The Older Foot

Question 1

What are some of the age related changed to feet that may cause pain, impaired performance & increase falls risk?

Answer 1

• Increased soft tissue stiffness
• Decreased ROM
• Decreased strength
• Less efficient propulsion when walking

Question 2

What are the age related changes to feet at an impairment, activity & participation level?

Answer 2

• Impairment: Skin, plantar soft tissues, joint range, muscle strength
• Activity: Foot posture, functional movement
• Participation: Sport

Question 3

What are some of the common foot problems in older people?

Answer 3

• Tib post dysfunction
• Ankle OA (secondary to ankle sprains)
• Sensation changes related to peripheral neuropathy & PAD
• Sensation changes related to spine

Question 4

What is tib post dysfunction a common cause of?

Answer 4

Acquired flat foot deformity in adults

Question 5

What patients are most at risk of tib post dysfunction?

Answer 5

Women >40 years

Question 6

What is the clinical presentation of tib post dysfunction?

Answer 6

• Pain & swelling of medial hindfoot
• Change in shape of foot or flattening of foot
• Valgus heel
• Flattened arch
• Abducted forefoot

Question 7

What are the treatments for tib post dysfunction?

Answer 7

• NSAIDs, rest, immobilisation for acute inflammation
• Orthorses for chronic symptoms
• Hindfoot osteotomy with tendon transfer in early stages
• Arthrodesis of hindfoot/ankle in later stages

Question 8

What are the interventions for foot pain in older adults?

Answer 8

• Joint mobilisations
• Hydro/foot exercises in water bath
• Extrinsic & calf raises
• Intrinsic foot strength
• Proprioception

Question 9

What is the PAD pain intervention?

Answer 9

• Intermittent walking to near max claudication pain 3/7
• Begin at 15 mins walking for first month, increase by 5 mins per month until 40 mins reached at 6 months
• During each session, pt walks until claudication reaches 3 on 0-4 pain scale, then rests

Question 10

What is the pain scale used in the PAD pain intervention?

Answer 10

0-4 pain scale

• 0 = no pain
• 1 = onset of pain
• 2 = mod pain
• 3 = intense pain
• 4 = max pain

Question 11

What are the red flags of foot problems in older adults?

Answer 11

DVT