Showing papers by "Hylton B. Menz published in 2007"

Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study

Abstract: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (± 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test. Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 ± 5.4 kg/m2 vs. 27.5 ± 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 ± 3.3 vs. 1.1 ± 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 ± 7.1° vs. 40.5 ± 6.6°; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI ≥ 30 kg/m2) (OR 2.9, 95% CI 1.4 – 6.1, P < 0.01) and to have a pronated foot posture (FPI ≥ 4) (OR 3.7, 95% CI 1.6 – 8.7, P < 0.01). Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.

Walking speed, cadence and step length are selected to optimize the stability of head and pelvis accelerations

Abstract: The aim of this study was to evaluate the hypothesis that an individual's preferred or usual walking speed, step length and cadence optimize the stability of head and pelvic accelerations in vertical (V), anterior-posterior (AP) and medio-lateral (ML) planes when walking. Acceleration patterns of the head and pelvis were recorded in ten healthy young adults as they walked on a level surface in three separate experiments: (1) walking at five different speeds, ranging from very slow to very fast; (2) walking in time to a metronome set at five different cadences, ranging from 33 to 167% of subjects' usual cadence; and (3) walking at five different step lengths varying from very short to very long while keeping in time with a metronome set at cadences 67, 100 and 125% of usual cadence. The results indicated that acceleration patterns in the V and AP planes were most stable when subjects walked at their usual cadence and step length. In the ML plane, stability was suboptimal, but still adequate, with the usual cadence and step length. The findings suggest that healthy young people walk in a manner that maximizes V and AP stability while maintaining adequate, though suboptimal ML stability.

Preventing Falls in Physically Active Community-Dwelling Older People: A Comparison of Two Intervention Techniques

Abstract: Background: Falls are common in physically active older people; however, most intervention studies have been targeted at frail older people. Objective: To evaluat

Plantar pressures are higher under callused regions of the foot in older people.

Abstract: Summary Background. Mechanically induced hyperkeratotic lesions (corns and calluses) are among the most common foot problems in older people. However, their aetiology is not well understood. Aim. To compare the magnitude of pressures generated under the foot when walking in older people with and without plantar calluses. Methods. Peak plantar pressure measurements were obtained from 292 participants (99 men and 193 women) aged 62–96 years (mean ± SD 77.6 ± 6.9) recruited from a retirement village and a university health sciences clinic. Comparisons were then made between callused and noncallused regions of the foot. Results. In total, 151 participants (52%) had at least one plantar callus. Those with plantar calluses were more likely to be female, have moderate to severe hallux valgus, and at least one lesser toe deformity. Regional peak plantar pressures were significantly higher in people with calluses under the second metatarsophalangeal joint (2.34 ± 0.46 vs. 2.12 ± 0.51 kg/cm2, P = 0.001), the third to fifth metatarsophalangeal joints (1.71 ± 0.46 vs. 1.50 ± 0.51 kg/cm2, P = 0.009) and the hallux (1.40 ± 0.34 vs. 1.23 ± 0.47 kg/cm2, P = 0.007) compared with people without calluses under these sites. Conclusion. Plantar pressures are significantly higher under callused regions of the foot in older people. Raised pressure may play a role in the development of plantar calluses by accelerating the turnover rate of keratinocytes in the epidermis. Future studies should focus on evaluating the efficacy of pressure-relieving interventions in the prevention and treatment of keratotic disorders in older people.

Physiological falls risk assessment in older people with Alzheimer's disease.

