During the course of a lifetime the foot is subjected to a considerable amount of trauma (acute and overuse), effects of local and systemic disease, misuse, neglect and the compensations from biomechanical pathology. Problems with the feet have been reported as being the single physical health symptom consistently associated with chronic difficulties in daily living among older people .
The prevalence of foot pathology in older persons is not clearly known, as it is very dependent on the criteria used in each study to define foot pathology. In many studies it is self-reported. Most studies show that around 10-30% of those over 65 age some sort of painful foot pathology but it has been reported as being as high as 80% ( – most of the differences are due to what is defined as a foot “problem” with poor agreement among most studies. Many studies may under-report the true prevalence due to those being questioned believing that foot problems are an inevitable part of aging. Up to 20% of older persons have some form of vascular insufficiency, putting them at greater risk of foot pathology and a more serious consequence of existing foot pathology. Poor vision, musculoskeletal disorders, obesity, postural hypotension etc inability for self care of feet. Females have more foot pathology than males and the prevalence of pathology increases with age.
The main problems reported in the various studies are – hyperkeratosis, nail problems, hallux valgus, digital deformity and swollen/aching feet.
More accurate data is needed for the adequate planning and funding of foot health care services for the older persons, especially in systems like the National Health Service in the UK , the Department of Veterans Affairs in Australia, and the Veterans Administration in the USA .
Factors contributing to foot pathology in the elderly:
• biological effects of ageing
• activity/ambulation levels (current and previous)
• attitudes to the foot and foot health
• past history of foot pathology
• footwear (current and previous)
• previous management of foot pathology
• co-morbidities (eg other chronic illness; medications)
• local and systemic diseases affecting the foot (eg vascular, neurological, rheumatological, diabetes mellitus)
• ability to render self care
• socioeconomic status
Consequences of foot pathology in the elderly:
the foot is rarely linked to mortality, but can be associated with significant disability, morbidity and dysmobility/immobility
affects walking ability ( decrease in social functioning). The impact of foot pain on functional performance has been shown to be substantial
chronic pain/discomfort psychological changes
less ability to carry out activities of daily living – those with foot pain have a 50% increased odds for disability in instrumental activities of daily living .
increased risk of falling Menz & Lord, 2001)
progression of pathology (eg hyperkeratotic lesion ulceration & infection amputation)
Footwear in the elderly:
• footwear plays a role both in the cause and prevention of pathology – footwear can help maintain mobility and prevent problems, but if inappropriate immobility and problems
• slip resistant footwear can be helpful to prevent falls
• 30% do not wear shoes around home during warmer months
Use of foot care services:
• older people are often thought to accept foot problems as an inevitable part of aging, with many not seeking health professional help for them (eg the lateral forefoot ache associated with early rheumatoid arthritis may be ‘tolerated’, until other symptoms develop elsewhere)
• in one Australian survey , 71% of older persons surveyed self reported as having a foot problem, but only 39% had sought professional help. 60% of these had consulted a podiatrist.
• in South Glamorgan, 53% of 560 older persons had 3 or more foot problems, but only a third of them were receiving podiatric care . The authors concluded that there was a mismatch between the provision of podiatry services and the capacity to benefit.
• Crawford et al (1996), in a survey of UK elderly persons aged 75 and over, found half were receiving podiatric care; 1/3rd where receiving the care in their home; similarly, White & Mulley (1989) found that half of those over 50 were receiving regular podiatric care.
• in a follow up of older patients in the UK’s National Health Service who were discharged due to a restriction on the provision of services showed that a significant number of those who were initially categorised as ‘low risk’ showed deterioration in foot health following discharge. Many moved quickly into a high-risk category. 63% of those discharged were at follow up unable to safely care for their own feet .
• fiscal constraints within the health care limit the provision of foot care services to the older persons
• Kinden (1999) in Australia found that the strongest predictors of podiatric service use where age, gender, presence of foot problems, difficulty with performing simple footcare routines, independence in instrumental activities of daily living and country of birth being outside of Australia. Level of income and health insurance status where not predictors.
• Gorter et al (2001) in the Netherlands found a prevalence of non-traumatic foot complaints in a population of 5679 aged greater than 65yrs of 20% (6/10 were painful); 45% had sought nonmedical care for their feet; 1/10 had not sought care; 4/10 used self care; 5/10 had consulted a chiropodist
Gerontology Forum at Podiatry Arena