The relationship between foot pain, anthropometric variables and footwear among older people
Introduction
The functional limitations from which older people suffer may be the result of foot problems. Munro and Steele (1998) and Menz and Lord (2001) identified a high prevalence of foot problems (71 and 87% respectively) among older adults, and in both cases, this was more common in women. Older women were more prone to halux valgus and plantar callus, which frequently lead to chronic painful conditions (Menz and Stephen, 2001, Menz et al., 2007).
Dhaliwal et al. (2003) reported that, in their study on 1486 older people of both genders, 34% had foot pain while Menz et al. (2006) reported that 36% of older people have debilitating foot pain. In older adults, foot pain is associated with changes in gait and balance, decreased mobility, low quality of life, and increased difficulty in activities of daily living, especially among the oldest of the older adults (Benvenuti et al., 1995, Menz and Stephen, 2001, Dhaliwal et al., 2003, Thomas et al., 2004, Keysor et al., 2005).
Footwear can also be a source of pain. With age, the width and height of the forefoot increases to a greater extent than the width and height of the hind foot, making it difficult to find appropriate shoes (Frey et al., 1995). Especially in old age, wearing inadequate shoes limits mobility and consequently impairs health, independence and quality of life (Finlay, 1995). It seems prudent that older women avoid wearing high-heeled shoes, which reduces the support base and consequently changes the weight distribution on the plantar surface of the foot, overloading the metatarsophalangeal joints and impairing balance (Tencer et al., 2004). This type of footwear may also be associated with pain because it is ineffective in the absorption of impact (Yung-Hui and Wei-Hsien, 2005) and favors esthetics to the detriment of comfort.
Corso (1998) reported that pain tolerance increases with age, which may lead to wearing tight shoes and consequent formation of calluses and foot deformities. Although many authors have found high percentages of older people wearing ill-fitting shoes (Frey et al., 1993, Burns et al., 2002, Menz and Morris, 2005), there is a lack of studies investigating the presence of pain felt when wearing shoes.
Another issue related to foot pain in older people is the extent to which changes in the anthropometric characteristics of the feet might be associated with the presence of pain. It has already been reported that flat feet and cavus feet are related to pain (Benvenuti et al., 1995, Burns et al., 2005, Badlissi et al., 2005, Statler and Tullis, 2005), however there is a need for studies investigating whether width, circumference and height may also influence foot biomechanics and shoe fit, and consequent pain.
Considering these issues, this study aimed to verify the prevalence of pain among older people when wearing shoes, and the relationships between foot pain, high-heeled shoes and anthropometric variables.
Section snippets
Methods
Individuals aged 60 years and over, of both genders, resident in the city of São Carlos, São Paulo, Brazil, were included in this study. Exclusion criteria were amputation of any part of the lower limbs or the use of bandages or orthoses that would prevent direct contact of the instruments with the skin. The sample was determined according to the age and gender ratios of the older population of São Carlos. Thus the sample was intentionally composed of 227 older women with a mean age of 69.6 ± 6.8
Results
The presence of foot pain was reported by 115 women (50.7%) and 52 men (30.2%). With respect to pain when wearing shoes, the complaints were more frequent in the female group; at least one painful region of the foot was registered for 60.8% of this group. In the male group, only 29.6% had the same complaint. Fig. 1 shows the percentage of complaints in various regions of the foot when wearing shoes for both groups. The toes were the most affected part, followed by the metatarsophalangeal joints
Discussion
A survey with 7878 people aged 50 years or more revealed that women were more prone to pain in at least one part of the body than men (Thomas et al., 2004), and in the present study the presence of foot pain and pain when wearing shoes was correlated with the female gender. These findings agree with the results of one of the few epidemiological studies on the incidence of foot pain among older people, which showed that women were twice as likely to present foot pain as men (Benvenuti et al., 1995
Acknowledgments
The authors are grateful for the financial support provided by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
References (36)
- et al.
A qualitative study on the comfort and fit of ladies’ dress shoes
Appl. Ergon
(2007) The effect of pes cavus on foot pain and plantar pressure. Clin
Biomech
(2005)- et al.
The arch index: a useful measure from footprints
J. Biomech
(1987) - et al.
