what-when-how
In Depth Tutorials and Information
C h a p t e r
2 
Chapter contents
The impact of
aging and
systemic diseases
on foot and lower
limb mechanics
Introduction  15
The aging foot - structure and 
mobility  16
Impact of diabetes on foot 
structure, foot pressure and 
gait  17
Impact of rheumatoid arthritis 
on foot structure, foot 
pressure and gait  20
Summary  25
Review questions  25
Reflection  25
Self-assessed questions  26
References  26
Further reading  27
“I don't like my feet much…they are the
thing that stop me walking normally…I
have learned to fight the pain to try and
walk better…then that shows in your
face…”
Rose
Introduction
The impact of systemic diseases on feet cannot
be underestimated in respect of pain, limitation
of activities and body image. There are many
factors that affect normal foot structure and
gait, ranging from genetic tendencies for spe-
cific foot types to systemic diseases. Addition-
ally, the normal aging process contributes to
alteration in normal foot structure and gait.
Some individuals experience the impact of a
combination of factors, for example an older
person with diabetes and abnormal foot func-
tion associated with a familial tendency for the
foot type that develops hallux rigidus. In cases
such as this, orthoses are a particularly impor-
tant aspect of management in the prevention
of pressure-induced problems such as foot
ulceration. Although this chapter is divided into
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