Abstract: Background: Falls are common in people with Alzheimer’s disease (AD). There is some evidence that deficits in vision, peripheral sensation, strength, reaction time and balance may b

Falls in Older People: Epidemiology of falls and fall-related injuries

Abstract: In this chapter, we examine the epidemiology of falls in older people. We review the major studies that have described the incidence of falls, the locations where falls occur and falls sequelae. We also examine the costs and services required to treat and manage falls and fall-related injuries. Before addressing these issues, however, it is helpful to briefly discuss four important methodological considerations that are pertinent to all research studies of falls in older people: how falls are defined, how falls are counted, how injurious falls are defined and what constitutes an older person. The definition of a fall In 1987, the Kellogg International Working Group on the Prevention of Falls in the Elderly defined a fall as ‘unintentionally coming to the ground or some lower level and other than as a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in stroke or an epileptic seizure’. Since then, many researchers have used this or very similar definitions of a fall. The Kellogg definition is appropriate for studies aimed at identifying factors that impair sensorimotor function and balance control, whereas broader definitions that include dizziness and loss of consciousness are appropriate for studies that also address cardiovascular and neurological causes of falls such as syncope, postural hypotension and transient ischaemic attacks.

Falls in Older People: Postural stability and falls

Abstract: Postural stability can be defined as the ability of an individual to maintain the position of the body, or more specifically, its centre of mass, within specific boundaries of space, referred to as stability limits . Stability limits are boundaries in which the body can maintain its position without changing the base of support. This definition of postural stability is useful as it highlights the need to discuss stability in the context of a particular task or activity. For example, the stability limit of normal relaxed standing is the area bounded by the two feet on the ground, whereas the stability limit of unipedal stance is reduced to the area covered by the single foot in contact with the ground. Due to this reduction in the size of the stability limit, unipedal stance is an inherently more challenging task requiring greater postural control. Regardless of the task being performed, maintaining postural stability requires the complex integration of sensory information regarding the position of the body relative to the surroundings and the ability to generate forces to control body movement. Thus, postural stability requires the interaction of musculo-skeletal and sensory systems. The musculo-skeletal component of postural stability encompasses the biomechanical properties of body segments, muscles and joints. The sensory components include vision, vestibular function and somatosensation, which act to inform the brain of the position and movement of the body in three-dimensional space.

Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study

Abstract: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (± 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test. Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 ± 5.4 kg/m2 vs. 27.5 ± 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 ± 3.3 vs. 1.1 ± 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 ± 7.1° vs. 40.5 ± 6.6°; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI ≥ 30 kg/m2) (OR 2.9, 95% CI 1.4 – 6.1, P < 0.01) and to have a pronated foot posture (FPI ≥ 4) (OR 3.7, 95% CI 1.6 – 8.7, P < 0.01). Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.

Podiatric involvement in multidisciplinary falls-prevention clinics in Australia

Abstract: Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role of podiatry in these clinics has not been clearly defined. The aims of this study were to determine the level of podiatric involvement in multidisciplinary falls clinics in Australia and to describe the assessments undertaken and interventions provided by podiatrists in these settings. Methods: A database of falls clinics was developed through consultation with departments of health in each state and territory. Clinic managers were contacted and surveyed as to whether the clinic incorporated podiatry services. If so, the podiatrists were contacted and asked to complete a brief questionnaire regarding their level of involvement and the assessment procedures and interventions offered. Results: Of the 36 clinics contact...

Foot health service provision by the Australian Department of Veterans' Affairs: do major podiatric medical interventions reduce the number of maintenance treatments?

Abstract: Background: In Australia, the Department of Veterans’ Affairs provides podiatric medical services, including nail surgery and the provision of footwear and orthoses, for war veterans and their dependents. We sought to evaluate whether the provision of these interventions reduces the number of ongoing maintenance treatments. Methods: We used the database of the Department of Veterans’ Affairs to document the number of major podiatric medical interventions (footwear, foot orthoses, nail surgery, and combinations of these interventions) for 1996–1997. The number of maintenance podiatric medical treatments provided in the 2 years before (1994–1996) and 2 years after (1997–1999) these interventions was then compared with a control group that did not receive any major interventions. Results: Compared with the number of treatments in the 2 years before the interventions, in the subsequent 2 years there was a significant increase in the mean ± SD number of maintenance treatments after receiving footwear only (10....

