BGS Falls Feet, footwear and falls. Prof. Dawn Skelton Monserrat Conde

Transcription

1 Feet, footwear and falls. Prof. Dawn Skelton Monserrat Conde 18 th International Conference in Falls and Postural Stability Birmingham, 15 th September 2017

2 Summary of session Falls and risk factors The aging foot Foot problems and falls Footwear and falls Foot interventions to prevent falls

3 Major risk factors All fallers (Odds Ratio) History of Falls Gait Problems Walking Aids Use Vertigo Parkinson s Disease Antiepileptic Drug Use Physical Disability Disability in Instrumental Activities in Daily Life Fear of Falling Recurrent Fallers (Odds Ratio) But nothing particularly on All fallers = fell at least once during follow up feet or footwear Recurrent fallers = fell at least twice during follow up N=74 studies, mean age 75, risk factor analysis performed on 31 risk factors studied in at least 5 different studies Deandrea S et al. Epidemiology. 2010;21:

4 Other Risk Factors Prescribed medications / multiple drug regimes Alcohol (>7 units per week) Poor vision (acuity, contrast, depth perception) Multiple conditions and co-morbidities (esp. Stroke, PD, dementias) Continence (urge, frequency, overactive bladder, nocturia) Environment Poor foot health and foot pain Skelton & Todd 2004; ABS BGS 2010; NICE 2012; CDC 2015

5 Gait and Falls Impaired gait (walking) is a prevalent and sensitive risk factor for falling Step length, gait speed, stride length and stance time variability are likely to differentiate between older fallers and non-fallers. Gait instability Tinetti ME, Kumar C. JAMA, 2010; Mortaza et al Eur j Phys Rehabil Med ; Hamacher D et alj.r. Soc. Interface,2011..

6 What happens to our feet as we age? Skin Reduction in plantar skin sensitivity. Soft tissue Slightly thicker More compressible Dissipate more energy Stiffer Thicker plantar fascia Toe nails Brittle onychomycosis Peters RM et al. Neurophysiol. 2016; Murdan S. Int J Pharm. 2016; Cheng et al. J Clin Ultrasound. 2012, Kwan et al. Clin biomech 2010; Hsu et al.. Arch Phys Med Rehab, 1998.

7 What happens to our feet as we age? Age-related changes to muscles Older adults display 32% lower hallux strength 27% lower toe strength 24-37% lower strength in ankle muscles. Uritani et al. J Foot Ankle Res. 2014, Spink et al. Gerontology Spink et al Arch Phys Med Rehabil. 2011; Menz et al, 2006,

8 What happens to our feet as we age? Foot posture Planus foot posture and pronated foot function have been positively associated with numerous foot conditions. More rigid, less propulsive gait. Hagedorn T et al. Plos one, 2013; Arnold JB et al. Gait Posture. 2014

9 Foot function and falls Ankle Foot ROM Strength Sensitivity Proprioception Minimum foot clearance Fall risk Reduced ankle foot function during gait may have a negative effect on balance, stability and ability to perform functional tasks. Mickle KJ et al. JAGS, 2011; Menz HB, Lord SR. JAGS, 2001; Spink MJ et al. BMJ,2011; Machado AS Arch Gerontol Geriatr, 2016; Barrett RS et al Gait Posture, 2016; Menz HB et al J Geront Series A Biol Med Sci,2005..

10 Foot function and falls Toes Toe elevation angle Flexor strength walking speed Single leg support Stride length Impaired balance Fall risk Mickel et al Clin Biomech, 2009; Takatori et al PMR,2015;Endo et al J Geront 2002; Menz et al Foot ank int, 2006;Misu et al J neuroeng rehab,2014;spink et al Arch Phys Med Rehab, 2011; Menz et al J Gerontol A Biol Med Sci,2005.

