handheld load on the body posture and foot pressure distribution in young adults. Thirteen young volunteers, free of any injury or pain, took part in the study (aged 21.53 ± 1.10 years). All the study participants were right-handed. An additional load (4 kg, placed in the rucksack) was asymmetrically held in each hand while standing still. For evaluation of the posture and foot pressure distribution, the investigation focused on three positions, i.e., no-load, a rucksack in the right hand, a rucksack in the left hand. We used a surface topography system and force platform for evaluation of the body posture and foot pressure examination, respectively. The results showed that the main changes in the body posture caused by an external load application manifested in trunk imbalance. The trunk was shifted in the direction opposite to the load. Trunk imbalance changes were statistically significant in all three comparisons (p = 0.001). Interestingly, changes in the rotations and lateral deviation seem to be dependent on the hand dominance. Greater foot pressure was observed on the loaded limb (p < 0.01), and highly significant differences were noted between the left and right foot in both loaded postures (p < 0.001). Further research needs to be done to check if lateralization is connected with body posture while holding an external load.
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Footwear is a modifiable risk factor for falls in older adults, including populations with metabolic disease, inflammatory arthritis, and neurodegenerative disease. Ill-fitting footwear, and specific design features, such as elevated heels and backless styles, can impair balance control and heighten the risk of falling. Although foot care is routine practice for some older adults to prevent ulceration (eg, diabetes) or relieve symptoms (eg, foot pain), new footwear interventions are emerging with the potential to ameliorate balance and walking impairments. Multifaceted podiatric interventions, which include appropriate footwear and importantly patient education, may have the capacity to reduce falls in older adults.
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Falls are one of the major health concerns for the elderly people. These falls often result in severe injuries which lead into huge medical expenses. Over the recent years, many ICT based fall detection and fall prevention solutions emerged to address the risk factors associated with falls. However, despite of these research studies, predicting the likelihood of falls still remains as a huge challenge in both medical and IT research domains. Data related to these risk factors being scattered among different healthcare providers can be attributed as a main reason for this challenge. This is further amplified by healthcare providers being reluctant to disseminate the data beyond their entities due to the security and privacy concerns. However, in recent years, blockchain has been proven as a promising technology to address the security and privacy challenges in healthcare data exchange as it provides a shared, immutable, and transparent audit trail for accessing data. Therefore, in this paper, we are going to propose a conceptual blockchain based fall prediction model leveraging smart contracts and FHIR (Fast Healthcare Interoperability Resources) standard to identify the elderly people who are at a higher risk of falling.
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Chapter
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Hallux valgus and lesser toe deformities are highly prevalent foot problems in older adults, affecting up to 74% of this population. One suggested cause of these toe deformities is inadequate strength of the intrinsic flexor muscles of the toes [1]. Adequate toe flexor strength is essential to control body weight shifts, propel the body during gait and assist in shock absorption during repeated impacts. Furthermore, a previous study using a qualitative measure of toe flexor strength reported associations between poor toe flexor strength and poor performance in balance and functional tests in elderly people [2]. Of further concern, in a sample of retirement home dwellers, fallers were more likely to have severe hallux valgus and fail a clinical test of toe-flexor strength more often than non-fallers [3]. However, this association has not been investigated in community-dwelling older people or assessed using a quantitative method of toe flexor strength. Therefore, the purpose of this study was to determine whether toe flexor strength or the presence of hallux valgus or lesser toe deformities were associated with the risk of falling in older community dwelling adults.
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The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings.
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The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.
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To assess (i) the relationship between forefoot joint damage and foot function (expressed as gait and pressure parameters), (ii) the relationship between foot function and pain, and (iii) the relationship between foot function and disability in patients with foot complaints secondary to rheumatoid arthritis (RA). Sixty-two patients with RA-related foot complaints were included. Measurements of joint damage, gait characteristics, plantar pressure, pain and disability were obtained. Data were analysed using descriptive and correlational techniques. s. Joint damage on radiographs of the forefoot correlated significantly with forefoot pressure (r = 0.296, P = 0.020). Further investigation of the metatarsophalangeal joints (MTPs) showed joint damage to correlate significantly with peak pressure and pressure-time integral (PTI) of MTP1 and MTP4. A significant correlation between PTI under the forefoot and barefoot pain was found (r = 0.290, P = 0.022). Gait parameters (total contact time and the duration of heel loading) and disability, measured with the Foot Function Index, were significantly correlated (r = 0.315, P = 0.013 and r = 0.266, P = 0.037, respectively). Forefoot joint damage in the rheumatoid foot is related to increased pressure under the forefoot, especially pressure under the first and fourth MTP joints. High forefoot pressure is associated with pain during barefoot walking. A prolonged stance phase and delayed heel lift are related to disability in daily activities.
