Alexander IJ: The Foot: Examination and Diagnosis, 2nd Ed, Churchill Livingstone, New York. ,1997. .
American Podiatric Medical Association: Foot Health Training: Guide for Long Term Care Personnel, American Podiatric Medical Association, Washington, DC. ,1977. .
Baran R, Dawber RPR, Tosti A, et al: A Text Atlas of Nail Disorders: Diagnosis and Treatment, CV Mosby, St Louis. ,1996. .
Baran R, Hay R, Haneke E, et al: Onychomycosis: The Current Approach to Diagnosis and Therapy, Martin Dunitz, London. ,1999. .
Beaven DW, Brooks SE: Color Atlas of the Nail in Clinical Diagnosis, Year Book Medical Publishers, Chicago. ,1984. .
Benvenuti F, Ferrucci L, Gurlink JM, et al: Foot pain and disability in older persons: an epidemiologic survey. .J Am Geriatr Soc 43::479. ,1995. .
Birrer RB, Dellacorte MP, Grisafi PJ: Common Foot Problems in Primary Care, 2nd Ed, Hanley & Belfus, Philadelphia. ,1998. .
Bowker JH, Pfeifer MA (eds): Levin and O’Neal’s The Diabetic Foot, 6th Ed, CV Mosby, St Louis. ,2001. .
Brenner MA: Management of the Diabetic Foot, Williams & Wilkins, Baltimore. ,1987. .
Brodie BS: Health determinants and podiatry. .J R Soc Health 121::174. ,2001. .
Cailliet R: Foot and Ankle Pain, 3rd Ed, FA Davis, Philadelphia. ,1997. .
Centers for Medicare & Medicaid Services: “Section 2323: Foot Care and Supportive Devices for Feet,” in Carriers Manual, Centers for Medicare & Medicaid Services, Baltimore, March 27. ,2002. .
Centers for Medicare & Medicaid Services: Transmittal AB-02-096: Coverage and Billing of the Diagnosis and Treatment of Peripheral Neuropathy with Loss of Protective Sensation in People with Diabetes, Centers for Medicare & Medicaid Services, Baltimore, July 17. ,2002. .
Collet BS: “Foot Problems,” in The Merck Manual of Geriatrics, ed by MH Beers, R Berkow, p 966, Merck & Co, Rahway, NJ. ,1990. .
Crawford VL, Ashford RL, McPeake B, et al: Conservative podiatric medicine and disability in elderly people. .JAPMA 85::255. ,1995. .
Eng W: “Geriatric Podiatry,” in Geriatric Curriculum Resource Guides for Health Professionals, p 1, Geriatric Education Center at Virginia Commonwealth University, Richmond. ,1986–1987. .
Evans JG, Williams TF, Beattie BL, et al: Oxford Textbook of Geriatric Medicine, 2nd Ed, Oxford University Press, Oxford. ,2000. .
Harkless LB, Krych SM: Handbook of Common Foot Problems, Churchill Livingstone, New York. ,1990. .
Helfand AE: A study in podogeriatrics: a pilot study of foot problems in the aged and chronically ill. .JAPA 53::655. ,1963. .
Helfand AE: Guide to a methodological approach for a community foot health study for the chronically ill and the aged. .JAPA 54::465. ,1964. .
Helfand AE: Keep them walking. .JAPA 58::117. ,1968. .
Helfand AE: The Foot of South Mountain: a foot health survey of the residents of a state geriatric institution. .JAPA 59::133. ,1969. .
Helfand AE: At the foot of South Mountain: a 5-year longitudinal study of foot problems and screening in an elderly population. .JAPA 63::512. ,1973. .
Helfand AE: The foot: geriatric overview: part 1. .The Foot 3::58. ,1993. .
Helfand AE: The foot: geriatric overview: part 2. .The Foot 5::19. ,1995. .
Helfand AE: Feet First, Pennsylvania Diabetes Academy, Harrisburg, PA. ,1995. .
Helfand AE: If the Shoe Fits, Pennsylvania Diabetes Academy, Harrisburg, PA. ,1998. .
Helfand AE: Public health strategies to develop a comprehensive chronic disease and podogeriatric protocol. .Natl Acad Pract Forum 1::49. ,1999. .
Helfand AE: Assessing the Older Diabetic Patient [CD-ROM], Pennsylvania Diabetes Academy and Pennsylvania Department of Health, Harrisburg, PA. ,2001. .
Helfand AE: “Disorders and Diseases of the Foot,” in Geriatric Review Syllabus: A Core Curriculum in Geriatric Medicine, 5th Ed, ed by E Cobb, E Duthie, JB Murphy, p 287, Blackwell Publishing, Malden, MA. ,2002. .
Helfand AE, Jessett DF: “Foot Problems,” in Principles and Practice of Geriatric Medicine, 3rd Ed, ed by MSJ Pathy, p 1165, John Wiley & Sons, New York. ,1998. .
