Elevated heels and adaptation to new shoes in frail elderly women

Footwear is supposed to have influence on postural control and is a potential aspect to address in the prevention of falls in the elderly. This study aimed to show whether measurements of static balance and gait are different with habitual shoes compared to new special senior shoes with different heel height and whether these results change after adaptation. In a randomized controlled intervention study, 26 subjects (median age 87 years) were recruited from two nursing homes and one facility of assisted living. Measurements of static balance and gait were performed with habitual shoes and two types of new special senior shoes differing in heel height. Measurements were repeated after five weeks. There was no difference in static balance and gait with habitual shoes compared to either of the new footwear offered. Results of performance with higher heels were not different compared to lower heels. No further effect of adaptation after wearing a new shoe over five weeks could be demonstrated. With respect to static and dynamic balance, there seems to be a wide range of acceptable footwear as long as the heel height is below a critical value. A standardized shoe can be used in the assessment of balance because the effect of adaptation can be neglected.     

Footwear characteristics and foot problems in older people

BACKGROUND: Foot problems are common in older people, however the contribution of incorrectly fitting footwear and heel elevation to the development of foot pain and deformity has not been fully evaluated. OBJECTIVES: To examine the relationship between footwear characteristics and the prevalence of common forefoot problems in older people. METHODS: Presence of foot pain and deformity were identified in 176 people (56 men and 120 women) aged 62-96 years (mean 80.09, SD 6.42) using a questionnaire and clinical assessment. Shoe fit was determined by comparing length, width and area measurements of shoes with foot measurements. Past and present use of high heels in women was documented, and heel elevation of footwear was measured. RESULTS: Most subjects wore shoes narrower than their feet. Women wore shoes that were shorter, narrower and had a reduced total area compared to their feet than men. Wearing shoes substantially narrower than the foot was associated with corns on the toes, hallux valgus deformity and foot pain, whereas wearing shoes shorter than the foot was associated with lesser toe deformity. Wearing shoes with heel elevation greater than 25 mm was associated with hallux valgus and plantar calluses in women. CONCLUSION: Incorrectly fitting footwear is common in older people and is strongly associated with forefoot pathology and foot pain. These findings highlight the need for footwear assessment in the management of foot problems in older people.     

Advice of the phlebologist concerning care of the foot, walking and the selection of shoes

The symbolic potential of the foot explains excessive psychological crystallizations and major patients' resistances to the phlebologist's advices. The author reviews hygiene advices concerning the feet (washing, pedicure, prevention of dermatoses and locking of joints), the three phases of physiological gait (heel gait, plantar and digital gait) and after a historical review of the shoes, exposes the damages caused by heels which are too high and describes the qualities of a physiological shoe.     

Effects of common footwear on joint loading in osteoarthritis of the knee

Objective

Elevated joint loads during walking have been associated with the severity and progression of osteoarthritis (OA) of the knee. Footwear may have the potential to alter these loads. This study compares the effects of several common shoe types on knee loading in subjects with OA of the knee.

Methods

Thirty‐one subjects (10 men, 21 women) with radiographic and symptomatic knee OA underwent gait analyses using an optoelectronic camera system and multicomponent force plate. In each case, gait was evaluated during barefoot walking and while wearing 4 different shoe types: 1) clogs, 2) stability shoes, 3) flat walking shoes, and 4) flip‐flops. Peak knee loads were compared between the different footwear conditions.

Results

Overall, the clogs and stability shoes resulted in a significantly higher (～15% higher) peak knee adduction moment (mean ± SD 3.1 ± 0.7 and 3.0 ± 0.7 divided by body weight [BW] × height [H] multiplied by 100, respectively; P < 0.05) compared with that of flat walking shoes (mean ± SD 2.8 ± 0.7 %BW × H), flip‐flops (mean ± SD 2.7 ± 0.8 %BW × H), and barefoot walking (mean ± SD 2.7 ± 0.7 %BW × H). There were no statistically significant differences in knee loads with the flat walking shoes and flip‐flops compared with barefoot walking.

Conclusion

These data confirm that footwear may have significant effects on knee loads during walking in subjects with OA of the knee. Flexibility and heel height may be important differentiating characteristics of shoes that affect knee loads. In light of the strong relationship between knee loading and OA, the design and biomechanical effects of modern footwear should be more closely evaluated in terms of their effects on the disease.     

