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Foot health: A ground-up approach to preventing falls

The Bottom Line

  • Foot-related problems may increase the risk of falls in older adults. 
  • Podiatrists provide assessment, diagnosis, and treatment of problems related to feet. 
  • Podiatry care that tackles foot health from multiple angles, may reduce falls in older adults living in the community.

Having trouble staying upright? If so, make sure your feet are in good health. This ground-up approach might be just what you need to keep your feet firmly planted on the ground.


You’ve heard it before…falls are the number one reason why older adults in Canada end up in the hospital (1). Aside from minor scrapes and bruises, a fall can make you fearful of falling again, and can also lead to serious injury, or even death. Falls—which can happen just about anywhere (2;3;4)—also cost the health care system billions of dollars each year (2;5;6).


There are lots of ways to prevent falls, including exercise, reviewing your medications, or getting your vision checked (2;7;8). Foot health is also important, but this strategy tends to receive less attention…until now, that is. Recently, there has been more research connecting falls to things like foot pain, week muscle strength, poor range of motion in your ankle, and bunions (2;9;10). Shoes can also be a problem, especially if they have a high heal, don’t have a strap, or have little contact with the sole of the foot (2;9-12).


If you’re worried about your foot health, you may want to see a podiatrist. Podiatrists specialize in taking care of feet, and will assess, diagnose and treat lower limb problems to improve your ability to move. Possible treatments include removing unhealthy tissue, surgery, changing footwear, or orthotics (2;13).


In Canada, you don’t need a referral from your doctor to see a podiatrist. And although they are not covered everywhere, podiatric services may be covered, at least in part, by some provincial health plans or by private insurance (14).


But is a visit to a podiatrist a good investment?

What the research tells us

A recent systematic review—the first of its kind—looked at whether podiatry care (or foot care) reduces falls among older adults living in care homes or the community. Few of the studies in the review looked at older adults in care homes, so more firm conclusions can only be drawn for adults living in the community. Three different types of podiatry care were considered: 1) single component care: podiatrist care with insoles or off-the-shelf footwear; 2) multicomponent care: podiatrist care with advice, information, exercises, and footwear and/or orthotics, if needed; and 3) multifaceted care: risk assessment from a multidisciplinary team (a team of professionals from a variety of different specialties) and a referral to a podiatrist. All types of care took place for at least three months and up to two years.


This review showed that both multicomponent and multifaceted care may decrease falls in older adults, although some people did report that they had increased foot pain after one year of multifaceted care. On the other hand, single component care was not effective. What’s more, people using insoles and off-the-shelf shoes reported ankle pain, blisters, and bruises, but these side effects did lessen over time.


As you age, taking care of your feet could improve your chances of staying on them. This means that visiting a podiatrist may be one type of ‘trip’ worth making.

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References

  1. Public Health Agency of Canada. Seniors’ falls in Canada: Second report. [Internet] 2014. [cited May 2019]. Available from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf 
  2. Wylie G, Torrens C, Campbell P, et al. Podiatry interventions to prevent falls in older people: A systematic review and meta-analysis. Age Ageing. 2019; 48(3):327–336. doi: 10.1093/ageing/afy189.  
  3. Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997; 337:1279–1284. doi: 10.1056/NEJM199710303371806.
  4. Rubenstein LZ. Falls in older people: Epidemiology, risk factors and strategies for prevention. Age Ageing. 2006; 35(Suppl 2):ii37–41. doi: 10.1093/ageing/afl084.
  5. Davis JC, Robertson MC, Ashe MC, et al. International comparison of cost of falls in older adults living in the community: A systematic review. Osteoporos Int. 2010; 21:1295–1306. doi: 10.1007/s00198-009-1162-0. 
  6. Tian Y, Thompson J, Buck D, et al. Exploring the system-wide costs of falls in older people in Torbay. UK: Kings Fund, 2013.
  7. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; (9): CD007146. doi: 10.1002/14651858.CD007146.pub3. 
  8. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019; (1):CD012424. doi: 10.1002/14651858.CD012424.pub2.  
  9. Awale A, Hagedorn TJ, Dufour AB, et al. Foot function, foot pain, and falls in older adults: The Framingham foot study. Gerontology. 2017; 63:318–324. doi: 10.1159/000475710. 
  10. Menz HB, Morris ME, Lord SR. Foot and ankle risk factors for falls in older people: A prospective study. J Gerontol A Biol Sci Med Sci. 2006; 61:866–870. doi: 10.1093/gerona/61.8.866.
  11. Mickle KJ, Munro BJ, Lord SR, et al. ISB Clinical Biomechanics Award 2009: Toe weakness and deformity increase the risk of falls in older people. Clin Biomech. 2009; 24:787–791. doi: 10.1016/j.clinbiomech.2009.08.011. 
  12. Sherrington C, Menz HB. An evaluation of footwear worn at the time of fall-related hip fracture. Age Ageing. 2003; 32:310–314. doi: 10.1093/ageing/32.3.310.  
  13. Vernon W, Borthwick A, Walker J. The management of foot problems in the older person through podiatry services. Rev Clin Gerontol 2011; 21:331–339. 
  14. Canadian Podiatric Medical Association. FAQs. [Internet] 2019. Cited May 2019. Available from https://www.podiatrycanada.org/faqs/

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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