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.

More Seniors Fell Over Throw Rugs Than Ice and Snow

Ice and snow in winter are fall risks
Icy ground (Image: Pixabay)

Many of us would have no doubt that ice and snow are significant fall risks. Hence, we would think that fall injuries such as fractures are more prevalent in the winter months. But apparently, this assumption is wrong!

A recent study1 shows that a majority of falls occur during the warm months of May through October, and most of the falls happened indoors rather than out.

In this study, the circumstances of 544 patients treated at The Hospital of Central Connecticut for hip fracture from 2013 to 2016 were analysed.

The results show that:

  • More than 55 % of hip fractures occurred during the warm months of May through October. Significantly, May (10.5 %), September (10.3 %) and October (9.7 %).
  • Most hip fractures occurred indoors ((76.3 %), with only 23.6 % happened outside.
  • Outdoor fractures – More than 60% happened during the warm months. The leading cause was tripping over an obstacle, followed by accident  involving a vehicle and falling on or down stairs.
  • Indoors fractures – More than 56% happened during warm months. The leading cause was tripping over an obstacle (especially throw rugs), followed by falling out of bed.

Because the study was centred at just one hospital in a particular location, therefore the results are not necessary representative nationally. However, we can still learn something from it.

Firstly, obstacles in the path of movement is the main fall risk whether indoor or out. Therefore, it is important to make sure the floor or ground is clear of clutters.

Secondly, we are reminded again that most falls happened at home.

Thirdly, since throw rug was singled out as the leading cause of fall, shouldn’t it be banished from our home? And replaced with something more secure? Carers of elderly should take note.

Final thought: Most seniors probably prefer to stay indoor during the winter months. Having fallen several times on icy roads and pavements in the past, I definitely won’t venture out when the weather is not agreeable. This probably explains why icy ground and snow are not big fall risk factors. What do you think?

 

 

Notes

  1. A preliminary study presented at the 2017 annual meeting of the American Society of Anesthesiologists in Boston. Study author Dr. Jason Guercio.

Keep Active and Strong

Yoga
Practicing Yoga (Pixabay)

We lose some muscle mass naturally as we grow older, that explains the declining muscle power and strength in the elderly. This problem gets worse if we lead a sedentary lifestyle or become bedridden due to illness.

But being old does not equate with weakness and frailty. Numerous studies have shown that regular physical exercise and strength training can help to build bone and muscle mass and improve our overall health and quality of life.

The muscles are strengthened when you lift or push against weight. This can be achieved by exercising with weights, or daily activities such as lifting and

Digging in the garden
Digging in the garden (Pixabay)

carrying groceries, mowing lawn, digging the garden or vacuuming.

Strong muscles improve balance and make it easier to perform everyday activities – climbing stairs, getting out of car, carry groceries, walking dog etc. –  with less risk of falling.

However, millions of people are letting their muscles wasting away. Based on a recent survey of over-65s in UK, the Chartered Society of Physiotherapy (CSP) said that nearly a quarter of elderly do not do muscle strengthening activities at all.

The internet age lifestyle is a big threat to our health. People are glued to their smartphones and reluctant to move. And they don’t have to leave home to get food or carry groceries!

This trend is worrying as we record more falls each day. Fall results in pain and injuries, and possibly death. A majority of hip fractures were suffered by elderly who fell, and it is costing the National Health Service around £1bn each year.

To prevent fall and stay healthy, NHS Choices1 recommends seniors who are generally fit and with no limiting health conditions to do:

  • at least 150 minutes of moderate aerobic activity such as cycling or walking every week
  • strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)

The strength exercises that you can do at home or in the gym include:

Strength exercise with weights
Strength exercise with weights (Pixabay)
  • exercise with weights
  • exercise with resistance bands
  • exercises that uses your own body weight, such as push-ups and sit-ups
  • vacuuming, digging and shovelling in the garden
  • carrying heavy load such as shopping
  • yoga

Seniors who have not done any exercise before must get advice from their doctors first. You should also get help from a physiotherapist who will guide you through exercises that fit your physical conditions.

 

Note

  1. http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-older-adults.aspx

Are You Ready for Tai Chi?

Group practice of Tai Chi
Group practice of Tai Chi

Tai Chi or Taiji, is a form of Chinese martial arts. It is a popular exercise usually practiced for health, although it can be used in combat too. It helps to improve muscular strength, balance and coordination.

Tai Chi is characterized by slow flowing movements, relaxed but mindful, almost like meditation in motion.

In China, you often see people practicing Tai Chi in parks or any open spaces, individually or in group. In recent years, it has also become popular in the West as more people become interested in holistic therapy.

Benefits

Tai Chi is a mind and body exercise. It is not just about physical movement, in fact, the emphasis is more on intention (意). During practice, the intention leads the body and the mind totally focuses on the actions, so that the brain is free from interference of other distractions. The meditative effect promotes self-awareness, and helps to enhance the regulatory functions of the nervous system.

