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LEARNING OBJECTIVES

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Learning Objectives

  • To recognize the need for foot health as a primary clinical need for the older individual and patients with chronic diseases.

  • To identify, recognize, and understand the changes in the foot and its related structures associated with aging, chronic diseases, and focal pathology.

  • To identify primary foot and related complications associated with aging and chronic diseases that detract from successful aging and increase disability.

  • To define clinical strategies to assess the “at risk” patient and understand primary management options, including service indicators and referral for care.

  • To develop management practices that stress assessment, education, prevention, management, and continuing education programs.

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Key Clinical Points

  1. Provide a comprehensive clinical assessment of the foot and related structures. This is especially important for those individuals with conditions that pose a high risk for pedal complications such as diabetes mellitus, peripheral vascular disease, peripheral neuropathy, end-stage renal disease, and degenerative joint changes that can limit mobility and affect quality of life.

  2. Changes in the foot and related structures as a result of aging are common causes of foot pain (podalgia). As a result, painful ambulation (pododynia dysbasia) and limitation in mobility can result. These conditions include hyperkeratotic lesions, onychodystrophy, onychomycosis, heel pain/plantar fasciitis, fat pad displacement and atrophy, hallux valgus (bunion), digiti flexus (hammertoe), ulceration (trophic, diabetic, and neurovascular), and the residuals of rheumatoid, degenerative, and gouty arthritis.

  3. Provide patient information and education that includes hygienic and preventive components, footwear, and orthotic recommendations.

  4. Provide information on referrals and coordinated care.

  5. Utilize a clinical podogeriatric assessment protocol that stratifies risk components and includes Medicare and Medicaid considerations as well as methods to prevent amputation.

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INTRODUCTION

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Diseases and disorders of foot and their related structures in the older patient represent a significant health concern in both prevalence and incidence. The immobility that results from local foot conditions and the focal complications of systemic diseases has a significant impact on the individual’s ability to maintain independence, retain quality of life, and not become a financial burden for society in general. Two important factors involved in the older patient’s ability to remain as a vital part of society are a keen mind and the ability to retain their mobility through ambulation.

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The human foot is both a static and mobile organ of function. It provides support for the body at rest and during propulsion and ambulation. It supports our ability to walk upright, which is a specific characteristic of man/woman. The ability to remain mobile and functional in society is a key activity of daily living and may well be the primary catalyst to independence for the older population. The loss of the ability to ambulate due to some foot and/or related problem or change not only produces physical limitations but also has a significant impact on the patient’s mental, social, and economic status.

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Some of the needs for appropriate foot and ...

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