By Sarah A. Curran, PhD
Modern day times not only see us living longer, but enjoying a wide array of advances in lifestyle, medicine, health, and social care, as well as the fast-paced changes in technology. Currently, 13% of the global population is over age 60, a figure which is increasing by 3% each year.1 The aging process is very much a developmental journey that is characterized by a multitude of age-related changes in appearance and structure, as well as biological and physiological processes. However, for some, the journey into mature years comes with a risk of developing chronic systemic diseases or conditions such as cancer, cardiovascular disease, neurological conditions, diabetes, and/or obesity. While these chronic conditions or diseases can occur in isolation, because of the numerous changes associated with aging, it is not unusual for many to have a number of chronic conditions and diseases at the same time. As such, this influences quality of life and independency, which can also have financial implications for care to the individuals themselves, their families, and society.2
Chronic conditions, the foot, and lower limb
Aside from the chronic systemic conditions, the aging process can also have effects on the foot and lower limb. The foot in particular plays a key role by providing foundational support and function that interlinks the lower limb and ground, enabling the body to move from one point to the next. These changes can include a lack of mobility, lesser-toe deformities, hallux valgus, and a broader and flatter foot, as well as a 24% to 40% reduction of foot and ankle muscle strength.3-6 In essence, the combination of these features compromises mobility and balance, increasing the risks of falls, as well as causing foot pain, which is reported by 1 in 4 older individuals.7 While many will seek help from health professionals, such as a podiatrist, general practitioner/physician, or physiotherapist, conservative management of such cases may be lacking. This is influenced further by a perception of older individuals that foot problems are just part of the aging process and unworthy of being managed.8
Management Approaches: Overview
Due to the complex interactions of comorbidities and aging, management of the older adult foot and lower limb has a tendency to increase with age.4 This comes under the remit of the multi-disciplinary team.5,6 This can include podiatrists, physiotherapists, vascular and orthopaedic surgeons, occupational therapists, dermatologists, nurses, and endocrinologists. Routine podiatric care, foot orthoses, and footwear are typically included in management.4-6 In recent years, progressive foot and ankle strengthening protocols have gained a useful evidence base in older populations.9-11 As with other patient groups, there is a trend for the key management domain to focus on patient education and prevention, and the use of physical activity, which can have a wider impact on health and well-being in general.13-14 This perhaps is particularly important since engagement in such activities (eg, short-distance walking to exercise classes) can minimize isolation of older individuals and improve balance, strength, and mobility—all while reducing the risk of falls.
Technology plays a key role in medicine and rehabilitation in general through the use of visualization, personalized medicine, and mobile technology. Early wearable technological devices came from a mechanical pedometer for counting steps; with the evolution of technology, similar present-day devices record your sleep patterns, heart rate, and calories burned, among other parameters. There are, however, rapid developments in the use of mobile medical technology that include in-body and on-body sensors which can benefit the clinician, researcher, clinical service, and most importantly, the patient—with such devices being patient-centric. This personalized data collection has a number of benefits that can assist with patient engagement and adherence, creating information and awareness for patients to respond to changes in symptoms, but also by providing objective biometrics through continuous and automatic measurement for risk-based assessment. This information differs from the traditional snapshot of self-reported patient data and can be communicated to the patient’s own device/smartphone app and directly to clinical centers and hospitals, thereby increasing patient safety and validity of the data collected.
Due to its low costs, lesser training needs, and the potential for better adherence, this constantly emerging field has an appeal to all patient groups, including those who are entering their advanced years. While many may argue that those in their advanced years have a limited awareness and understanding of modern technology (the term “technophobic” is often used), today’s adults over age 65 are in fact more digitally connected than before, with many owning a smartphone and being active on the internet and social media.16 This trend will only accelerate.
As we move forward in the next decade, clinicians, patients, and service providers will need to embrace technology to cope with the myriad operational and financial demands placed on healthcare systems. Through the use of evidence-based research, mobile applications and other forms of hardware and software will assist in delivering educational and preventative management of lower limb and foot conditions, as well as promoting the engagement of an active lifestyle and improving overall health.
Sarah Curran, PhD, is Professor of Podiatric Medicine and Rehabilitation at the School of Sport and Health Sciences, Cardiff Metropolitan University in the United Kingdom. She is long-standing member of the LER Editorial Advisory Board.
- World Health Organisation. Global health and ageing. https://www.who.int/ageing/publications/global_health.pdf?ua=1. Accessed 4th November 2018.
- Ge L, Ong R, Yap CW, et al. Effects of chronic diseases on health-related quality of life and self-related quality of life and self-related health among three adult age groups. Nurs Health Sci Gerontol. 2018;51:346-351.
- Golightly YM HM, Dufour AB, Hillstrom HJ, et al. Foot disorders associated with overpronated and oversupinated foot function: the Johnston county osteoarthritis project. Foot Ankle Int. 2014;35:1159-1165.
- Menz HB. Chronic foot pain in older people. Maturitas. 2016;91:110-114.
- Menz HB. Biomechanics of the ageing foot and ankle: a mini review. Gerontology. 2016;61:381-388.
- Menz HB, Jordan KP, Roddy E. Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK. Rheumatology. 2010;49:1391-1398.
- Thomas MJ, Roddy E, Zhang W, et al. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain. 2011;152:2870-2880.
- Menz HB, Barr ELM, Brown WJ. Predictors and persistence of foot problems in women aged 70 years and over: A prospective study. Maturitas. 2011;68:83-87.
- Endo M, Ashton-Miller JA, Alexander NB. Effects of age and gender on toe flexor muscle strength. J Gerontol A Biol Sci. Medical Sciences 2092;57A:M392-M397.
- Menz HB, Zammit GV, Munteanu SE, et al. Plantarflexion strength of the toes: age and gender differences and evaluation of a clinical screening test. Foot and Ankle Int. 2006;27:1103-1108.
- Uritani D, Fukumoto T, Matsumoto D, et al. Reference values for toe grip strength among Japanese adults aged 20-79 years: a cross-sectional study. J Foot Ankle Res. 2014;7:28.
- Ge L, Ong R, Yap CW, et al. Effects of chronic diseases on health-related quality of life and self-related quality of life and self-related health among three adult age groups. Nursing Health Sciences Gerontology. 2018;51:346-351.
- Otero M, Esain I, Gonzalez-Suarez AM, et al. The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis. Clin Interv Aging. 2017;12:505-513.
- Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American college of sports medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510-1530.
- Matthew-Maich N, Harris L, Ploeg J, et al. Designing, implementing, and evaluating mobile health technologies for managing chronic conditions in older adults: A scoping review. JMIR Mhealth Uhealth. 2016;4:e29.
- Anderson M, Perrin A. Tech adoption climbs among adults. May 2017. https://www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/. Accessed 10th June 2019.