The Role of Podiatrists in Fall Prevention in the Elderly

Introduction

Established fall prevention guidelines advise older persons to get their feet evaluated by a podiatrist as a precaution due to the age-related reduction in foot strength and flexibility, as well as, growing research showing that foot disorders increase the risk of falling. By providing foot health treatment, patient education, health promotion, rehabilitation, and mobility services, podiatrists can significantly lower the risk of falls based on individual risk factors. Among other things, this entails diagnosing and treating foot discomfort, finding and treating underlying biomechanical and gait irregularities, prescribing exercise regimens, and giving advice on foot health and footwear. The function of the podiatrist within falls prevention teams or services might also include promoting the role of the podiatrist and teaching other clinical staff about medical issues influencing gait, postural stability, and footwear.

What Are the Risk Factors for Falling in the Elderly?

In addition to the psychological burden introduced by pain, foot pain is particularly problematic with regard to falls because it may impair balance and functional ability.

1. Every patient over the age of 65 has their prospective fall risk evaluated with the aim of assisting each senior patient in understanding their particular fall hazards.

2. Having a record of earlier falls.

3. Certain health conditions such as Parkinson’s disease, stroke, and rheumatoid arthritis- assessment of the patient's gait, strength, and balance as well as the condition of their feet.

4. Certain medications might make people more likely to fall.

5. Availability of home safety measures and walkways (throw rugs, slippery shower floors, etc.).

6. Each senior patient's orthostatic blood pressure, both when they are standing and when they are lying down (for some people, standing up suddenly can cause dizziness and a consequent fall).

7. Podiatric disorders that could cause a person to fall.

How Do Podiatrists Assess Fall Risk in the Elderly?

There are significant risk factors for falls in older people that are entirely within the purview of podiatric practice. Foot discomfort, for instance, is a separate and statistically significant factor that raises the chance of falling and is associated with an increased incidence of older falls and podiatry. Furthermore, one of the podiatry's main goals is to alleviate foot pain.

Age-related declines in ankle flexibility and foot muscular strength directly contribute to an elevated risk of falling. Another important goal of podiatry is to restore the strength and flexibility of the feet and ankles. Age-related foot issues include hallux valgus (bunions), hammertoes, abnormalities of the lesser toes, plantar fasciitis, and foot ulcers, all contribute significantly to the risk of falling in the elderly. Another factor that might cause a fall is a foot condition with loosened ligaments, weakened fat pads, or decreased blood supply. Another important goal of podiatry is to effectively treat various foot problems and find a cure for them.

Moreover, it is crucial to ask about a patient's pre-existing medical conditions when obtaining their medical history with an eye toward assessing their risk of falling because numerous health issues and the circumstances that go along with them can make a person more likely to fall. For example, according to studies, adult women with rheumatoid arthritis have more foot impairment and disability. In this demographic, foot impairments but not pain are linked to a greater fear of falling. In addition, self-reporting foot issues that affect balance is common among people with Parkinson's disease and stroke survivors, who are more likely to have foot issues that affect balance.

Moreover, patients with systemic lupus erythematosus frequently have corns and calluses. Many participants with systemic lupus erythematosus reported falls as a result of decreased sensation in their feet, which is most directly connected to corns and calluses. Those who have survived a stroke have significantly greater foot pronation and stroke patients with a history of falls have more pronation than patients who have not fallen, according to the Foot Posture Index Score. Even after accounting for amputation reasons, the risks of falling are about 3.5 times higher for people with lower limb amputation and concurrent vascular comorbidities than for those without comorbidities, with falls being particular. Obesity, illnesses, and the negative effects of drugs like antidepressants and over-the-counter sedatives may be outside the purview of podiatry but still contribute to the risk of falling.

What Are the Interventions for Fall Prevention in the Elderly Advised by Podiatrists?

• Each patient is given information about their changeable risk factors and appropriate fall prevention measures.

• People with an increased risk of falls will be advised about aids like nightlights, grab bars in the shower, and cane or walker use.

• As and when needed, podiatrists collaborate with parents, or guardians, or caretakers to create a preventative program.

• Instruction in shoe fitting, non-slip traction, insoles, heel height, sole contact area, orthotics, and/or advising people on suitable footwear.

• Introducing elderly individuals to an exercise regimen for the feet and ankles to improve balance and prevent falls. Exercise regimens may emphasize endurance, flexibility, balance, or strength. Group exercise under supervision and following home exercise regimens recommended by the doctor all have positive effects.

• Verifying visual acuity and, if necessary, referring the patient to an optometrist or ophthalmologist. When a person has cataract surgery on the first afflicted eye, the risk of falling is reduced.

• People who experience frequent falls due to carotid sinus hypersensitivity, a disorder that may cause variations in heart rate and blood pressure, may benefit from the insertion of a pacemaker.

• Multifactorial interventions determine an individual's fall risk before implementing treatment plans or setting up referrals for it in order to lower the risk.

• With the exception of those with low blood levels of vitamin D, using vitamin D supplements is unlikely to minimize falls. With the exception of those who are at a high risk of falling, such as those who have significant visual impairment, interventions to increase home safety do not appear to be successful.

• Some drugs increase the risk of falling; wearing anti-slip shoe devices in freezing circumstances can prevent falls. Making sure that prescriptions are examined and modified may help to prevent falls. Falls may be decreased by a gradual withdrawal from various medications used to treat depression, anxiety, and sleep disorders.

Conclusion

Older persons should have their feet inspected by a podiatrist as a preventive measure due to the age-related decline in foot strength and flexibility, as well as growing research showing that foot disorders increase the risk of falling. In order to lower the risk of falling, podiatrists can assess the value and impact of footwear as well as foot and ankle therapies. Therefore, routine assessment of risk factors for falls in the elderly by podiatrists would be effective in the prevention of falls due to aging or underlying medical conditions.