what-when-how
In Depth Tutorials and Information
2
sections relating to aging, diabetes and rheumatoid arthritis, practitioners
should not forget that many patients do in fact present with problems
associated with a combination of some or all of these. Nevertheless, foot
orthoses (and indeed appropriate footwear, covered in Chapter 7) are an
important consideration in relieving symptoms, improving mobility and
preventing limb-threatening lesions. The purpose of this chapter is to give
the reader some indication of the importance of assessing patients with
these conditions for foot orthoses and footwear. In order to do that, some
of the underlying problems associated with these conditions are detailed
as they influence decision making in relation to the design and function
of the various interventions.
It is not intended that this chapter be a definitive guide to these condi-
tions and so the reader is provided with several references and sugges-
tions for further reading.
The aging foot - structure and mobility
Foot problems lead to some of the most distressing and disabling symp-
toms and conditions affecting older people. The ability to remain pain free
and ambulatory is a key element in successful aging. Foot and related
problems and their impact may be local, or they may be associated with
systemic conditions caused by disease. The medical conditions that place
older patients most at risk for serious foot problems are vascular, neuro-
logical and endocrine diseases, as well as arthritis.
Feet are put under pressure during static and dynamic loading, with
this pressure being compounded by the hard surfaces on which we walk.
This potentially creates repetitive micro- and macro trauma, and any
inability of the foot to adapt to stress produces inflammatory changes in
bone and soft tissue. These problems may manifest in symptoms of pain,
discomfort and loss of function associated with the structure of the foot,
involving joints, tendons and ligaments. Specifically, foot problems such
as plantar fasciitis, metatarsalgia, the development of lesser toe deformity,
and deformity of the hallux are common problems in the aging foot
(
Helfand and Jessett 1998
). Because of limited joint mobility and associ-
ated symptoms, older people may lose the normal heel-to-toe motion in
the feet when walking, and many adopt a shuffling gait.
Author
Note
Minor trauma in the aging foot can lead to fracture, therefore a
stress fracture should be suspected when foot pain is severe and
prolonged.
