what-when-how
In Depth Tutorials and Information
There may be progressive loss of muscle mass and atrophy of tissue as
a consequence of disease, decreased function or lack of activity, all of
which increase the risk of osteopenia in older adults. Because even minor
trauma can result in a fracture, a stress fracture should be suspected
when foot pain is severe, prolonged and not otherwise explained.
Foot problems, associated foot pain and inappropriate footwear can
contribute to trips and falls in the elderly. Owing to osteopenia, bones are
more vulnerable to fracture, and the most common sites of fracture inju-
ries include the neck of femur and the wrist. Any elderly person presenting
in clinic should be questioned about falls and near misses. If there is a
history of falling or tripping, they should be referred to a 'falls team' for
more detailed assessment. Certainly their footwear-wearing habits and
footwear suitability should be addressed, and the need for accommodat-
ing foot orthoses to relieve painful symptoms and improve stability must
be recognized.
Key
Concept
Older people should be questioned about falls and near misses.
Footwear suitability and the need for accommodative foot orthoses
should be assessed and if there is a history of falls, refer to a
specialist 'falls team'.
In summary, degenerative diseases commonly impact the elderly person's
foot as a consequence of severe or repetitive trauma, inflammation,
metabolic change, repeated and chronic micro-trauma, strain, obesity
and osteoporosis. These conditions can increase pain, limit mobility and
threaten the older person's ambulatory status.
Impact of diabetes on foot structure, foot pressure
and gait
Peripheral neuropathy is a common problem for many people living with
diabetes, with up to 50 per cent presenting at diabetic foot clinics diag-
nosed with the condition (
Edmonds and Foster 1999
).
Peripheral neuropathy can affect many of the body's nerve pathways,
including the sensory, autonomic and motor nerves. Loss of sensation,
known as sensory neuropathy, is commonly observed in the diabetic foot
because raised levels of circulating glucose in the bloodstream can over
time permanently interfere with normal nerve function. The typical clinical
features include a loss of sensitivity to touch, pain, temperature and vibra-
tion. It can affect the motor pathways that innervate skeletal muscle, and
autonomic pathways that innervate smooth muscle in the blood vessels,