The Foot Posture Index: Rasch analysis of a novel, foot-specific outcome. Arch. Phys. Med
Rehabil
(2007) - et al.
Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index. Clin
Biomech
(2006) The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP)
Pain
(2004)- et al.
Effects of shoes inserts and heel height on foot pressure, impact force, and perceived comfort during walking
Appl. Ergon
(2005) - et al.
Footwear, walking patterns and falling in the elderly
(1990) Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons
J. Am. Geriatr. Soc.
(2005)Foot pain and disability in older persons: an epidemiologic survey
J. Am. Geriatr. Soc.
(1995)
Sex differences in pain
Behav. Brain Sci.
Statistics notes: measurement error
BMJ
Older people and ill fitting shoes
Postgrad. Med. J.
Etude statistique sur la mesure des pieds en France
Med. Chir. Pied
The somatosensory system
Prevalence of lower extremity pain and its association with functionality and quality of life in elderly women in Australia
J. Rheumatol
Foot problems and footwear prescription
Biostatistics: A Methodology for the Health Sciences
Cited by (54)
Foot pressure monitoring using single layer carbon loaded piezoresistive material
2020, Microprocessors and MicrosystemsCitation Excerpt :From the assessment by Hodge et al., typical forefoot pressure, assessed with an in-shoe pressure contraption, was correlated to foot torment. [40–47] From the examination, PP and PTI were evaluated [70,71]. PTI was allied to foot torment, whereas no association among PP and foot-torment was found.
Subject-specific identification of three dimensional foot shape deviations using statistical shape analysis
2020, Expert Systems with ApplicationsCitation Excerpt :For some people, this pain is linked to foot deformities, with common conditions including hallux valgus (Garrow et al., 2001; Nix, Vicenzino, Collins, & Smith, 2012), collapsed foot arches (Xiong, Goonetilleke, Witana, Weerasinghe, & Au, 2010; Young, Niedfeldt, Morris, & Eerkes, 2005), and club feet (Agarwal & Rastogi, 2018; Ganesan, Luximon, Al-Jumaily, Balasankar, & Naik, 2017). For others, foot pain has been associated with improperly fitting footwear (de Castro, Rebelatto, & Aurichio, 2010; Dobson, Riddiford-Harland, Bell, & Steele, 2018), indicating that a more precise characterization of foot shape would be valuable in footwear fitting and design (Deselnicu, Vasilescu, Mihai, Purcarea, & Militaru, 2016; Rodrigo, Goonetilleke, & Witana, 2012; Sarghie, Mihai, & Herghiligiu, 2016; Wunderlich & Cavanagh, 1999). Despite a clear link between foot shape and foot pain, one study has reported that more than half of its participants who experienced debilitating foot pain did not seek professional help (Garrow et al., 2004).
Everyday footwear: An overview of what we know and what we should know on ill-fitting footwear and associated pain and pathology
2019, FootCitation Excerpt :Additional to the gait changes that have been shown to occur, the clinical effects of ill-fitting footwear can lead to skin lesions (blisters, hyperkeratotic lesions, rubbing soreness and ulceration) [19,20]. It is suggested that in turn these changes can lead on to pathology and pain [21,22]. This indirect association linking the development of a lower limb pathology to choosing to wear ill-fitting footwear is not based on strong evidence.
Validation of a 3D foot scanning system for evaluation of forefoot shape with elevated heels
2017, Measurement: Journal of the International Measurement ConfederationThe relationship between arch height and foot length: Implications for size grading
2017, Applied ErgonomicsCitation Excerpt :A recent study of army recruits found that a substantial proportion of personnel could not be fitted with an army boot, specifically due to variations in arch height (Baxter and Baxter, 2011). Women with higher arch indexes have been shown to report a higher prevalence of footwear related pain (Paiva de Castro et al., 2010a) with 48.5% of diabetic females and 69.2% of diabetic males wearing footwear that was too long for them simply to accommodate height and width dimensions (Paiva de Castro et al., 2010b). To provide more ergonomic footwear lasts, manufactures should consider Allometry (The biological study that explores the non linear geometric relationship between body structures with increasing size) rather than the simple Isometric length dimensional grading currently used (Bertram, 2011).