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Foot Problems in Older Adults: Associations with Incident Falls, Frailty Syndrome and Sensor-Derived Gait, Balance, and Physical Activity Measures

Amy Muchna, Bijan Najafi, Christopher S Wendel, Michael Schwenk, David G Armstrong, Jane Mohler
Journal of the American Podiatric Medical Association 2017 August 30

BACKGROUND: Research on the relationship between foot problems and frailty is sparse and could be elucidated via advances in wearable sensor-based measures of gait, balance, and physical activity (PA). This study examined the impact of foot problems on likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.

METHODS: Arizona Frailty Cohort Study participants (community-dwelling adults 65 years and older without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.

RESULTS: Of 117 participants, 41 (35%) were non-frail, 56 (48%) pre-frail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem 63% in non-frail, 80% in pre-frail [OR=2.0], and 95% in frail [OR=8.3], p=.03 for trend), due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling, but not with fall history or incident falls over 6-months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased medial-lateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percent walking, percent standing and total steps per day.

CONCLUSIONS: Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling among older adults, which may ultimately improve healthy aging and reduce risk of frailty.


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