Foot disorders and falls in older persons.
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.
Chaiwanichsiri
Dootchai
D
Department of Rehabilitation Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand. dootchai@hotmail.com
Janchai
Siriporn
S
Tantisiriwat
Natthiya
N
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005530:Foot Deformities / Q000453:epidemiology / Q000503:physiopathology*; D005534:Foot Diseases / Q000453:epidemiology / Q000503:physiopathology*; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D012775:Shoes / Q000009:adverse effects / Q000706:statistics & numerical data; D020886:Somatosensory Disorders / Q000209:etiology*; D013785:Thailand / Q000453:epidemiology; D016138:Walking