Unsafe Footwear Impairs Balance and Increases the Risk of Fall

Safe shoes fit securely and has non-slippery soles
Safe shoes fit securely and has non-slippery soles

Elderly who fell and injured themselves often were found wearing inappropriate shoes.

In “The Guideline for the Prevention of Falls in Older Persons”, both American Geriatric Society and British Geriatric Society have pointed out inappropriate footwear as a major cause of concern.

Whether indoor or outdoor, unsafe footwear can cause loss of balance and bad gait. The risk of falls is especially high for elderly whose muscular strength and balance are already impaired.

What kind of footwear increase the risk of falls?

Evidences collected by researchers show that falls were often associated with the following kinds of shoes:

  • Loose, worn or backless slippers. These are one of the most common causes of older people falling.

    Open-backed slippers and slip-on shoes are not safe for elderly
    Backless slippers and slip-on shoes are not safe for elderly
  • Poorly fitting shoes. To accommodate painful feet, some elderly like to wear soft and/or overly long and wide shoes.
  • Slip-on shoes, such as sling backs or flip flops and shoes without fasteners.
  • Shoes with poor grip or worn soles can cause you to slip especially on wet surfaces.
  • Shoes with minimal contact with the ground, such as high heels, can make your foot unstable and can cause your ankle to turn.

Wear Proper Shoes to Prevent Falls

People of all ages should understand the importance of wearing well-fitting shoes, and wear suitable shoes for a particular activity. One of the main causes of foot problems such as bunions and corns is badly-fitting shoes.

Apparently, three out of four people over the age of 65 wear shoes that are too small. Perhaps it is because we did not realise our feet actually get bigger as we age. Besides, the feet and ankles may become swollen because of chronic medical conditions.

It is often a combination of foot problems and inappropriate footwear that increases the risk of falling.

What are the characteristics of safe shoes?

  • It should fit well and neither too loose or too tight on the feet. Some people may need footwear specially made to accommodate and protect swollen feet and ankles.
  • It has a high back or collar to support the ankle.
  • The sole is firm and not too thick for better sensation of foot position.
  • The sole is slip resistant with tread for good grip.
  • A low square heel which is not more than an inch to improve stability.
  • Adjustable fastener – laces or buckles or Velcro – on the front so that it won’t slip off easily.

Indoor footwear

As mentioned earlier, elderly should avoid loose, backless slippers. It is recommended that older people wear close-backed, well-fitted, slip-resistant slippers or house shoes indoors. A house-shoe offers the comfort of a slipper, but with the stable support of a shoe.

A wide opening makes it easier to get your foot in and out of the slipper which is important if you have swollen feet. But make sure it can be strapped down securely so that it won’t slip off easily.

Do not walk bare-footed or in socks or stockings.

For some cultures and in hot climate, folks may prefer to walk bare-footed at home. However, it has been shown that a proper pair of shoes provide more grip than bare feet and enhance walking stability. Shoes also protect the feet from mechanical injuries.

Get help

Podiatrists, also called chiropodists in UK and Ireland, are foot care specialists. Ask your doctor to refer you to one if you have pain or any other foot problems.

Your podiatrist can help you choose suitable shoes and orthotic inserts if you need them.

Diabetes sufferers will benefit from seam-free footwear made to avoid rubbing, which can lead to ulcers that are difficult to heal. In UK, specially fitted footwear can be purchased free of VAT if the wearer has a chronic medical condition such as diabetes. You should be able to get further information about this from a podiatrist as well.

 

 

Further Reading:

Menant J, Steele J, Menz H, Munro B, Lord S (2008). Optimizing Footwear for Older People at Risk of Falls. Journal of Rehabilitation Research & Development, 45(8), pp. 1167–1182.

 

Plantar Fasciitis and Helpful Remedies

A friend phoned and said doctor told her she has plantar fasciitis in her right foot. “The pain is killing me,” she said. “Could be the walking.”

She has recently taken up walking exercise and strength training, and has been very enthusiastic about it.

So, what is plantar fasciitis?

Plantar fasciitis is a foot problem that results in pain and stiffness in the bottom of the foot, usually in the heel. The pain is most unbearable when you climb stairs or standing still.

Plantar fascia is the ligament joining the heel to the toes
Plantar fascia is the ligament joining the heel to the toes

What causes plantar fasciitis?

Despite advance medical science, the cause of plantar fasciitis is not very clear.

