Foot care: A step in the right direction for fall prevention
Posted April 22, 2016
Do you consider the condition of your client’s feet and footwear when assessing their risk for falls? Although there is no evidence that assessing or addressing footwear and foot problems as a single intervention will prevent falls in older adults living in the community, these aspects of a holistic assessment should be included as part of an individualized, multifactorial intervention for preventing falls in the community (Winnipeg Regional Health Authority, 2011).
If a person’s feet are in poor condition, they may have difficulty bearing weight, have impaired balance, or walking ability (gait). Foot problems are common in older adults, and affect upwards of 60-80% of older people living in the community, with more women than men being affected. The most commonly reported foot problems are: pain from corns, calluses and bunions; foot deformities, such as hallux valgus, hammer toes and nail conditions (Australian Commission on Safety and Quality in Healthcare, 2009). Such problems with the feet are recognized as contributing factors to mobility impairment in older adults. Those in pain may walk more slowly, and may find it more challenging to complete daily tasks. The presence of foot deformities can alter the pressure distribution of the foot, and impair balance and functional ability. Altered plantar tactile sensitivity has also been noted as a risk factor for falls, because it may impair the ability to maintain postural control when walking, particularly on uneven or irregular surfaces. For those with diabetic neuropathy, this is particularly relevant, as neuropathy may impair standing stability, which places the individual at risk for falls and fractures (Canadian Diabetes Association). Feet should be assessed regularly, and referral made to a member of the health care team with specialty in this area, as appropriate. For those with diabetes, a daily foot care regimen should be established, and an annual (at minimum) foot assessment conducted by a health care provider.
Foot pain and foot problems can also lead to lack of activity and reluctance to exercise. Sedentary behaviour is a known risk for falls, and being physically active lowers the older adult’s risk of falling and the number of falls they have. There is growing evidence to suggest that physical activity helps to maintain mobility, muscle strength, reaction time, balance, and bone mineral density, which leads to the reduction of falls risk and osteoporotic fractures. For resources and more information on leading an active lifestyle in older adulthood, visit the Canadian Centre for Activity and Aging.
But what about footwear? Now that summer is coming, it is a good time to speak with your clients about appropriate footwear, and how they can reduce their risk for falls by making good choices. Although a number of features of shoe design have been implicated as having an impact on balance, there is inconclusive evidence that a certain type of footwear increases the risk of falling. However, features of footwear that have been linked to fall risk include soles that are too thick, a tread that is too smooth (or worn down), and shoes with heels that are too high and/or too narrow (Seniors' Falls in Canada: Second Report - Public Health Agency of Canada). Features that make a shoe safer include: laces or strong fastening to hold the foot firmly; a supportive collar, preferably high; low, square heel to improve stability; thin, firm midsole for the feet to “read” the underlying surface; and, slip-resistant sole (Australian Commission on Safety and Quality in Healthcare, 2009) . Beyond the shoe itself, another issue that should be considered when speaking to your clients about footwear is fluid retention in the ankles and feet. Shoes may become too tight or too loose as fluid retention causes fluctuation in the size of the foot. Loose shoelaces create another fall risk, and those that walk barefoot or in socks while in the house should be encouraged to wear shoes whenever possible (Falls Injury Prevention/Strategies and Actions for Independent Living).
Many public health units, falls prevention programs and community service agencies have public education materials you can share with your clients and their families about care of the feet and the selection of appropriate footwear. Check out your local resources today!