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The objectives of this study were (i) to examine the psychometric properties of the Manchester Foot Pain and Disability Index (MFPDI) in community-dwelling older people, and (ii) to determine the correlates of disabling foot pain in this age-group. A questionnaire consisting of medical history, the MFPDI, the Goldberg Anxiety and Depression Scale (GADS) and the Medical Outcomes Study Short Form 36 (SF-36) was administered to a sample of 301 community-dwelling people (117 men, 184 women) aged between 70 and 95 yr (mean 77.2, s.d. 4.9), who also underwent a clinical assessment of foot problems. Using the MFPDI case definition, 108 people (36%) were found to have disabling foot pain. Within this subgroup, the MFPDI had high internal consistency (Cronbach's alpha=0.89). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern about appearance, and activity restriction, which explained 62% of the variance in the original items. Participants with disabling foot pain were more likely to report pain in the back, hips, knees and hands or wrists, and exhibited flatter feet and less range of motion in the ankle joint. The MFPDI and its subscales were significantly associated with scores on the GADS depression subscale and the general health and mental health components of the SF-36. These findings confirm the high prevalence of disabling foot pain in older people, and suggest that the MFPDI is a suitable tool for assessing foot pain in this population.
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This study investigated changes in the kinematics of elderly people who experienced at least one fall 6 months prior to data collection. The authors hypothesized that, in order to decrease variability of walking, people with a history of falls would show different kinematic adaptations of their walking patterns compared with elderly people with no history of falls. Twenty-one elderly people who had fallen within the previous 6 months ("fallers"; mean age=72.1 years, SD=4.9) and 27 elderly people with no history of falls ("nonfallers"; mean age=73.8 years, SD=6.4) walked at their preferred stride frequency (STF) as treadmill speed was gradually increased (from 0.18 m/s to 1.52 m/s) and then decreased in steps of 0.2 m/s. Gait parameter measurements were recorded, and statistical analysis was applied using walking speed and STF as independent variables. Fifty-seven percent of the fallers were unable to walk at the fastest speed, whereas all nonfallers walked comfortably at all walking speeds. Although the fallers showed significantly greater STF, smaller stride lengths, smaller center-of-mass lateral sway, and smaller ankle plantar flexion and hip extension during push-off, they showed increased variability of kinematic measures in their coordination of walking compared with the nonfallers. Although the fallers' adaptations were expected to reduce variability in the coordination of walking, they showed less stable gait patterns (ie, greater variability) compared with the nonfallers. Increased variability of walking patterns may be an important gait risk factor in elderly people with a history of falls.
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Degenerative disorders of the foot often are painful during standing and walking. It is assumed that, because of bone deformity, callus, and deformity of the plantar pads, the plantar pressure distribution changes. Prescription of orthopaedic shoes for patients with degenerative disorders of the foot is based on the hypothesis that excessive pressure under the foot causes pain. The goal of this study was to evaluate the effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain, in patients with degenerative disorders of the foot. Additionally, the relationship between plantar pressure parameters and foot pain was studied, with special emphasis on second and third metatarsal heads. Seventy-seven consecutive patients with degenerative disorders of the foot were recruited from the outpatient clinics of seven rehabilitation centers and rehabilitation departments of university hospitals in the Netherlands. The study was prospective. The Questionnaire for Usability Evaluation for Orthopaedic Shoes was used to measure perceived foot pain. To measure plantar pressures, the Pedar in-shoe pressure measurement system (Novel GmbH, Munich) was used. The effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain in patients with degenerative disorders of the foot, was analyzed by means of a paired sample t-test. To select the pressure parameter (Pmax, P(TI,) and P(av)) most closely associated with walking pain, within-subject correlation coefficients were calculated. Custom-made orthopaedic shoes significantly decreased perceived foot pain by at least 23%, and significantly reduced plantar pressure under all foot regions by at least 9%. A significant correlation (r = 0.521) was found between walking pain and the average pressure beneath the second and third metatarsal heads. Based on these results, it can be concluded that custom-made orthopaedic shoes are effective in reducing foot pain and foot pressure. The moderate (significant) relationship between average pressure and walking pain can be used as a tool for evaluating custom-made orthopaedic shoes prescribed for patients with degenerative disorders of the foot.