Slip resistance of casual footwear: implications for falls in older adults

BACKGROUND: A large proportion of falls in older people are caused by slipping. Previous occupational safety research suggests that inadequate footwear may contribute to slipping accidents; however, no studies have assessed the slip resistance of casual footwear. OBJECTIVE: To evaluate the slip resistance of different types of casual footwear over a range of common household surfaces. METHODS: The slip resistance of men's Oxford shoes and women's fashion shoes with different heel configurations was determined by measuring the dynamic coefficient of friction (DCoF) at heel contact (in both dry and wet conditions) on a bathroom tile, concrete, vinyl flooring and a terra cotta tile using a specially-designed piezoelectric force plate apparatus. RESULTS: Analysis of variance revealed significant shoe, surface, and shoe-surface interaction effects. Men's Oxford shoes exhibited higher average DCoF values than the women's fashion shoes, however, none of the shoes could be considered safe on wet surfaces. Application of a textured sole material did not improve slip resistance of any of the shoes on wet surfaces. CONCLUSION: Heel geometry influences the slip resistance of casual footwear on common household surfaces. The suboptimal performance of all of the test shoes on wet surfaces suggests that a safety standard for casual footwear is required to assist in the development of safe footwear for older people.     

Effects of specialized footwear on joint loads in osteoarthritis of the knee

OBJECTIVE: Elevated dynamic joint loads have been associated with the severity and progression of osteoarthritis (OA) of the knee. This study compared the effects of a specialized shoe (the mobility shoe) designed to lower dynamic loads at the knee with self-chosen conventional walking shoes and with a commercially available walking shoe as a control. METHODS: Subjects with knee OA were evaluated in 2 groups. Group A (n = 28) underwent gait analyses with both their self-chosen walking shoes and the mobility shoes. Group B (n = 20) underwent gait analyses with a control shoe and the mobility shoe. Frontal plane knee loads were compared between the different footwear conditions. RESULTS: Group A demonstrated an 8% reduction in the peak external knee adduction moment with the mobility shoe compared with self-chosen walking shoes (mean +/- SD 49 +/- 0.80 versus 2.71 +/- 0.84 %BW x H; P < 0.05). Group B demonstrated a 12% reduction in the peak external knee adduction moment with the mobility shoe compared with the control shoe (mean +/- SD 2.66 +/- 0.69 versus 3.07 +/- 0.75 %BW x H; P < 0.05). CONCLUSION: Specialized footwear can effectively reduce joint loads in subjects with knee OA, compared with self-chosen shoes and control walking shoes. Footwear may represent a therapeutic target for the treatment of knee OA. The types of shoes worn by subjects with knee OA should be evaluated more closely in terms of their effects on the disease.     

Factors associated with falling in patients with Parkinson's disease and atypical parkinsonism: An assessment using the Tinetti Gait and Balance Scale

Aim:   To identify factors associated with falling, we assessed the Tinetti Gait and Balance Scale (TGBS) for patients with Parkinson's disease (PD) and atypical parkinsonism (AP), and assessed the Unified Parkinson's Disease Rating Scale (UPDRS) for patients with PD.
Methods:   A cross sectional study was conducted in a university hospital, with the subject constituting 30 PD patients and 22 AP patients. Each item included in the TGBS and the UPDRS part III were scored in the clinical setting. Fallers were categorized if the patient experienced at least one fall in the prior six-month period.
Results:   Thirty-five patients were categorized as fallers. When comparing PD fallers and PD non-fallers, a subscore comprising a sum with 'walk stance' and 'nudge on sternum' in the TGBS showed a significant difference. Total UPDRS part III score indicated a significant difference during the medication ON period, whereas the difference was insignificant during the medication OFF period. The presence of dyskinesia or freezing of gait was not different. In addition, 'walk stance' only in the TGBS showed a significant difference between PD fallers and AP fallers.
Conclusions:   We concluded that 'walk stance' and 'nudge on sternum' in the TGBS may be useful for evaluating factors associated to falling in PD. 'Walk stance' item merits inclusion into routine assessment in PD in addition to UPDRS part III.     