Helfand AE, Cooke HL, Walinsky MD, et al: Foot pain and disability in older persons: pilot study in assessment and education. .JAPMA 86::93. ,1996. .
Helfand AE, Cooke HL, Walinsky MD, et al: Foot problems associated with older patients: a focused podogeriatric study. .JAPMA 88::237. ,1998. .
Helfand AE (ed): Clinical Podogeriatrics, Williams & Wilkins, Baltimore. ,1981. .
Helfand AE (ed): Public Health and Podiatric Medicine, Williams & Wilkins, Baltimore. ,1987. .
Helfand AE (ed): The geriatric patient and considerations of aging: part I. .Clin Podiatr Med Surg 10.:1993. .
Helfand AE (ed): The geriatric patient and considerations of aging: part II. .Clin Podiatr Med Surg 10.:1993. .
Highmark Government Services Administrators: Medicare Report: Coverage Requirements for Routine Foot Care, June 2, 2002, p 33, Highmark Government Services Administrators, Camp Hill, PA, July 14. ,2002. .
Jessett DF, Helfand AE: “Foot Problems in the Elderly,” in Principles and Practice of Geriatric Medicine, 2nd Ed, ed by MSJ Pathy, p 1301, John Wiley & Sons, New York. ,1991. .
Klenerman L (ed): The Foot and Its Disorders, 3rd Ed, Black-well Scientific Publications, London. ,1991. .
Libow LB, Sherman FT (eds): The Core of Geriatric Medicine, CV Mosby, St Louis. ,1981. .
Lorimer D, French G, O’Donnell M, et al: Neale’s Disorders of the Foot: Diagnosis and Management, 6th Ed, Churchill Livingstone, New York. ,2002. .
McCarthy DJ (ed): Podiatric Dermatology, Williams & Wilkins, Baltimore. ,1986. .
Merrill HE, Frankson J Jr, Tarara EL: Podiatry survey of 1011 nursing home patients in Minnesota. .JAPA 57::57. ,1967. .
Merriman LM, Tollafield DR: Assessment of the Lower Limb, Churchill Livingstone, New York. ,1995. .
Pathy MSJ (ed): Principles and Practice of Geriatric Medicine, 3rd Ed, John Wiley & Sons, New York. ,1998. .
Plummer ES, Albert SG: Focused assessment of foot care in older adults. .J Am Geriatr Soc 44::310. ,1996. .
Reichel W (ed): Clinical Aspects of Aging, 3rd Ed, Williams & Wilkins, Baltimore. ,1989. .
Robbins JM: Primary Podiatric Medicine, WB Saunders, Philadelphia. ,1994. .
Samitz MH: Cutaneous Disorders of the Lower Extremities, 2nd Ed, JB Lippincott, Philadelphia. ,1981. .
Samman PD, Fenton DA: The Nails in Disease, 4th Ed, William Heinemann Medical Books, London. ,1986. .
Sims DS, Cavanagh P, Ulbrecht JS: Risk factors in the diabetic foot: recognition and management. .Phys Ther 68::1887. ,1988. .
Starin I, Kuo N: The Queensbridge Health Maintenance Service for the Elderly, 1961–1965. .Public Health Rep 81::75. ,1966. .
Strauss MB, Hart JD, Winant DM: Preventive foot care. .Post-grad Med 103::233. ,1998. .
Tollafield DR, Merriman LN (eds): Clinical Skills in Treating the Foot, Churchill Livingstone, New York. ,1997. .
Williams TF (ed): Rehabilitation in the Aging, Raven Press, New York. ,1984. .
Woodside N, Shapiro J: Podiatry services at clinics of a local health department. .Public Health Rep 82::389. ,1967. .
Yale JF: Yale’s Podiatric Medicine, 3rd Ed, Williams & Wilkins, Baltimore. ,1987. .
Yale I, Yale JF: The Arthritic Foot and Related Connective Tissue Disorders, Williams & Wilkins, Baltimore. ,1984. .
This study sought to demonstrate the prevalence of foot conditions in older individuals and their association with chronic risk diseases such as diabetes mellitus, peripheral arterial disease, and arthritis, and to develop care plans to reduce complications from local foot problems and chronic diseases. One thousand individuals older than 65 years who were ambulatory and not institutionalized underwent a standardized and validated podogeriatric examination assessment protocol or index. Overall, 74.6% of all patients had a history of pain, 57.2% were receiving current care for diabetes mellitus, 22.9% indicated current care for peripheral vascular disease, 94.2% had onychodystrophy, 64.2% had one or more foot deformities, 64.0% demonstrated some loss of protective sensation, and 81.7% had one or more symptoms and signs of peripheral arterial insufficiency. These findings demonstrate that foot problems in the older population result from disease, disability, and deformity related to multiple chronic diseases as well as changes associated with repetitive use and trauma. Older people are at a high risk of developing foot-related disease and should receive continuing foot assessment, education, surveillance, and care. (J Am Podiatr Med Assoc 94(3): 293–304, 2004)