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Background: Plantar pressure measurement may be a helpful evaluation tool in patients with foot complaints. Determination of dynamic pressure distribution under the foot may give information regarding gait, progress of disorders, and the effect of treatment. However, for these measurements to have clinical application, reproducibility, consistency, and accuracy must be ascertained. We compared the reproducibility of measurements among one-step, two-step, and three-step protocols for data collection in patients with arthritis. In addition, the number of measurements needed for a consistent average was determined for the protocol that was found to be the most reproducible. Methods: Twenty patients with foot complaints secondary to arthritis participated in the study. Each patient was tested with a pressure platform system using two of the three testing protocols. Reproducibility of contact time and maximal peak pressure were assessed. Intraclass Correlation Coefficients (ICC) were calculated for measurement results among protocols. In stage two of the study, the number of measurements needed for a consistent average was determined by calculating the first three measurements, the first five measurements, and then all seven measurements for both feet. ICC of three, five, and seven measurements were compared. The two-step protocol (13 patients), which was found in stage one of the study to be the most reproducible, was used for this determination. Results: Reproducibility was found to be reasonable or good for all three measurement protocols. The mean values of contact time for the one-step protocol were found to be higher than the mean values of contact time for the two-step or three-step protocols in both feet. The differences between the one-step and three-step protocols were statistically significant for the left foot only. The mean peak pressure did not show statistically significant differences among the three protocols. The one-step and three-step protocols were not used for stage two of the study. Using the two-step protocol, three measurements were found to be sufficient for obtaining a consistent average. Conclusions: The results of our study indicated that the one-step, two-step, and three-step protocols of collecting plantar pressure measurements in patients with foot complaints secondary to chronic arthritis were all similar. However, the use of the two-step protocol is recommended over the one-step and three-step protocols; the one-step protocol produced a longer stance phase that did not resemble normal walking and when comparing the two-step and three-step protocols, the two-step protocol was less time consuming and less strenuous for patients with painful feet.
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The authors conducted a mail survey that examined foot problems, rates of utilization of foot-health services, and the perception of foot problems as medical conditions in a sample of people aged 65 years and older who lived independently. Although 71% of the 128 respondents reported suffering from foot problems, only 39% had consulted medical personnel about their feet, and only 26% identified their foot pathologies as medical conditions. More female than male respondents experienced foot problems and had visited medical personnel about their feet. Increased education of older individuals about their foot-care requirements, as well as increased access to pediatric medical services, is recommended.
Article
Foot problem assessments were performed on 135 community-dwelling older people in conjunction with clinical tests of balance and functional ability. Eighty-seven percent of the sample had at least one foot problem, and women had a higher prevalence than men of foot pain, hallux valgus, plantar hyperkeratosis, lesser digital deformity, and digital lesions. Postural sway did not differ between older people with and without each of these foot conditions. However, the presence of specific foot conditions impaired performance in a more challenging balance test and in some functional tests. In particular, older people with foot pain performed worse in a leaning balance test, stair ascent and descent, an alternate step-up test, and a timed six-meter walk. Furthermore, multiple regression analyses revealed that foot pain was a significant independent predictor of performance in each of these tests. These results show that the presence of foot problems, particularly foot pain, impairs balance and functional ability. As foot pain is amenable to treatment, podiatric intervention has the potential to improve mobility and independence in older people.
Chapter
The human foot plays an important role in all weight-bearing tasks, as it provides the only direct source of contact between the body and the supporting surface. When walking, the foot contributes to shock absorption, adapts to irregular surfaces, and provides a rigid lever for forward propulsion (1). Any disruption to the precise timing of foot and ankle motion has the potential to decrease both the stability and efficiency of gait patterns.