Biomechanical properties of shoes and risk of falls in older adults

OBJECTIVES: To determine the relationships between the biomechanical properties of shoes worn in a cohort of healthy older adults and the risk of falling. DESIGN: Nested case-control study, comparing biomechanical measurements of shoes worn by those who reported a fall with measurements of shoes worn by age- and sex-matched nonfallers engaged in broadly similar activities. SETTING: On-site measurements where falls occurred. PARTICIPANTS: A cohort of 1,371 older adults, of whom 327 reported a fall and 327 served as age- and sex-matched controls. MEASUREMENTS: Shoe measurements related to lateral stability (heel height and width, critical tipping angle), foot position sense (heel-collar height, sole thickness, and sole flexibility), and the shoe/surface interface (foresole material, shoe-to-ground coefficient of friction, sole contact area). RESULTS: Greater heel height was associated with increased risk of a fall (P for trend=.03), whereas greater sole contact area was associated with reduced risk (P for trend=.005). Shoe characteristics related to foot position sense bore little apparent relation to fall risk. Coefficients of friction of 0.5 or greater were observed in 93% of shoes measured, indicating that very few were excessively slippery. CONCLUSION: Certain measurable properties of shoes were found to be significantly related to risk of falls in older adults. Wearing shoes with low heels and large contact area may help older adults reduce the risk of a fall in everyday settings and activities.     

Footwear characteristics and risk of indoor and outdoor falls in older people

BACKGROUND: Footwear characteristics have been shown to influence balance in older people; however, the relationship between footwear and falls is unclear. OBJECTIVE: To determine the relationships between footwear characteristics and the risk of indoor and outdoor falls in older people. METHODS: Footwear characteristics (shoe type, heel height, heel counter height, heel width, critical tipping angle, method of fixation, heel counter stiffness, sole rigidity and flexion point, tread pattern and sole hardness) were assessed in 176 people (56 men and 120 women) aged 62-96 (mean age 80.1, SD 6.4) residing in a retirement village. Falls were recorded over a 12-month follow-up period and comparisons made between fallers and non-fallers. RESULTS: 50 participants (29%) fell indoors and 36 (21%) fell outdoors. After controlling for age, gender, demographic characteristics, medication use, physiological falls risk factors and foot problems, those who fell indoors were more likely to go barefoot or wear socks inside the home (OR = 13.74; 95% CI 3.88-48.61, p < 0.01). However, there were no significant differences in indoor or outdoor footwear characteristics between fallers and non-fallers. Five indoor fallers (10%) and three outdoor fallers (8%) stated that their shoes contributed to their fall. CONCLUSION: Footwear characteristics were not significantly associated with falls either inside or outside the home. Risk of falling indoors was associated with going barefoot or wearing socks. Older people at risk of falling should therefore be advised to wear shoes indoors where possible.     

Reducing joint loading in medial knee osteoarthritis: shoes and canes

OBJECTIVE: Increased medial knee loading is associated with a much higher risk of disease progression in knee osteoarthritis (OA). Interventions that can reduce medial knee joint load have the potential to slow disease progression over time. We evaluated the effects of shoes and a cane on knee load in people with knee OA. METHODS: Forty people with medial knee OA underwent 3-dimensional gait analysis to measure their peak knee adduction moment, an indicator of medial knee joint load. Results when walking in bare feet were compared with those obtained when walking in their own usual shoes. Twenty participants also underwent testing using a cane, and results were compared with walking unaided. RESULTS: Compared with barefoot, walking in shoes was associated with a significant increase in the peak knee adduction moment (mean +/- SD N x m/BW x H% 3.49 +/- 0.84 versus 3.77 +/- 0.90; P < 0.001), although there was considerable individual variation. The use of a cane resulted in a 10% decrease in the knee adduction moment (mean +/- SD N x m/BW x H% 3.76 +/- 0.95 versus 3.38 +/- 0.68; P = 0.001). CONCLUSION: Wearing shoes increases medial knee joint load compared with walking barefoot. Given the variable response to shoes observed, further research is required to ascertain which shoe types might be optimal for those with knee OA. The use of a cane significantly reduces medial knee loading and has the potential to reduce the risk of disease progression in knee OA.     

