Introduction to feet and ageing. Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University

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1 Introduction to feet and ageing Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University

2 Looking after your feet to reduce your risk of falling - Webinar 25 th June 2013 Introduction to feet and ageing Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University

3 Ageing effects on the feet Newly diagnosed

4 Ageing effects on the feet Newly diagnosed Skin Nails Bones & Joints Muscles Tendons Ligaments Soft-tissues Arterial system Venous system Nervous system Presence of disease

5 Ageing effects on the feet Newly diagnosed Skin Nails Bones & Joints Muscles Tendons Ligaments Soft-tissues Arterial system Venous system Nervous system Presence of disease

6 Anatomy and function of the foot

7 Anatomy and function of the foot

8 Foot function Joint Range of Motion During Walking 1- Heel-rocker 2- Ankle rocker 3- Toe-rocker Force and pressure distribution during Walking Spatial and Temporal parameters

9 The biomechanical consequences.falls Normal foot function Age related changes Walk with correct timing and spacing + Move joints with sufficient range, direction and timing + Generate sufficient muscle force and joint power + Distribute pressure effectively across the foot Compensation

10 Ageing effects on bones and joints Newly diagnosed Decreased bone mineral density Joint space narrowing Loss of articular cartilage Osteophyte formation Deformity Reduced / loss of function A C B

11 Ageing effects on muscles and tendons Decreased muscle mass Decreased muscle strength Flexion deformities Atrophy of interossei muscles digital deformity

12 Achilles tendinopathy

13 Achilles tendinopathy

14 Achilles tendinopathy

15 Achilles tendinopathy

16 Ageing effects on soft tissues Newly diagnosed Atrophy of fat pad Displacement of fat pad Reduced elasticity Increased stiffness Increased risk of injury

17 Why walking on pebbles A B C D

18 Ageing effects on vascular system Taken from - Your Risk of Heart Disease. How to Turn Back the Clock When Your Blood Vessels Grow Old Before You Do. Ron Winslow. Intermittent claudication Newly diagnosed Rest pain Loss of hair Skin colour & temperature changes Impaired wound healing

19 Ageing effects on venous system Newly diagnosed understanding_venous_reflux_disease.html

20 Ageing effects on Skin Newly diagnosed Thinning of skin Lower oil secretion - Dryer itchy skin Pigmentation changes Reduced strength Reduced elasticity

21 Ageing effects on nails Thickening of nails Newly diagnosed Increased prevalence of fungal infections Trauma to nail bed nail pathologies Difficulty cutting nails ingrowing toenails Neglect

22 Ageing Summary table Structure Age related change Impact Newly diagnosed Bones and joints Fat pad Osteopenia, osteoarthritis Atrophy of fat pads Fat deposition around ankle Increased risk of fracture, pain, reduced movement in joints, deformity Pain under heel and forefoot Reduced movement at the ankle Muscles Reduced muscle mass Reduced muscle strength, impact of gait style Ligaments Tendons Less elastic, stiffer, reduced proprioceptive function Changes in tendon structure - collagen More prone to injury Widening of forefoot and lowering of arch Decreased tensile strength, tendinopathy, increased risk of rupture,

23 Ageing Summary table Structure Age related change Impact Newly diagnosed Skin Thinner, drier Less compliant and resilient Prone to cracking, callus, ulceration formation Nail Thicker, brittle Difficult to cut, more prone to ingrowing toenails, onychomycosis Arterial system Venous system Loss of artery compliance Changes in resistance Arteriosclerosis Decreased elasticity (less elastic tissue and collagen cross-linking) Incompetent valves, backflow and increased venous Higher blood pressure Orthostatic hypotension Reduced blood supply, loss of hair, dystrophic nails, pain, impaired healing, ulceration Varicose veins Oedema limited joint movement Hemosiderin deposition, stasis dermatitis, ulceration

24 Thank you for your attention Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University

Localized collection of pus in a cavity

Localized collection of pus in a cavity Loss of feeling or sensation induced to permit surgery Common example: Injection given to numb up the toe prior to performing an ingrown toenail procedure Mechanical