Wednesday, November 16, 2011   |  Print

Preventing Falls: More than just a Footnote!

“Footloose” is not such a good idea as we age! “Taking care of your feet,” reports Harvard Medical School, “could improve your chances of staying on them.”


Falls frequent and costly


In an article titled “Feet and falling,” readers are reminded that each year about one in every three older Americans takes a tumble.  Chances of falls increase as these seniors move into their 80s and 90s. According to the Centers for Disease Control, falls are the leading cause of injury death among older adults. They are also the most common cause of nonfatal injuries and hospital admissions for trauma. In 2008, more than 19,700 older adults died from unintentional fall injuries. In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries, an amount equal $28.2 billion in 2010 dollars.


An overlooked cause of falls – the aging foot!


According to the Harvard article, foot problems and foot pain get mentioned in the roll call of risk factors, but usually near the end and frequently as an afterthought behind slippery throw rugs, poor lighting, and side effects from multiple medications.


The feet, like the rest of the body, feel the effects of age.  Muscle tissue thins; blood is more likely to pool in veins, causing swelling; nerves don’t function as well, resulting in loss of sensation; foot tissue may also change in ways that provide less cushioning; and structural changes (bunions, faltering arches, curling toes, diabetic issues) increase with age.


Making the connection


Over the past several years, more attention has been given to research connecting falls to foot pain and, perhaps, to common foot problems.  Investigators at the Institute for Aging Research (based at Harvard-affiliated Hebrew SeniorLife long-term care facility) found that foot pain seems to be a bigger factor in indoor falls than in outdoor falls.  


In 2010, Karen Mickle, an Australian researcher, reported on a study of relationship between foot pain and falls in a general, “community-dwelling,” non-high-risk population. Published in the Journal of the American Geriatrics Society, the study reported that, by a sizable margin, people who fell were more likely to have been bothered by foot pain than the people who didn’t fall.


A definite relationship between foot care and fall prevention!


Another Australian study reported in the medical journal BMU findings from the first-ever randomized clinical trial testing whether foot care would prevent falls. Over a year’s time, the foot care program reduced the number of falls by 36% in a study enrolling several hundred older people (average age 74) with foot pain.  


The key: simple exercises, inexpensive orthotics, and footwear advice!


Three simple exercises featured in the Harvard article were: 


1/ To alleviate mild bunions (haliux valgus), with heels on the ground, place a large elastic band around the ends of the big toes and gently rotate feet away from each other. The goal is to increase the range of motion in the metatarsophalangeal joint affected by the bunion, rather than actually correcting the bunion.


2/ To strengthen the ankle (especially the tibialis posterior muscle), place a resistance band around the arch of the foot and the leg of a table and rotate the ankle to stretch the band out away from the table.  


3/ To strengthen the muscles that contribute to the tendency for toes to curl in old age, use the toes to pick up small stones or marbles.


But wait, there’s more!


The Harvard article cautions about making pronouncements about what actually works to prevent falls.  


According to the article’s authors, a major review in 2010 of fall prevention research “surprised a few doctors and researchers by concluding that it was ‘unclear’ whether the kind of fall risk assessment and management programs favored by groups like the American Geriatrics Society do, in fact, work . . .”  The reviewers identified only two interventions supported by results from clinical trials: exercise programs and (according to the Harvard writers, another surprise!) vitamin D pills. Some interventions, the authors reminded, are easier to test in clinical trials than others.  They concluded with several suggestions:


Choose shoes wisely – and wear them.

About 35% people are off by a least a half a size in knowing their correct shoe size, and older people need to be even more careful about width to allow for foot changes.  Even though Harvard researchers conducted a study that showed the choice of footwear didn’t have much of an effect on falls, they found that people who wore shoes indoors were less likely to suffer a serious injuring from a fall than those who “padded around in slippers or socks or went barefoot.”    


Lose weight.

According to the article, if an individual’s weight pushes the BMI into the high 20s or 30s, that puts more force on the feet.  Although it hasn’t been proven to reduce chances of falling, taking a load off can spare pain.


Try prefabricated orthotics first.

Orthotics do seem to prevent some falls by stabilizing the feet, redistributing pressure, and providing additional tactile input, according to Hylton Menz, an Australian podiatrist and frequent author on many foot and fall studies.  While custom-made orthotics may cost several hundred dollars, the prefabricated kind cost around $50.  Based on the data available and cost differential, Menz, a Fulbright Visiting Scholar in 2011 at the Institute for Aging Research, says it makes sense to try prefabricated first, unless there is a major foot deformity.


Get a little bit of a workout.

Exercises for the feet and ankles (previously mentioned in the article) can help offset the muscle loss and stiffness that naturally set in with old age.  Menz also cites yoga as an example of exercise that may prevent foot problems.  


-Harvard Health Letter, November 2011

-Falls Among Older Adults: An Overview,, accessed 11-9-11




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