减重平板训练对老年帕金森病患者姿势和平衡能力的改善作用

目的探讨减重平板训练对老年帕金森病（parkinson's disease, PD）患者姿势和平衡能力的改善作用。 方法选取2018年1月至2019年6月浙江医院收治的74例老年PD患者,其中采用常规药物联合传统物理训练进行康复治疗38例（对照组）,在对照组治疗基础上给予减重平板训练进行康复治疗36例（观察组）。采用统一帕金森病评分量表（unified rating scale for Parkinson's disease, UPDRS）Ⅲ评估步态和姿势异常;采用Berg平衡量表（Berg balance scale, BBS）评估平衡能力;采用功能独立性评定量表（functional independence measure, FIM）评估运动能力。比较分析两组患者治疗前后UPDRSⅢ、BBS、FIM评分的差异。组间及组内比较均采用t检验。 结果与治疗前比较,观察组和对照组治疗后UPDRSⅢ评分、BBS评分、FIM评分均明显增高（t=2.815、3.016、4.281,2.035、2.049、2.234;均P<0.05）。两组患者治疗前UPDRSⅢ评分、BBS评分、FIM评分的差异均无统计学意义（t=0.975、0.784、0.539,P>0.05）;观察组治疗后UPDRSⅢ评分、BBS评分、FIM评分均明显高于对照组（t=2.346、2.035、3.014,P<0.05）。 结论减重平板训练能有效改善老年帕金森病患者的姿势和平衡能力。     

The relationship of disease duration to foot function, pain and disability in rheumatoid arthritis patients with foot complaints

OBJECTIVE: To assess the relationship between disease duration and foot function (expressed as pressure and gait parameters), foot pain and disability, in patients with foot complaints secondary to rheumatoid arthritis (RA). METHODS: Sixty-two patients with RA-related foot complaints were included. Disease duration was defined as the time since RA was diagnosed. A pressure platform was used to measure both pressure parameters (i.e. pressure-time integrals and peak pressures in the forefoot) and gait parameters (i.e. total loading time and loading time in different foot regions). In addition, measurements of foot pain, disability (i.e. walking time and self reported disability), forefoot joint damage and disease activity were obtained. Data were analysed using partial correlations (Spearman), correcting for age. RESULTS: Disease duration was significantly correlated with the maximum pressure-time integral (PTI) measured under the forefoot (r = 0.330, p = 0.01). Disease duration was also significantly correlated with gait parameters, i.e. total loading time (r = 0.265, p = 0.04), duration of heel loading and duration of toe loading (r = 0.326, p = 0.01 and r = -0.288, p = 0.03 respectively), and walking time (r = 0.297, p = 0.02). Disease duration did not correlate with self-reported foot pain or disability. CONCLUSION: In patients with RA-related foot complaints, longer disease duration is associated with impaired foot function and reduced walking speed. These findings are interpreted as an alteration in pressure distribution and gait pattern during the course of disease, with a shift from a heel-to-toe roll-over process to a more shuffling gait.     

Reliability of foot trajectory measures within and between testing sessions.

BACKGROUND: Impaired control of foot trajectory during the swing phase of gait is hypothesized to increase the risk of slipping or tripping. Before assessing the predictive validity of foot trajectory measures with respect to incidence of falls, it is necessary to establish their reliability. The purpose of this study is to assess within- and between-session reliability of foot trajectory measures and traditional temporal-distance measures in healthy elderly women during gait. METHODS: Sixteen healthy, elderly women (ages 65-79 years) completed six sets of five trials each of natural and fast cadence gait during a 3.5-hour period on each of 4 days. An optoelectric motion analysis system and heel switches were used to obtain both foot trajectory (minimum toe clearance during swing, vertical, and horizontal heel contact velocities) and temporal-distance measures (step width, cadence, velocity, stride length, and time). RESULTS: Within-session test-retest reliability of all variables at natural and fast speeds was good to excellent, with intraclass correlation coefficients (ICCs) of greater than 0.9 for all but one measure (fast cadence stride time). ICCs for between-session test-retest reliability were slightly lower, but still greater than 0.9 for all but two measures (fast cadence stride time and natural cadence vertical heel contact velocity). Heel contact velocities quantified at the instant of heel contact correlated strongly with values obtained by averaging over the last 2% of the gait cycle. DISCUSSION: The good to excellent within- and between-session reliability of these foot trajectory measures supports their use as a possible means of assessing subtle changes in gait motor control. Confirmation of an association between alterations in foot trajectory measures and incidence of falls awaits further study.     