The plantar fascia is the ligament that connects the heel to the front of the foot (runs under the arch of your feet). It supports the arch of your foot and helps you walk.

In plantar fasciitis, the ligament is damaged by tiny tears and breakdown of collagen. It is the result of repetitive injury of excessive straining. The damage is most significant where the plantar fascia joins the bones, especially the heel bone.

Some known risk factors include standing, walking, running over long period, especially on hard surfaces. Flat feet, high arch, inward rolling of the foot, a tight Achilles tendon or calf muscles, pregnancy and obesity have also been blamed.

Wearing shoes with poor sole and arch support when you do training can also result in plantar fasciitis.

Although heel spur, a small bony calcification on the heel bone, is found in up to 50% of those with plantar fasciitis, it is not the cause of heel pain.

Who are likely to suffer?

Plantar fasciitis is a common cause of heel pain. One in ten people are affected at some point of their life, especially people between 40–60 years of age.

The condition tends to happen to people whose occupations or sports put a lot of stress and strain on their feet. They include: teachers, shop assistants, catering staff, factory workers, ballet dancers, soldiers, athletes, long distance runners etc. It seems more common in women.

What are plantar fasciitis symptoms?

Plantar fasciitis causes pain to the heel or arch
Plantar fasciitis causes pain to the heel or arch

Typical symptom of plantar fasciitis is sharp heel pain. It usually affects just one foot but may happen to both feet. The pain is most acute in the first few steps after getting out of bed, or after sitting down for some time. The pain may ease off when you continue walking. Symptoms of numbness, tingling, swelling, burning, or radiating pain have been reported but they are rare.

Although heel pain is the most common complaint, we may have pain in the ball of the foot and along the arch too. It hurts most when climbing stairs or standing for a long time.

Common plantar fasciitis treatments

If you have foot pain, please go to see your doctor or a podiatrist to get a proper diagnosis. It is important to differentiate plantar fasciitis from other foot complaints such as arthritis or stress fracture.

In most cases, plantar fasciitis will improve with rest and conservative treatment. There isn’t a best treatment applicable to everybody. You may find relief from a combination of remedies. And it may take several months for the symptoms to clear.

To start with, rest and stay off your feet if possible. You should stop or reduce the activity which brought on the problem. In the acute stage, apply cold compress to the sore area for 15 to 20 minutes, three or four times a day may help to reduce pain and swelling.

Stretching the plantar fascia and Achilles tendons is a recommended treatment for plantar fasciitis. You can get help from a physical therapist for this. He or she can also teach you plantar fasciitis exercises to strengthen your calf muscles, to stabilize your walk and lessen the workload on your plantar fascia.

You can wear a night splint to stretch the Achilles tendon and plantar fascia. This can help prevent pain and stiffness in the morning.

Inappropriate footwear is often the culprit of foot problems. You must wear shoes that have good arch support and heel cushioning.

Orthotic or shoe insert for arch support may be helpful. It is designed to alleviate the pain, and reduce the strain on the ligament to prevent further damage. If the pain is specifically in the heel, a gel heel cradle can be worn to cushion and support the heel.

A boot cast can be worn to immobilize the foot and reduce strain, thus allow the plantar fascia to heal. You can take the boot cast off when you need to, for example, to take a shower.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, may help to relieve the pain. You should ask for medical advice if there is any worry about allergies or contraindications.

If the problem has not improved after trying all the above for several months, your doctor may recommend other options:

  • steroid injection
  • platelet-rich plasma injection
  • extracorporeal shockwave therapy
  • Tenex procedure

Surgery is the last option when all else failed to stop pain. But it must weigh against the unwanted side effects of weakening the arch of the foot.

 

If you ignore the condition and not getting treatment or rest, further strain can rupture the plantar fascia. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.

You can develop chronic plantar fasciitis from recurring acute attacks. This can change the way you walk and cause injury to your legs, knees, hips, and back.

Therefore, it is wise to stay with some of the preventative remedies even when all the symptoms have cleared.

Foot Problems Increase the Risks of Falling

Foot problem can increase the risk of fallingCommon symptoms of foot problems are pain, swelling, redness, tingling and numbness of one or both feet. Many of us probably have experienced some or all of above. It takes a lot of grit to walk with blisters, right?

Whether causing pain or numbness, foot problems can affect our balance and change the way we walk. It increases the risk of falling and injuries which the elderly are particularly vulnerable.

