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Friday, August 13, 2010

Why do we fall: Falls. Foot Care and Footwear

Ageing brings change to the way we walk. We begin to slow down spending more time with both feet on the ground. There is a marked increase in body sway which promotes instability. The angle of toe clearance gets smaller and the lower angle of the foot at take off, the easier it is to catch unseen objects. These changes are made more obvious with arthritis or painful knees, hips, neck and spine. Balance problems and blood pressure also add considerably to the safety of walking as does failing eyesight and sore feet. Men slip and ladies trip. Less frequently misplaced steps such as standing in a hole, legs giving way, or loss of balance can also cause falls. Inattentiveness or not taking time are also contributory factors. Experts believe most falls in the lederly are preventable and the more care you take the less likely you will have a fall.
One in four people aged 60 plus will have a fall in the year. One fall can be the beginning of a falls career and the associated injuries are a leading cause of hospitalisation in older people. Men slip and women trip. Anyone can fall but those living with long term conditions such as heart conditions, diabetes, Parkinson’s disease, arthritis, osteoporosis, high/low blood pressure, depression and dementia do have an increase the risk of falling. Sore feet can also lead to unsteadiness, poor posture and imbalance. Things which contribute include: muscle or joint stiffness, poor vision, pain and lack of energy and or concentration. Inattentiveness or not taking time is also contributory factors. Consequently most falls are preventable and the more care you take the less likely you will have a fall.

Prevention includes maintaining a healthy lifestyle, keeping physically fit, being mentally alert as well as being involved in a social network. Most falls are caused by personal issues such as life style; physical and mental state; and environmental hazards. Reduce falls risk by staying mobile and improve movement in joints. Be active and strengthen muscles. Improve walking patterns and balance and monitor your medications. Physical activity helps maintain leg and hip strength and ankle flexibility. It also improves bone strength and slows osteoporosis. Regular exercise increases cardiovascular stamina, assists joint movement and stability as well as improve balance, co-ordination and walking patterns. Increased energy levels helps maintains a healthy weight and improve sleep patterns. Putting together 30 minutes per day is enough. If you have a medical condition chat to your doctor first.

The best kinds of activity are those which use all parts of the body like walking, swimming and dancing. So too is active gardening, housekeeping and walking the dog. There are many walking groups like Walk there today  to find thirty. Activites which focus on balance include: tai chi, yoga, pilates; and for strength training and fitness try aerobics or acqua-aerobics.

Sore Feet
Many people accept sore feet come with age but that is not always true. A high percentage of first time fallers have foot problems. The vast majority are women and many recurrent fallers are more likely to suffer foot problems. A routine vist to the podiatrist can put paid to more recurring foot ailments.

Monitor your medications and eyesight
Make a list and know what medication you are prescribed form your doctor and what they are for. All medicines have side effects and sometimes these can affect balance. Talk to your GP or pharmacist if you experience:
• Drowsieness
• Dizzieness
• Light headedness
• Unsteadyness
• Blurred or double vision
• Difficulty thinking clearly

Have your medicines reviewed regularly and check for any interactions with no prescribed drugs you may be taking .

Eat healthy
• Eat a wide variety of nutritious foods
• Drink alcohol in moderation

Stop smoking

Poor balance accounts for upt to 25% of falls among elderly people. . Factors that can effect balance include:

• Loss of muscle strength
• Reduced joint mobility and stability
• The side effects of some medicines
• Ear problems
• Sudden movements particularly rising quickly (postural hypertension)
• Post hip and knee replacement

Footwear
According to Menz, Morris and Lord (2009) footwear characteristics were not significantly associated with falls either inside or outside the home. They found falls were associated more with going barefoot or wearing socks only indoors. Menant et al (2008) found elevated heels of 4.5 cm height did significantly impair balance in older people. The potential benefits of wearing shoes with a hard sole or a high heel-collar on balance in older people warrant further research in ambulatory tasks. Based on findings of a systematic literature review, older people should wear shoes with low heels and firm slip-resistant soles both inside and outside the home. Further findings suggest older adults are slower terminating gait rapidly than their younger counterparts and that footwear is likely to influence whole-body stability during challenging postural tasks on wet surfaces.


Whilst the characteristics of shoes have been shown to influence balance in older people, the relationship between footwear and slips, trips and falls is still  unclear. According Menant et al (2008) the relationship between changes to the somatosensory feedback from foot and ankle combined with modifying frictional conditions at the shoe/floor interface many be related. To date however no one is sure which shoe features are beneficial or detrimental to balance in older people. Always wear well fitting shoes which is appropriate to the activity.
According to Chari et al (2009) athletic and canvas shoes (sneakers) were the styles of footwear least associated with falls in older adults during everyday activities. Going barefoot or in stocking feet was associated with sharply increased risks .Bare feet might provide better slip resistance than socks or stocking feet but previous studies have associated barefoot mobilisation with increased falls in the elderly.


Common hazards inside include:
• Slippery floors
• Clutter or obstacles on the floor
• Loose mats or scatter floors
• Different floor surfaces

Hazard outside are:
• Uneven paths
• Clutter
• Poorly lit areas
• Wet surfaces

What to do if you fall
  • Don’t panic
  • Check for serious injury
  • Get up slowly and safely
  • If seriously injured call for help / ambulance

Further Reading
Chari S, Haines T, Varghese P and Economidis A. (2009) Are non-slip socks really 'non-slip'? An analysis of slip resistance BMC Geriatrics 2009, 9:39doi:10.1186/1471-2318-9-39.
Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, Frankenfeld CL, Tautvydas M, Larson EB. Footwear style and risk of falls in older adults.
Menz H.B., Morris M.E., & Lord S. R. (2009) Footwear Characteristics and Risk of Indoor and Outdoor Falls in Older People Gerontology.
Menant JC, Steele JR, Menz HB, Munro BJ, & Lord SR. (2008) Effects of Footwear Features on Balance and Stepping in Older People. Gerontology. 2008 Feb 4 [Epub ahead of print]
bMenant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev. 2008;45(8):1167-82.
cMenant JC, Steele JR, Menz HB, Munro BJ, Lord SR. (2009) Rapid gait termination: Effects of age, walking surfaces and footwear characteristics.Gait Posture. 2009 Apr 7. [Epub ahead of print]
Tencer AF, Koepsell TD, Wolf ME, Frankenfeld CL, Buchner DM, Kukull WA, LaCroix AZ, Larson EB, Tautvydas M. Biomechanical properties of shoes and risk of falls in older adults.

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