Falls in the elderly are associated with significant morbidity and, after a serious fall, indeed predict the transition within a year of 10-15% of seniors to long-term care facilities. Additionally, the one-year and three-year mortality for seniors is 16.4 % and 40.5% following a report of more than one fall in the past 3 months (about double the average). When a hip fracture complicates the fall, the all-cause mortality is three times higher than for the average population and as high as 27% in one year in some studies. 

Many factors are at play in the deterioration of senior patients experiencing falls and mobility decline. Faltering stability may arise from inadvertent overmedicating with hypotensive agents and beta-blockers, or the consequences of previous cerebrovascular accidents, Parkinson's disease and myopathies. Excluding these more overt and obvious conditions, one of the greatest determinants of falls is toe strength. Toe strength affects stability, which is a problem in an estimated 1:4 people over the age of 65 years. 

The problem of falls relating to toe strength, foot proprioception and distal muscular control piqued my interest and led to a curiosity to explore this issue further with expert physiotherapist Allan Abbott. Allan is known for pushing the boundaries of knowledge and learning, and for providing a fresh perspective on many functional issues affecting us that one may not have considered previously in any detail. In an earlier podcast, Allan helped us explore breathing techniques designed to enhance physiologic function, and I would commend these episodes, including 139,140, as well as 153 and 154, to you. 

The concept of dying from the feet up warrants careful examination and thorough understanding. Hopefully, after listening to this podcast, you will believe, as I do, that we could all benefit from the ideas Allan explores. 

I was keen to learn more about the major factors contributing to foot problems, the exercises we should be considering and recommending as well as performing regularly ourselves to improve toe strength, balance and dexterity. The role of footwear and how one may select “good” foot support in terms of orthotics is also of significant importance and interest. 

If you are interested in improving foot function and limiting morbidity both for your patients and yourself, please join me with Allan as he navigates this fascinating topic.

References:

Mr Allan Abbott - Physiotherapists http://www.healthinnovations.net.com/

The prognosis of falls in elderly people living at home: Donald et al. Age and Ageing. Vol 28. March 1999.

Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study

Panuka et al.BMC Muskuloskeletal Disorders. May 20, 2011

Older adults and balance problems. Sep 2022. www.nia.nih.gov