Many older people suffer a fall with consequent injury such as a fractured shoulder, wrist, hip, ankle or foot. In the UK there is an active falls prevention initiative, promoted by the National Health Service. Not so in South Africa, although we are aware of the problem.
Have you ever thought how the state of your feet could contribute to a fall? Podiatrists should be involved in preventing falls and your visit to one could help to prevent one.
Hazel Tomkins, a British podiatrist, writing in Podiatry Now has detailed how your feet can cause a fall.
So, if you want to stand on your own two feet here’s what to look out for.
Any corn, callus, ulceration, painful nail condition alters the way your foot hits the ground. This usually makes walking uncomfortable and unsteady. With age, the cushioning fatty pad on the soles of the feet thins out – giving less protection to the bones and joints underneath.
Changes to the basic shape of the feet alters the ability to walk evenly. Often the cause of these changes is reduced muscle strength. On the other hand, any change in posture – quite common as we age – is associated with weakening of our muscles, so there is the potential for loss of balance or unsteadiness.
Watch out for changes to the length of your legs after hip or knee replacement surgery. The pain has gone but you really do need to do all the physiotherapy to restore muscle strength and balance.
At the same time there are many changes to hearing and eyesight which affect the ability to balance and see clearly what is going on around us.
If you have any nerve changes associated with diabetes (neuropathy), you are disadvantaged, because you have a reduced ability to respond to the sensory stimuli around you. On the other hand, arthritis can cause deformity as well as stiffness, making movement difficult, slower or unsteady.
Research into barefoot walking showed a 19% worse performance when barefoot compared with even a least unstable shoe. Going barefoot or stocking feet dramatically increases the falls risk.
Simple you might think, I’ll wear slippers or shoes. Well this is an area of some dispute. There is good scientific evidence that if you change to a lower or flat heel after a lifetime of wearing high heels, you have a greater risk of falling! At the same time there is research which suggests that the most important feature of footwear in preventing falls is the grip of the sole on the ground. Added to that is the need for good fit and thicker soles.
So what to do?
Keep mobile – exercise regularly – start walking, even if you use a walking aid. Maybe you need to start using one? Make sure that you can see and hear as well as possible.
A visit to a podiatrist for a biomechanical assessment is an important way to identify any underlying structural and functional problems. Treatment of any painful foot condition, such as corns and calluses, is essential and information on the best shoes for you, will be provided.
Avoid higher heels, barefoot walking and slippers. Consider wearing trainers with a rippled sole. A word of warning though, some trainers have really ‘grippy’ soles and that can cause a fall!
Try to remove all loose carpet runners and potential hazards that you could trip over. Make sure the lighting in your home is adequate (most falls occur at home!).
It takes team work to prevent falls, so get any advice that you can, or share it with those who you know are at most risk of a fall.
Closed Kinetic Chain Exercise for Joint Rehabilitation was the title of a Rehabilitation Workshop that I was invited to yesterday. It took place at the University of the Witwatersrand Sports Science Institute and introduced me to Reboundology and a quite extraordinary piece of kit called Kangoo Jumps.
Kangoo Jumps are a Swiss designed boot that almost defies description – the nearest that I can come to is – a Ski boot with an oversized doughnut lying on its side as a sole!
They have the ability to reduce the impact force to the ground by up to 80%. This patented Impact Protection System utilises the principles and practice of closed chain kinetics.
Basically, the difference between open and closed chain kinetics is that in open chain there is still some movement in part of the limb, this allows additional twists or rotations to affect other body parts. In the closed chain, the part is stabilised (eg foot or hand) against a hard surface. It’s actually more complicated, but this is what I understand at present.
Rebound exercise is different due to the following factors: During rebound exercise; We are opposing gravity and acceleration: Acceleration in the vertical plane develops a greater G-force: All these forces come together at the bottom of the bounce: Cells have to work harder to maintain their position in space: This explains why trampolinists have extra unexplained strength.
Kangoo Jumps utilise these principles by allowing you to jump up and down, whilst concentrating your body weight through your centre of gravity.
I was able to test the theory in practice when we were put through an exercise session. I had a great time bouncing around the gym, being guided in various exercises. The first thing I became aware of was that my posture improved immediately, I stood up straighter and my core lower abdominal muscles were getting a workout! My heart rate went up quite quickly too. In addition, yesterday and more importantly, today, I don’t have any muscle soreness or stiffness.
Where you will be asking is the Science? There have been many studies worldwide, but there is ongoing research underway at the University of the Witwatersrand. Have a look on the website www.kangoojumps.co.za
Reboundology has also been the subject of considerable research by N.A.S.A
The application of this technology is for rehabilitation as well as strengthening. (You would be surprised who is using them!) For example they will improve balance, co-ordination and agility; improve foot alignment; increase overall muscular tone. They stimulate cellular bone rebuilding ability. The potential application in managing arthritis is an exciting thought.
Closed chain kinetics using Kangoo Jumpssseems to me to be offering a new clinical modality and challenge to our current way of thinking. You can be any age from 6 to 90! I can’t wait to start rebounding!
I have just seen the 8 year old child with Traction Apophysitis featured in previous posts. Since January 26, when I first saw him, he has followed a strict programme of reduced activity.
He has been fantastic in wearing trainers at school – remember that all the other children are barefoot – and severely limiting or stopping any activity that caused pain. Although, about a month ago we did let him start swinging a golf club at the driving range!
His mother reports that he no longer sits on the side of the bed in the morning rubbing his painful feet. Has no pain after school, even though he has recently started playing some soccer at break time and he is completely pain-free.
Today’s X-rays show a normal appearance of the calcaneal epiphysis (the growth area/point at the back of the heel), and improved bone density.
The plan now is to slowly start activity again and that will be rugby.(He plays barefoot). The trainers must still be worn as often as possible. Follow up will be in 6 months.
The diagnosis of Traction Apophysitis is usually based on the presenting clinical symptoms, as the X-ray findings are often inconclusive. Nevertheless we must never ignore the younger child with painful heels and always consider Traction Apophysitis.
Management is clearly “rest”, by reducing or avoiding those activities that cause pain. A supportive but soft/cushioning trainer is the best footwear. There is a place for short term anti-inflammatories followed preferably by topical gels and plasters.
Whatever we try, there is always the question of ‘what would have happened if we had done nothing?” I believe that that decision can only be made with the individual patient in front of you, so that you can respond with clinical judgement and personal empathy. However there is no doubt that for many children it is a transient condition.
My apologies for not getting the case history on the site as promised.
THE COMPLETE CASE HISTORY WILL BE ON THE WEBSITE SOON.
I’ve just come across an article I wrote a while ago for the South African Journal of Natural Medicine and thought it might be useful as a reminder as we embark on another year.
We need to take care of our lives, our relationships and our bodies as we renew our efforts in the New Year – and that includes our feet.
Take a look now at You and Your Feet
Bunions are among the most common and frequently most painful of conditions affecting the foot.
Remembering that your feet carry ALL of your weight ALL of the time that you are standing or walking then it is not surprising that the complex structure of your feet sometimes suffers re-alignment as they strive to accommodate our lives and activities. Sometimes we do not help matters by forcing our feet into unsuitable or badly fitting shoes.
Go to the Foot Health Articles section for some useful advice on bunions.