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Purpose: To review the principles of multivariable analysis and to examine the application of multivariable statistical methods in general medical literature. Data sources: A computer-assisted search of articles in The Lancet and The New England Journal of Medicine identified 451 publications containing multivariable methods from 1985 through 1989. A random sample of 60 articles that used the two most common methods--logistic regression or proportional hazards analysis--was selected for more intensive review. Data extraction: During review of the 60 randomly selected articles, the focus was on generally accepted methodologic guidelines that can prevent problems affecting the accuracy and interpretation of multivariable analytic results. Results: From 1985 to 1989, the relative frequency of multivariable statistical methods increased annually from about 10% to 18% among all articles in the two journals. In 44 (73%) of 60 articles using logistic or proportional hazards regression, risk estimates were quantified for individual variables ("risk factors"). Violations and omissions of methodologic guidelines in these 44 articles included overfitting of data; no test of conformity of variables to a linear gradient; no mention of pertinent checks for proportional hazards; no report of testing for interactions between independent variables; and unspecified coding or selection of independent variables. These problems would make the reported results potentially inaccurate, misleading, or difficult to interpret. Conclusions: The findings suggest a need for improvement in the reporting and perhaps conducting of multivariable analyses in medical research.
Article
Objective. To investigate the effectiveness of foot orthoses in the management of plantar pressure and pain in subjects with rheumatoid arthritis. Design. A repeated measures study in which the independent variable was orthosis design. Dependent variables, including pressure, gait and pain parameters, were examined using analysis of variance and correlation statistics. Background. The aim of orthotic management of the rheumatoid foot is to relieve metatarsalgia through the reduction of metatarsal head pressure. Few studies have investigated the relative effectiveness of different orthosis designs. To date, no studies have examined the relationship between plantar pressure and second metatarsal head pain in rheumatoid arthritis subjects. Methods. Twelve rheumatoid arthritis subjects with foot involvement and second metatarsal head pain were tested. Four styles of foot orthosis (prefabricated, standard custom moulded, custom with metatarsal bar, custom with metatarsal dome) were compared to a shoe only control. An EMED Pedar system was used to measure plantar pressure during repeated trials of comfortable cadence walking and quiet standing. Reports of subjective pain were recorded for each orthosis as were orthosis preferences. Results. All orthoses significantly reduced pressure beneath the first and second metatarsal heads compared to the shoes only control. The custom moulded orthosis with metatarsal dome was the most effective orthosis for reducing subjective ratings of pain. A significant correlation (r = 0.562) was found between ratings of pain and average pressure beneath the second metatarsal head. Conclusions. Results from this study suggest that average pressure measurement may be a useful indicator in the management of metatarsalgia in RA. Further study is required to improve understanding of the relationship between rheumatoid foot mechanics and pain.
Article
Of 1042 individuals aged 65 years and over who were successfully interviewed in a community survey of health and physical activity, 35% (n=356) reported one or more falls in the preceding year. Although the overall ratio of female fallers to male fallers was 2.7: 1, this ratio approached unity with advancing age. Mobility was significantly impaired in those reporting falls. Asked to provide a reason for their falls, 53% reported tripping, 8% dizziness and 6% reported blackouts. A further 19% were unable to give a reason. There was no association between falls and the use of diuretics, antihypertensives or tranquillizers, but a significant association between falls and the use of hypnotics and antidepressants was found. Discriminant analysis of selected medical and anthropometric variables indicated that handgrip strength in the dominant hand and reported symptoms of arthritis, giddiness and foot difficulties were most influential in predicting reports of recent falls.
