HELP PREVENT FALLS IN THE ELDERLY
Biomechanics and prescribing foot orthoses can sometimes be perceived as a treatment modality for the young and sporty. However, increasing research is showing that biomechanical intervention for the elderly can be valuable to help stability, prevent falls and generally improve quality of life. This high-quality research paper looks at how a multifaceted intervention, including biomechanics, can benefit patients.
EFFECTIVENESS OF A MULTIFACETED PODIATRY INTERVENTION TO PREVENT FALLS IN COMMUNITY DWELLING OLDER PEOPLE WITH DISABLING FOOT PAIN: RANDOMISED CONTROLLED TRIAL.
Spink, M., Menz, H., Fotoohabadi, M., Wee, E., Landorf, K., Hill, K. & Lord. S. (2011).
British Medical Journal (BMJ 2011;342:d3411)
This Parallel group randomised controlled trial looked at 305 elderly men and women in the community with disabling foot pain. 153 were allocated to a multifaceted podiatry intervention which comprised foot orthoses, advice on footwear, subsidy for footwear, a home-based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The remaining 152 participants only received routine podiatry care. After 12 months the intervention group experienced 36% less falls than those in the control group.
What it all means:
“Falls in older people are a major public health problem, with 1 in 3 people aged 65 and over falling each year” Essentially, integrating the use of foot orthoses, footwear advice, exercises and education into routine Podiatry care can reduce the risk of falls in the elderly.
• “Foot pain, reduced range of motion, toe weakness, and toe deformity have each been shown to be independent risk factors for falling.”
• Walking barefoot, walking in socks alone, wearing shoes with inadequate fixation (such as no laces, straps, or buckles), increased heel height, and reduced contact area of sole are all risk factors of falling.
• The multifaceted podiatry intervention group benefitted by:
o 36% fewer falls
o Significant improvements in strength (ankle eversion)
o Improved range of motion (ankle dorsiflexion and inversion/eversion)
o Improved balance
• Compliance to intervention was generally good but not perfect!
Putting it into practice:
1. The components of a multifaceted approach are inexpensive and relatively simple to implement, it just needs a little planning and a slight change of practice. Foot orthoses don’t necessarily have to be bespoke with complicated prescriptions, often simple prefabricated orthoses can be hugely beneficial, for example, Bio-Advanced or Bio-Soft - these can also be customised in clinic if required.
2. EDUCATION IS CRUCIAL, as is getting your patient on board with their treatment and what’s required from them. Advice from you, leaflets, booklets…etc… all of these can help to reinforce the message. Giving them foot orthoses is only part of the bigger picture, your patient still needs to do the exercises, buy the right shoes and generally comply with their treatment.
3. Foot and ankle exercises are also crucial. Recent research has shown that stronger intrinsic foot muscles and stronger small ankle joint muscles can improve foot posture and reduce falls and injury.