双侧丘脑底核交叉电脉冲脑深部电刺激对帕金森病步态障碍的疗效观察

目的评价双侧丘脑底核（STN）交叉电脉冲脑深部电刺激（DBS）对帕金森病（PD）步态障碍（GD）的治疗效果。 方法纳入南通市第四人民医院神经外科自2019年6月至2021年6月收治的35例行双侧STN-DBS治疗的PD患者为研究对象。所有患者采用交叉电脉冲DBS持续刺激3个月,其后转为单极DBS刺激3个月,通过世界运动障碍学会第三版统一帕金森病评估量表（MDS-UPDRS Ⅲ）评估患者运动症状的变化,起立行走试验（TUG）评估患者GD的治疗效果,帕金森病生活质量量表-39（PDQ-39）评估患者生活质量变化,并收集患者不良反应表现。 结果35例PD患者采取交叉电脉冲DBS和单极DBS治疗后的MDS-UPDRS Ⅲ评分为（27.31±9.14）和（27.74±9.62）分,对比差异无统计学意义（P>0.05）;交叉电脉冲DBS治疗后FOG-Q评分为（9.40±1.70）分,TUG步数（19.29±1.47）步,TUG时长为（10.97±1.40）s,PDQ-39评分分别为（59.46±1.71）分,均低于单极DBS治疗后[（12.54±1.99）分,（22.46±1.24）步,（13.97±1.24）s,（67.80±1.83）分],差异均具有统计学意义（P<0.05）。 结论双侧STN交叉电脉冲DBS治疗可以明显改善PD患者的GD,有效提升患者的生活质量。     

Bringing gait analysis out of the laboratory and into the clinic

The potential value of objective assessment of gait in geriatric medicine cannot be explored fully whilst gait analysis remains a laboratory research tool, imposing special conditions which often preclude its use in the elderly. We describe a method of gait analysis suitable for the geriatric clinic and illustrate its use in documenting the response to interventions in three patients presenting with falls due to parkinsonism. Irregularity between gait cycles was noted, a finding previously described in Parkinson's disease, dementia and normal old men at a fast walking speed. Such irregularity may prove to be a major risk factor for falls. Where multiple pathologies which disturb gait coexist, measurement of changes in gait in response to treatment may provide a much needed means of audit.     

Regional variation and changes with ageing in vibrotactile sensitivity in the human footsole

Recently there has been indirect evidence suggesting that age-related elevation in footsole vibration detection may be associated with balance and gait dysfunction. As a first step in investigating this dysfunction, the current study determined by how much plantar vibration sensation decreases as a function of age, and if change is dependent on frequency and location of vibration application. Vibration thresholds were assessed at 4 frequencies (25-400 Hz), at 55 locations, and in young and older participants. Results showed there were 3 regions of sensitivity on the footsole: the ball/medial arch, the lateral border of the foot and heel, and the toes. Thresholds for fast-adapting type I receptor (FAI)-mediated frequencies were age invariant; however, thresholds for fast-adapting type II receptor (FAII)-mediated frequencies increased with age. These changes may be one of many factors contributing to age-related changes in gait.     

A case of elderly onset Parkinson's disease complicated by dropped head syndrome

An 86-year old man presented with a 7-year history of gait disturbance. He was admitted to our hospital on April 2000 because he was experiencing difficulty eating due to progression of dropped head syndrome. Upon standing and sitting, remarkable dropped head and kyphosis were observed. When lying, the patient was able to stretch his neck, and he could stand and walk with the aid of a walker. Rigidity and resting tremor were present predominantly in the lower limbs. Parkinson's disease was diagnosed therefore L-dopa and Cabergoline were administered. Parkinsonism and dropped head syndrome improved in response to treatment. Cases involving dropped head syndrome due to Parkinson's disease are reportedly improved by L-dopa, but exasperated by dopamine agonists. The mechanism of dropped head is thought to be an imbalance in the tonus of the anterior and posterior neck muscles. Dropped head in the present case may have been a complication of Parkinson's disease since it improved in response to L-dopa.     