Article
Hallux valgus and lesser toe deformities are highly prevalent foot problems in older people. One factor contributing to the development of these toe deformities is reduced toe flexor strength. As adequate toe flexor strength is also crucial in maintaining balance, it was hypothesised that poor toe flexor strength and toe deformities would increase the risk of falls in community-dwelling older people. The feet of 312 men and women aged 60-90 years were assessed for the presence of lesser toe deformities and hallux valgus. Hallux and lesser toe flexor strength were assessed using an emed AT-4 pressure platform and novel test protocol. Participants were then followed prospectively to determine their falls incidence over 12 months. During the 12 month follow-up, 107 (35%) participants experienced a fall. Compared to non-fallers, fallers displayed significantly less strength of the hallux (11.6 (SD 6.9) versus 14.8 (SD 7.8)% BW, P<0.01) and lesser toes (8.7 (SD 4.7) versus 10.8 (SD 4.5)% BW, P<0.01), and were more likely to have hallux valgus (relative risk [RR]=2.36; 95% CI=1.03-5.45; P<0.01) and lesser toe deformity (RR=1.32; 95% CI=1.04-1.69; P<0.01). Reduced toe flexor strength and the presence of toe deformities increase the risk of falling in older people. To reduce this risk, interventions designed to increase strength of the toe flexor muscles combined with treatment of those older individuals with toe deformities may be beneficial.
Article
Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.
Article
To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
Article
Serious fall injury represents a little studied, yet common and potentially preventable, cause of morbidity and mortality among older persons. We determined the frequency of, and risk factors for, experiencing serious fall injury events among older persons in the community. A representative sample of 1103 community-living persons aged 72 years and older underwent comprehensive baseline and 1-year evaluations. During a median 31 months of follow-up, fall data were obtained using fall calendars. Injury data were obtained from telephone interviews and from surveillance of emergency room and hospital records. At least one fall was experienced by 546 (49%) participants. A total of 123 participants, representing 23% of fallers and 12% of the cohort, experienced 183 serious fall injury events. The factors independently associated with experiencing a serious injury during a fall included cognitive impairment (adjusted odds ratios 2.2; 95% confidence interval 1.5, 3.2); presence of at least two chronic conditions (2.0; 1.4, 2.9); balance and gait impairment (1.8; 1.3, 2.7); and low body mass index (1.8; 1.2, 2.5). In a separate analysis, including only subjects who fell, female gender (1.8; 1.1, 2.9) as well as most of the above factors were associated with experiencing a fall injury. Several readily identifiable factors appeared to distinguish the subgroup of older fallers at risk for suffering a serious fall injury. These factors should help guide who and what to target in prevention efforts.
Article
To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living. Cross-sectional survey of a community-dwelling older population. A total of 459 subjects, 73% of the population aged 65 years and older living in Dicomano, Florence, Italy. A standardized medical examination was performed by a geriatrician to collect information on the presence of pain, specific problems of the feet, gait, and several indicators of physical health status. Disability in basic and instrumental activities of daily living was evaluated by self-report. The prevalence of foot pain was very high, especially in subjects affected by calluses or corns, hallux deformities, hammer toes, pes planus, and edema and among those who complained of difficulty in looking after the basic needs of the feet. Patients with foot pain needed a greater number of steps and longer time to walk the same distance. Foot pain was associated with a higher prevalence of disability in instrumental activities of daily living, particularly those related to standing and ambulation capacities, but it was not related to higher prevalence of disability in basic activities of daily living. Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability. This hypothesis needs to be tested in longitudinal studies and specific intervention trials.
Article
To review the principles of multivariable analysis and to examine the application of multivariable statistical methods in general medical literature. A computer-assisted search of articles in The Lancet and The New England Journal of Medicine identified 451 publications containing multivariable methods from 1985 through 1989. A random sample of 60 articles that used the two most common methods--logistic regression or proportional hazards analysis--was selected for more intensive review. During review of the 60 randomly selected articles, the focus was on generally accepted methodologic guidelines that can prevent problems affecting the accuracy and interpretation of multivariable analytic results. From 1985 to 1989, the relative frequency of multivariable statistical methods increased annually from about 10% to 18% among all articles in the two journals. In 44 (73%) of 60 articles using logistic or proportional hazards regression, risk estimates were quantified for individual variables ("risk factors"). Violations and omissions of methodologic guidelines in these 44 articles included overfitting of data; no test of conformity of variables to a linear gradient; no mention of pertinent checks for proportional hazards; no report of testing for interactions between independent variables; and unspecified coding or selection of independent variables. These problems would make the reported results potentially inaccurate, misleading, or difficult to interpret. The findings suggest a need for improvement in the reporting and perhaps conducting of multivariable analyses in medical research.