Falls in Older People: Exercise interventions to prevent falls

Abstract: Exercise has a major role to play in preventing falls among older people and is recommended in recent evidence-based guidelines for falls prevention. As acknowledged in these guidelines, there are many different types of exercise, some of which are likely to result in greater reductions in falls than others. It is therefore incumbent upon health professionals to do better than merely suggest that older people should exercise. As Hadley has stated ‘telling an older person that ‘exercise’ can prevent falls is not much better than telling them that ‘antibiotics’ can cure an infection: although true, the advice would be much more useful if it were more specific’. This chapter aims to assist the health professional to prescribe exercise for falls prevention. The first section reviews the findings of randomized controlled trials into exercise interventions for falls prevention. From this, a synthesis of the findings is undertaken in an effort to delineate the important components for successful exercise interventions. Analysis of randomized controlled trials (RCTs) investigating exercise and falls In revising and updating this chapter, a detailed analysis of the specific components of exercise was undertaken. A total of 44 RCTs of exercise interventions for falls prevention written in English were identified via searches of electronic databases (MEDLINE, CINAHL, EMBASE, PEDro), and reference lists of systematic reviews and clinical practice guidelines.

Falls in Older People: Modifying the environment to prevent falls

Abstract: This chapter outlines commonly suggested environmental modification strategies, and reviews the literature evaluating falls prevention programmes that have involved environmental modification as an individual intervention or as part of multi-faceted programmes. It discusses potential barriers to home modification, issues related to hazard removal and design strategies for minimizing older people's risk of falling in public places. Approaches for addressing environmental risk factors within institutions are discussed in Chapter 15. Environmental modification strategies Table 8.1 in Chapter 8 presents a list of environmental falls risk factors that have been suggested in the literature. These posited risk factors are replicated in Table14.1 along with potential solutions. Environmental modification as an individual intervention Environmental modification is seen by many as an attractive falls prevention strategy. The homes of most older people have many environmental hazards and the majority of these are amenable to modification. Correction and/or removal of potential hazards is a one-off intervention that can be carried out relatively cheaply. Indeed, cost-effectiveness modelling has predicted that spending AUD$244 per person on a programme involving home assessment by an occupational therapist and subsequent modifications, would save $92 per person and $916 per fall prevented, over a ten year period. However, this study assumes that such a programme could prevent 25% of falls. Reductions of this magnitude have yet to be demonstrated in controlled studies. Early investigations indicated that home modification might be an effective falls prevention strategy for the general population of older people.

Falls in Older People: Exercise interventions to improve physical functioning

Abstract: As indicated in Chapter 10, exercise is a key intervention strategy for preventing falls in older people. Many diverse forms of exercise have been used in trials, ranging from highly prescribed resistance training regimes and laboratory-based balance training to unstructured general exercise programmes. In addition to studying the efficacy of exercise programmes on falls, many studies have also assessed the effectiveness of such programmes on a range of physical outcome measures, including strength, balance and gait. These studies elucidate the mechanisms by which exercise may prevent falls. Although falls are relatively common, most older individuals do not fall very frequently. Thus, large studies with long follow-up periods are required to detect the effects of exercise on fall rates. In contrast, the effects of exercise on risk factors for falls can be detected with smaller studies. Thus, complementary information can be gleaned from the analysis of studies with falls risk factors as outcome measures. Indeed, Liu-Ambrose and colleagues found that the risk of falling, as measured on the Physiological Profile Assessment tool (PPA, described in Chapter 16), could be reduced by around 50% by resistance or agility training. This chapter describes the major forms of exercise that have been used in studies of older people, and summarizes the evidence for the effectiveness of each form on falls risk factors such as balance, strength and functional abilities. Additional considerations, including exercise setting selection, target population selection, and factors affecting adoption and adherence, are then explored.