Author: Brian McCurdy, Podiatry Today
Severe foot pain and planus posture leave patients at a higher risk of falling, according to a recent study in Gerontology.
The study, focusing on 1,375 patients with a mean age of 69, found that 263 patients related one fall in the past year and 152 patients had two or more falls. Researchers note that foot pain was linked with a 62 percent greater risk of recurrent falls and patients experiencing moderate or severe foot pain had higher odds of two or more falls. In addition, the study notes that patients with planus foot posture have a 78 percent higher risk of falls while foot function had no association with falls.
In his practice, Doug Richie, DPM, FACFAS, has found patients with foot pain have significant impairment of balance.
“This is obvious when we watch (patients) walk but more dramatic when asking them to perform specific balance tests such as the modified Romberg test where they stand on one foot with arms folded and close their eyes,” says Dr. Richie, an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif.
David G. Armstrong, DPM, MD, PhD, acknowledges the long-held idea that instability is a driver of fear of further movement and can increase the risk for falls. The study lends “strong evidence to the fact that what we do in podiatric medicine and surgery can have a profound impact in stabilizing that thing that’s closest to the ground,” according to Dr. Armstrong, an incoming Professor of Surgery at the Keck School of Medicine at the University of Southern California and the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
As for planus foot posture, Dr. Richie notes the older patient with adult-acquired flatfoot clearly demonstrates balance impairments with clinical testing. Anecdotally, he has found this patient population will report more falls than the average older patient in his practice. As for all patients with planus foot types, Dr. Richie has not seen a trend toward increased fall risk in his own patient population unless those patients also have pain. He notes research has shown that patients with various foot postures and a planus foot type have compromised dynamic balance.
Patients with foot pain and planus foot posture demonstrate weakness of the ankle, which Dr. Richie says compromises their “ankle strategy” to maintain upright posture.
“Strengthening all the lower extremity muscles from the hip down can definitely improve balance over time. Balance training with a wobble board or other devices will also improve postural control in all patient populations,” notes Dr. Richie.
When most clinicians think about instability, Dr. Armstrong feels they focus on the brain or the head and neck, and do not think very much about the foot and ankle. He says the recent study highlights the need for focusing on the lower extremity in preventing falls.
As for older patients with foot pain, Dr. Richie notes studies have shown that specific strengthening of the toe flexors combined with the use of customized foot orthoses can reduce fall risk. To reduce falls in his own clinical practice, he commonly refers elderly patients to a qualified physical therapist for balance training and makes specific footwear recommendations, including requiring patients to wear shoes at home. Finally, Dr. Richie implements custom foot orthotic therapy to improve balance in elderly patients with foot pain and abnormal foot posture.