Article
The authors conducted a mail survey that examined foot problems, rates of utilization of foot-health services, and the perception of foot problems as medical conditions in a sample of people aged 65 years and older who lived independently. Although 71% of the 128 respondents reported suffering from foot problems, only 39% had consulted medical personnel about their feet, and only 26% identified their foot pathologies as medical conditions. More female than male respondents experienced foot problems and had visited medical personnel about their feet. Increased education of older individuals about their foot-care requirements, as well as increased access to podiatric medical services, is recommended.
Article
To investigate the effectiveness of foot orthoses in the management of plantar pressure and pain in subjects with rheumatoid arthritis. A repeated measures study in which the independent variable was orthosis design. Dependent variables, including pressure, gait and pain parameters, were examined using analysis of variance and correlation statistics. The aim of orthotic management of the rheumatoid foot is to relieve metatarsalgia through the reduction of metatarsal head pressure. Few studies have investigated the relative effectiveness of different orthosis designs. To date, no studies have examined the relationship between plantar pressure and second metatarsal head pain in rheumatoid arthritis subjects. Twelve rheumatoid arthritis subjects with foot involvement and second metatarsal head pain were tested. Four styles of foot orthosis (prefabricated, standard custom moulded, custom with metatarsal bar, custom with metatarsal dome) were compared to a shoe only control. An EMED Pedar system was used to measure plantar pressure during repeated trials of comfortable cadence walking and quiet standing. Reports of subjective pain were recorded for each orthosis as were orthosis preferences. All orthoses significantly reduced pressure beneath the first and second metatarsal heads compared to the shoes only control. The custom moulded orthosis with metatarsal dome was the most effective orthosis for reducing subjective ratings of pain. A significant correlation (r=0.562) was found between ratings of pain and average pressure beneath the second metatarsal head. Results from this study suggest that average pressure measurement may be a useful indicator in the management of metatarsalgia in RA. Further study is required to improve understanding of the relationship between rheumatoid foot mechanics and pain. Appropriate foot orthosis design can substantially improve comfort in RA patients with symptomatic feet. A custom moulded foot orthosis incorporating a metatarsal dome was the most effective design for subjects with painful second metatarsal heads. Foot pressure measurement technology can be a useful adjunct to research and clinical management of the painful rheumatoid foot.
Article
The midgait protocol is the most commonly used method to collect pressure platform data. Spatial limitations, however, frequently render this technique unsuitable. Alternative gait protocols have focused on gait initiation procedures in obtaining data. The current study investigated whether a commonly cited two-step gait initiation protocol, or a two-step gait termination protocol produced pressure data more representative of the criterion, midgait method. A pressure platform was used to collect data for 25 asymptomatic subjects using the midgait, two-step gait initiation and two-step gait termination walking protocols. The contact duration, percentage contact duration, peak pressure, peak force, pressure-time integral and force-time integral were calculated for seven sites within the foot. Multivariate analysis of variance with repeated measures identified significant protocol by site interactions for all variables except the force-time integral. The gait initiation protocol, although having minimal effect on peak pressures beneath the forefoot, markedly altered the relative timing parameters of the foot. In contrast, the gait termination protocol had minimal effect on temporal parameters, but resulted in a reduction in pressures beneath the forefoot. Abbreviated gait protocols are often employed in plantar pressure studies. This study suggests that the choice between a gait initiation and termination protocol is largely dependent on the gait parameter of interest.
Article
This study outlines the design and validation of a new self-administered instrument for assessing foot pain and disability. The 19-item questionnaire was tested on 45 rheumatology patients, 33 patients who had attended their general practitioner with a foot-related problem and 1000 responders to a population survey of foot disorders. Levels of reported disability were found to be greatest for rheumatology patients and least for community subjects. In addition, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a health care professional and those who did and did not have a history of past and current foot pain. A good level of agreement was found when items on the questionnaire were compared with similar items on the ambulation sub-scale of the Functional Limitation Profile questionnaire. A Cronbach's alpha value of 0.99 and item-total correlation values between 0.25 and 0.62 confirmed the internal consistency of the instrument. Finally the results of a principal components analysis identified three constructs that reflected disabilities that are associated with foot pain: functional limitation, pain intensity and personal appearance. The design of the foot disability questionnaire makes it a suitable instrument for assessing the impact of painful foot conditions in both community and clinical populations.