Our feet are small compared to our body that they have to support. Every footfall and every step we take is a big stress on the bones, joints, muscles, ligaments and tendons. Just imagine the wear and tear of our poor feet after decades of standing, walking, jumping and running.

Like other parts of the body, our feet change as we grow older. The padding under the heel and the ball of the foot wears off gradually. The arches are flatter and less flexible, and the ankles and joints become stiff. We need bigger size shoes because the feet are wider and longer. Because of these changes, we may develop foot pain and other problems. Apparently, one in three people over the age of 65 has foot pain, stiffness, or aching feet.

 

Pain

Foot pain are caused by a number of conditions such as arthritis and gout. The most common ones seen in older adults are listed below.

Fractures or small crack can happen to anyone of the 26 bones of the foot, especially the toes. This is often caused by overactivity or change in activity such as trying a new exercise. People with osteoporosis are particularly vulnerable.

Bunions develop when the joints in the big toe (sometimes the small toe) are out of alignment. Eventually, the toe bends abnormally inwards and becomes swollen and tender. Bunions tend to run in families. In the early stage, the pain may be relieved by wearing shoes wide at the instep and toes, taping the toes, or wearing cushion pads. Severe cases require surgery to relieve the pressure and repair the toe joint.

Calluses and corns are dead, yellowish, thickened skin found on toes or the ball of foot. It is caused by friction and pressure when the feet rub against the shoes. Wearing better fitting shoes may be the answer. Over-the-counter medicines for treating corns contain acids that destroy the tissue but do not treat the cause. It is safer for the elderly, especially those with diabetes or poor circulation, to get help from a podiatrist or chiropodist.

Hammertoes is caused by shortening of the tendons at the toe joints. Usually the second toe is affected but it may happen to other middle toes too. The toe

Hammertoes cause pain and imbalance
Hammertoes cause pain and imbalance

curls up with a rigid or flexible joint, which becomes bigger and stiffer as it rubs against the shoes. Hammertoes can affect walking and balance and lead to other foot problems. It may run in families but the usual culprit is pointed and badly fitting shoes. Splinting and corrective footwear are helpful. In very serious cases, surgery may be needed.

Ingrown toenail occurs when part of the nail grows into the flesh causing pain and bleeding. It usually affects the large toes and is the result of not cutting the nails properly. The nail can be removed safely by a foot specialist and the damaged tissues allowed to heal. Ingrown toenails can often be

Ingrown toenail is a common cause of foot pain
Ingrown toenail is a common cause of foot pain

avoided by cutting the toenail straight across and level with the top of the toe.

Heel pain is usually caused by heel spurs or plantar fasciitis. A heel spur is a bony protrusion of calcium deposits on the underside of the heel bone. Plantar fasciitis is inflammation of the connective tissues that join the heel bone to the toes. These two conditions are often related. They are caused by over straining of the muscles and ligaments from: long periods of standing/walking/ running, wearing badly fitting shoes, or being overweight. Helpful treatments include foot supports, heel pads, heel cups, and physiotherapy. Sometimes surgery is needed.

 

Swelling

Our feet can become swollen after standing or sitting for long periods. It is because of blood pooling in the lower part of the body.

A sprained ankle is swollen and painful because you might have torn a ligament or tendon. Another likely cause of swelling is stress fractures.

But swollen feet and ankles can be due to chronic heart and vascular diseases, kidney diseases, and obstruction of the lymphatic system. Therefore, if your feet swell excessively and there is no history of injuries, you must see your doctor right away.

 

Numbness and pins-and-needles sensation

Numbness and/or pins and needles sensation of the feet is related to nerve problems of many underlying causes. If your gait becomes unstable and you can’t feel the ground because of the numbness, you are at risk of falling.

Some of the common causes are:

  • A pinched nerve, for example, a herniated disk in the lower back.
  • Blood supply to a nerve in the foot is reduced or cut off as a result of peripheral artery disease (PAD). As well as foot numbness, the leg may be cold and painful.
  • Peripheral neuropathy is a complication of diabetes; as a result, the patient loses sensation in their feet.
  • Numbness can also be related to other neurological disorder such as Multiple Sclerosis, stroke, or long-standing alcoholism.

 

A podiatrist or chiropodist is a trained specialist in footcare. He or she can diagnose your foot problem and advice the appropriate treatment. Most foot problems can be treated effectively, often as simple as a new pair of shoes.

Do you have pain, or swelling, or numbness in the feet? Or foot problems such as bunions, hammertoes or corns? If so, don’t suffer needlessly, go see a podiatrist.

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