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Foot Problems in Older Adults

Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures

Amy Muchna Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.
Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ.

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Bijan Najafi Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.

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Christopher S. Wendel Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.
Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ.

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Michael Schwenk Network Aging Research, Heidelberg University, Heidelberg, Germany.

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David G. Armstrong Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA.

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Jane Mohler Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.
Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ.

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Background:

Research on foot problems and frailty is sparse and could advance using wearable sensor–based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.

Methods:

Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.

Results:

Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day.

Conclusions:

Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty.

Corresponding author: Jane Mohler, NP-C, MPH, PhD, Department of Medicine, Arizona Center on Aging, University of Arizona College of Medicine, 1821 E Elm St, Tucson, AZ 85719. (E-mail: jmohler@aging.arizona.edu)