Diseases and disorders of foot and their related structures in the older patient represent a significant health concern. The immobility that results from local foot conditions and the focal complications of systemic diseases have a significant impact on individuals’ ability to maintain their independence, retain a quality of life, and become financial concerns 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.
The human foot is both a static and a 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 modern humans. 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 walk owing to some foot problem or change not only produces physical limitations but also has a significant impact on the patient's mental, social, and economic status. On average, 90% of the adult population older than 65 years will demonstrate some evidence of foot pain that alters independent activity. Foot and related complications also represent a significant factor for many hospital admissions, especially related to complications associated with diabetic and vascular ulceration and infection.
The goal of this chapter is to provide the geriatric health-care provider with a foundation of knowledge about the aging foot in health and disease. There is an extensive and unique comprehensive podiatric assessment and a medical vocabulary associated with the field of podiatry. An example of a comprehensive assessment and a list of podiatric terms are provided as appendices available in the online version of this text.
There are multiple factors that contribute to the etiology of foot problems in older patients. The primary factors include the aging process itself, years of use and abuse, repetitive stress, neglect, foot deformity, and the presence of multiple chronic diseases. Other significant factors include the degree of ambulation, limitation of activity, prior institutionalization, as well as prior and improper self-care. Foot problems are also affected by impaired vision, obesity, the inability to bend, and peripheral sensory loss. Local foot factors include altered biomechanics and pathomechanics, soft-tissue atrophy and plantar fat pad displacement, limited joint mobility, and contractures. Discomfort, pain (podalgia), ambulatory dysfunction, and pain when walking (pododynia dysbasia) become distressing and disabling.
In addition to factors of the host, agent factors that contribute to the development of foot conditions include hard flat surfaces for ambulation, trauma, foot-covering material and fabrication, foreign bodies, and foot-to-shoe-last incompatibilities. Environmental factors that affect the foot include customs and shoe styles; low income; adequate care and referral; nutrition; poor foot health education; cultural barriers; physical changes such as climate, flooring materials, and covering; the health-care ...