Prevalence and severity of gait disorders in Alzheimer's and non-Alzheimer's dementias

OBJECTIVES: To compare the prevalence, severity, and type of gait and balance disorders in Alzheimer's disease (AD), vascular dementia (VaD), Parkinson's disease with dementia (PDD), dementia with Lewy bodies (DLB), Parkinson's disease without dementia (PD), and age-matched controls. DESIGN: Cross-sectional. SETTING: Secondary care clinics in geriatric psychiatry, neurology, and geriatrics. PARTICIPANTS: Two hundred forty-five participants aged 65 and older (AD, n=40; VaD, n=39; PDD, n=46; DLB, n=32; PD, n=46; and controls, n=42). MEASUREMENTS: Prevalence and severity of gait and balance disorders were assessed using the Tinetti gait and balance scale. The types of gait disorders in each diagnostic group were classified using the Nutt et al. classification. RESULTS: Gait and balance disorders were more common with PDD (93%), VaD (79%), and DLB (75%) than with PD (43%) and AD (25%) and in controls (7%). The risk of gait and balance disorder was higher in the non-Alzheimer's dementia groups (VaD, PDD, and DLB) than in the AD group (odds ratio=15 (95% confidence interval=6-37). If a gait disorder was present in mild dementia (Cambridge Examination for Mental Disorders of the Elderly cognitive subsection score >65), this was diagnostic of non-Alzheimer's dementia, with sensitivity of 78% and specificity of 100%. Non-Alzheimer's dementia groups had worse Tinetti gait and balance scores than the AD group (all P<.001). The types of gait disorders discriminated between non-Alzheimer's dementias. CONCLUSION: The findings support the idea that gait and balance assessment may augment the diagnostic evaluation of dementia.     

Objective assessment of abnormal gait in patients with rheumatoid arthritis using a smartphone

A disturbance in gait pattern is a serious problem in patients with rheumatoid arthritis (RA). The aim of the present study was to examine the utility of the smartphone gait analysis application in patients with RA. The smartphone gait analysis application was used to assess 39 patients with RA (age 65.9?±?10.0?years, disease duration 11.9?±?9.4?years) and age-matched control individuals (mean age, 69.1?±?5.8?years). For all RA patients, the following data were obtained: disease activity score (DAS) 28, modified health assessment questionnaire (mHAQ), and assessment of walking ability. Patients walked 20?m at their preferred speed, and trunk acceleration was measured using a Smartphone. After signal processing, we calculated the following gait parameters for each measurement terminal: peak frequency (PF), autocorrelation peak (AC), and coefficient of variance (CV) of the acceleration peak intervals. The gait parameters of RA and control groups were compared to examine the comparability of the 2 groups. Criterion-related validity was determined by evaluating the correlation between gait parameters and clinical parameters using Spearman??s correlation coefficient. The RA group showed significantly lower scores for the walking speed, AC, and CV than the control group. There were no significant differences in PF. PF (gait cycle) was mildly associated with gait speed (P?<?0.05). AC (gait balance) was moderately associated with the DAS, mHAQ, gait ability, and gait speed (P?<?0.05). CV (gait variability) was moderately associated with the DAS, gait ability, and gait speed (P?<?0.05). This is the first study to examine the use of a smartphone device for gait pattern measurement. The results suggest that some gait parameters recorded using the smartphone represent an acceptable assessment tool for gait in patients with RA.     

Worsened orthostatic hypotension due to levodopa administration in a case of Parkinson's disease

A 70-year-old woman began to experience gait disturbance in 1995, followed by the appearance of action tremor of the left hand in 1996. This tremor was subsequently noted in the right hand. Her doctor initially diagnosed Parkinson's disease and administered amantadine and levodopa. The gait disturbance and tremor improved. However, she stopped taking the medication and her symptoms worsened in April, 1998. She was admitted to our hospital, and showed rigidity and action tremor predominantly on the left side, frozen gait, postural reflex disturbance and orthostatic hypotension. Following levodopa administration, her UPDRS score improved from 61.3 +/- 1.2 (mean +/- SD) to 41.7 +/- 5.4. However, she experienced a greater decrease in systolic blood pressure following administration upon standing, from 12.5 +/- 5.8 mmHg to 17.8 +/- 9.2 mmHg. Thus, although levodopa administration led to an improvement in rigidity, tremor and akinesia, her orthostatic hypotension worsened. Based on the present results clinicians should be aware of the potential of worsened orthostatic hypotension when prescribing levodopa to treat Parkinson's disease.