Although Tai Chi can be practiced at any age, it probably suits the temperament of middle age or older people more. For the seniors, practicing Tai Chi regularly are rewarded with a number of benefits:

  1. Improve muscular strength and flexibility of the joints. Although a low-impact exercise, the slow movements work on a large group of muscles, accompanied by bending, turning and squatting.
  2. Improve balance and coordination thus decreases the risk of falls. According to published studies*, seniors who practiced Tai Chi were less likely to fall and sustained injuries than those who did not.
  3. Tai Chi is effective in improving balance control and flexibility for people with Parkinson’s disease.
  4. Tai Chi can prevent osteoporosis by reducing the rate of bone density loss.
  5. It is an aerobic exercise. During actions, the deep rhythmic abdominal breathing increases lung capacity and oxygenation of blood.
  6. It improves blood and lymphatic circulation.
  7. The meditative nature helps to reduce stress and improve mental health and sleep quality.

Brain health

Tai Chi has been shown to have positive impact on brain health such as increasing the brain volume and slowing the progress of cognitive decline. But study in this area is quite limited.

Recently, a new research project which aims to find out whether Tai Chi benefits people with dementia has been announced. The project – The TACIT Trial: TAi ChI for people with demenTia, is led by Dr Samuel Nyman at Bournemouth University, UK.

“This is the first trial of Tai Chi with people with dementia in the UK. It is also the first trial in the world to include assessments to see how Tai Chi might help with people with dementia’s balance and help prevent them from falling,” said Dr Nyman.

Girl practicing Tai Chi
Girl practicing Tai Chi

You can learn Tai Chi by attending classes offered by qualified instructors. They are usually available in community centres, health clubs and fitness centres. Since no special equipment is required, once you have learned the moves, you can practice anywhere, indoor or outdoor, alone or in group.

Before starting any new exercise programme, it is wise to check with your doctor whether there is any contraindication or particular caution you should take.

 

Note.

* “Tai Chi for risk of falls. A meta-analysis.” Rafael Lomas-Vega, Esteban Obrero-Gaitán, Francisco Javier Molina-Ortega, and Rafael del-Pino-Casado. Journal of the American Geriatrics Society; Published Online: July 24, 2017 (DOI: 10.1111/jgs.15008).

Alcohol Misuse Among Elderly

Elderly alcohol misuse is a hidden health problem
Elderly alcohol misuse is a hidden health problem (Image: Pixabay)

There is a rising problem of alcohol misuse among the elderly. Recent studies show that the over 65s in Britain and elsewhere drink more heavily than previous generations of seniors.

Alcoholism is associated with many medical, social and economic problems. Older people who drink heavily also subject themselves to fall injuries, dementia, liver disease, heart disease and brain damage.

The Facts

UK national guidelines advise no more than 14 units of alcohol a week for women and 21 units a week for men. But a study on the drinking habits of people aged over 65 in an inner-city population in London found that 1 in 5 people drank more than the recommended limits. Among the 5% heavy drinkers, men were consuming more than 49 units a week, while women 23 units a week. Independently, data obtained by Health Survey for England 2015 revealed fairly similar alcohol consumption figures among older people.

Elderly who drink excessively put themselves at risk of falls and fall injuries as well as many other medical conditions such as dementia, brain damage and liver disease. In the past decade, more over-65s were being hospitalised with alcohol related problems, adding great pressure on the National Health Service.

The problem is not unique in Britain. Data from Wisconsin’s Department of Health Services shows that 2,266 senior citizens died from alcohol-related falls between 2010 and 2016, and the trend is rising. A recent article published in The Cap Times (August 30, 2017) revealed that Wisconsin’s elderly death rate from falls is twice the national average in the US. Some experts are linking the problem to rising binge drinking rates among elderly residents.

A Hidden and Dangerous Problem

Elderly’s misuse of alcohol is often overlooked. Many doctors are unaware their patients have drink problem. The Royal College of Physicians estimated up to 60% of older people who were admitted to hospital because of confusion, repeated falls at home, recurrent chest infections and heart failure may have unrecognised alcohol problems.

The problem is hidden because elderly usually drink at home and they only take small amount at a time. It is very reasonable that Aunty Daisy needs a sip of whiskey to calm her nerves. However, the harm develops when she drinks often and every day.

Seniors who have alcohol problems generally fall into two groups: those who have abused alcohol since their younger days and those who started drinking later in life.

Loneliness could lead to alcohol misuse
Loneliness could lead to alcohol misuse (Image courtesy of Pixabay)

Why do they take to drinks? Boredom from retirement, loneliness, loss of mobility, loss of partner, unable to cope with old age and death, bereavement, are all possible reasons.

Due to slower metabolism, older people are less able to handle alcohol than younger drinkers. In addition, most elderly have been prescribed medications for treating insomnia, depression, and various cardiovascular problems. Drinking alcohol on top of these medications can result in blur vision, disorientation, loss of balance, and therefore more likely to fall and sustain injuries which may be fatal.

The strain on the healthcare system is predictable with the aging population if action is not taken to tackle the problem now.

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