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Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role of podiatry in these clinics has not been clearly defined. The aims of this study were to determine the level of podiatric involvement in multidisciplinary falls clinics in Australia and to describe the assessments undertaken and interventions provided by podiatrists in these settings.
Methods: A database of falls clinics was developed through consultation with departments of health in each state and territory. Clinic managers were contacted and surveyed as to whether the clinic incorporated podiatry services. If so, the podiatrists were contacted and asked to complete a brief questionnaire regarding their level of involvement and the assessment procedures and interventions offered.
Results: Of the 36 clinics contacted, 25 completed the survey. Only four of these clinics reported direct podiatric involvement. Despite the limited involvement of podiatry in these clinics, all of the clinic managers stated that they considered podiatry to have an important role to play in falls prevention. Podiatry service provision in falls clinics varied considerably in relation to eligibility criteria, assessments undertaken, and interventions provided.
Conclusions: Despite the recognition that foot problems and inappropriate footwear are risk factors for falls, podiatry currently has a relatively minor and poorly defined role in multidisciplinary falls-prevention clinics in Australia
I worked with Falls Prevention (Stay on your feet WA), Injury Control Unit in Perth for many years as they were introducing their Falls prevention strategies. Very interesting it was too but what was disappointing was during the podiatry phase when local pods were openly invited to contribute ideas on the role of the podiatrist in the prevention of falls, there was a very disappointing return. Only a few individuals assisted and dedicated their time to the project but otherwise nothing.
I was particularly interested the other day to read the new brochure on Stay on your feet WA which boldly promotes the services of podiatry.
BACKGROUND: Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people.
METHODS: Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual care" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle.
DISCUSSION: This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use.
Background: Fall rates are high among older people even in the healthy population. An aging foot may affect ambulatory function and increase the risk of fall(s).
Objective: To study foot musculoskeletal disorders, falls and associated factors in healthy elderly subjects. Methods: Healthy volunteers aged 60-80 years who were independent in self-care and walking were recruited from urban Bangkok. Trained physicians evaluated health status, foot problems, and fall(s) history of all subjects. Walking performance was assessed using the 'Timed Get Up & Go' test and 6-m walking speed. Footprints were taken from the standing position. Foot dimensions and footwear were also measured by certified orthotists. Associated factors of foot disorders and falls were analyzed.
Results: There were 213 subjects: 108 men, 105 women with a mean age of 68.6 +/- 5.4 years. Foot deformities presented in 87% and were not significantly associated with walking performance or falls. Foot pain was found in 14% with a male:female sex ratio of 1:4. The causes of pain were plantar fasciitis, hallux valgus, callus, metatarsalgia, and inappropriate footwear. Subjects with foot pain had slower walking speed (1.14 +/- 0.12 vs. 1.19 +/- 0.12 m/s, p = 0.056). Falls were reported in 29.5% of women and 12.9% of men (p = 0.004). Multivariate analyses demonstrated that fall risk factors were female gender (OR = 2.4, 95% CI = 1.13-5.12), plantar fasciitis (OR = 6.8, 95% CI = 1.52-31.02), and knee osteoarthritis (OR = 3.6, 95% CI = 1.71-7.59). Subgroup analyses revealed that visual deficit was associated with falls in women (OR = 4.7, 95% CI = 1.75-12.73), and impaired foot protective sensation was associated with falls in men (OR = 5.1, 95% CI = 1.46-18.38).
Conclusions: Aging foot deformities presented different characteristics among genders and were mostly asymptomatic. Foot pain, especially from plantar fasciitis, increased risk of falls in healthy older persons. Foot assessment, foot pain management, and proper footwear play important roles in fall prevention.
Podiatry involvement in falls prevention
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