Feet & Falls

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Foot, Function and Fall Risk

Like the rest of the body the foot can alter as it gets older. Consider for a moment how long it has being supporting you and carrying your weight? In a lifetime it is estimated that people walk 128,000 kms. Research has identified that there is a 60 to 85% increase in foot problems with people aged 65+.

The role of the foot

The foot provides a very stable base from which many activities literally spring. Walking is considered as a series of moving/ stepping from one foot to the other. The foot is made up of many bones, ligaments and muscles which are needed to support the entire body weight which in turn assists the body keep well balanced when stationary or when moving.

There are many age changes that occur in the foot area which may compromise and alter the gait pattern thereby becoming less safe. Feet play an important part in the functional ability of an individual to assist efficient and effective movement to occur in all situations and environments that may be presented to them. Efficient movement reduces the risk of injuries, some of which may result from a fall, when gait may be challenged or compromised.

Functions of the feet

  • Body support
  • Balance
  • Projecting the body forward when walking
  • Feeling the ground to provide body position sense
  • Assist with alignment of the whole body

Conditions of the feet and foot problems associated with the older adult

Foot problems examples:

  • Bunions & corns
  • Arthritis
  • Dropped arches or flat feet
  • Decreased sensation
  • Neuropathies such as Diabetes

The 3 major foot issues identified that increase the risk of falls are

  1. Foot problems. Problems may change walking patterns mainly due to the pain and stiffness associated with the conditions (hallux valgus) NB. From Tinetti research
  2. Pain – Incidence of foot pain is 22 – 59 % and greater increases in women
  3. Numbness/ reduced sensation/vascular issues

If there are problems with the feet then there is an increased risk of fall and associated injuries. Falls and related injuries are a major issue which can be associated with aging and inactivity. If an older person has had a fall, there is an increased risk of falling again.

  • 66% of people who fall will experience another fall within six months.
  • 50% of falls will result in injury.
  • Serious injury occurs in 10% of falls.
  • Injury from a fall puts a person more at risk – particularly fractures.
  • 25% of those who fracture a hip will die within six months of the injury.
  • Falls can lead to loss of confidence and reduction in activity which can lead to more falls

The joints in the feet may have changed shape, have some arthritic changes and are not quite so mobile and stable. The muscles and ligaments may not be as strong as they used to be and so the shape of the foot may change becoming broader with arches flattening out. With these changes the whole foot can no longer provide as much support and the projectory powers it was designed to do so effectively and efficiently therefore compromising the gait pattern and body balance control.

The foot also serves as a sensory device (the sole of the foot and ankle area especially) relaying messages to the brain to assist with the fine tuning mechanism of the body. The foot and ankle area provides sensory input to the brain relating to where the body is positioned in space which enables the body to respond effectively and stay upright enabling everyday activities be carried out easily. This sense of the body position is necessary to maintain good balance and body control. The sensation in the foot can diminish for various reasons hence problems can start compromising movements especially those which involve travelling from place to place and in controlling any activity incorporating balance as an integral part of it.

Foot problems may change walking patterns mainly due to the pain and stiffness associated with the conditions. Generally with ageing there is increased stiffness in the joints of the feet especially in the metatarsal heads, smaller ranges of plantar flexion, inversion and eversion along with reduced flexibility and Range of Movement in the ankle. If there is also a reduction in strength in the muscles of the feet and toes, there will be functional ability issues affecting gait and balance (controlling sway). This will be affected especially when walking on uneven surfaces. With the above combined it results in a reduced response to different impact velocity and the ability to attenuate shock.

Obviously if you have problems with the foot it is advisable that it is addressed through the appropriate channels (health professionals) and well fitting comfortable shoes need to be acquired. This should the first step to assist people in their endeavors to walk easily and efficiently, be well balanced and remain in control. There are many exercises and activities which can, and need to, be undertaken to assist the foot remain as mobile and strong as possible allowing the body to function easily and maintain good body control.