11 Foot health problems and falls Foot health problems are common in older people. Impaired balance and gait Foot pain Hallux valgus Lesser toe deformity Plantar fasciitis Fall risk Menz et al Foot ank int, Spink et al Arch Phys Med Rehab, 2011; Menz et al J Gerontol A Biol Med Sci,2005; Chaiwanichsiri D. et al Gerontology

12 Footwear features and balance N=29 mean age 79 years Effect of footwear on balance Standard shoe and seven other shoes that differed from the standard shoe in one feature only (namely: elevated heel (4.5 cm), soft sole, hard sole, flared sole, bevelled heel, high heelcollar and tread sole) Significantly increased sway in the elevated heel versus the standard shoe condition A high heel-collar and a hard sole showed trends towards being beneficial to balance Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Gerontology. 2008;54(1):18-23.

13 Footwear and falls Certain types of footwear have been associated to falls High heels Reduced soles contact area Inadequate fixation No shoes Non-slip socks? Inconclusive. Tencer AF et al. J am geriar soc 2004; Menant et al. Gerontology 2008; Sherrington C, Menz MB. Age Ageing 2003, Hartung B, Lalonde M. Geriar Nurs

14 What is the best footwear to prevent falls? A Review Footwear influences balance and the subsequent risk of slips, trips, and falls by altering somatosensory feedback to the foot and ankle and modifying frictional conditions at the shoe/floor interface. Walking indoors barefoot or in socks and walking indoors or outdoors in high-heel shoes have been shown to increase the risk of falls in older people. Based on findings of a systematic literature review, older people should wear shoes with low heels and firm slip-resistant soles both inside and outside the home. Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. J Rehabil Res Dev. 2008;45(8):

15 Foot and footwear Interventions An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42; 1 trial). One trial comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64) but not the risk of falling. Gillespie et al. Interventions for preventing falls in older people living in the community. Cochrane Library 2012

16 Foot and ankle Exercise interventions Australia Multicomponent FA exercise 36% fewer falls. Improvement in strength and ROM Improvement in balance. Spink MJ, Menz HB, Fotoohabadi MR, Wee E., Landorf KB, Hill KB, Lord SR. BMJ 2011; ;342:d

17 Foot and ankle exercise interventions UK Multicomponent FA exercise Small non-sig. reduction in falls. Less multiple falls Increase in foot pain Small benefit in QALY Cockayne S et al.plos One 2017;12(1):1/15 17

18 Foot and ankle exercise interventions UK Multicomponent FA exercise Reduction in falls rate. Wylie G et al. BMC Geriatrics 2017;17:143 18

19 Foot and Ankle Exercise Programs on Reducing the Risk of Falling in Older Adults : Systematic Review and MA 8 RCT s included. Results: Small to moderate overall effects for balance (d = 0.46, P = 0.001) and ankle flexibility (d = 0.29, P = 0.006). No sig. overall effects for ankle plantar flexor strength and walking performance. Conclusions: FA exercise can improve certain fall risk related motor outcomes and reduce falls Adherence? Characteristics of programs? Schwenk et al. JAMPA.2013 Vol103(6): 534:547 19

20 ents/en- GB/Falls/ID201320%20FAW%20 best%20foot%20forward.pdf?dtr k=true 20

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25 DA Skelton. Foot problems and Falls. EMT Conference 2012 Use of elastic bands and other Ankle Inversion Big toe stretch equipment Ankle Eversion Arch exerciser 25

26 Take home messages Fallers have weaker foot and ankle muscles and worse range of motion at the ankle than non-fallers Fallers have more foot deformities and more disabling foot pain than non-fallers Footwear is not that important to falls prevention but indoors people should be advised to wear shoes (not socks or go barefoot) Foot and ankle exercise programs have benefits to fallers. Foot health and footwear assessment should be part of an effective falls prevention service AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons 26

27 Thank you. Monserrat Conde s PhD studies are funded by FCT and MCTES (Reference SFRH/BD/103445/2014) 27

28 What are your thoughts about these exercises? Would you make any changes? Include more? Exclude any? What about progression? Why? 28