Elsevier

Applied Ergonomics

Volume 41, Issue 1, January 2010, Pages 93-97
Applied Ergonomics

The relationship between foot pain, anthropometric variables and footwear among older people

https://doi.org/10.1016/j.apergo.2009.05.002Get rights and content

Abstract

Objective

To verify the prevalence of pain among older people when wearing shoes, and the relationships between foot pain, high-heeled shoes and anthropometric variables.

Method

Both feet of 227 older women and 172 older men were evaluated with respect to anthropometric variables, arch index and foot posture index. The participants were also asked about the presence of foot pain while wearing high-heeled shoes. The data were analyzed using the Chi-square test, Pearson's correlation, MANOVA, multiple regression analysis, t test, and analysis of probability.

Findings

The prevalence of foot pain when wearing shoes was high and was associated with the female gender, however wearing high-heeled shoes was not associated with pain. The women with foot pain presented larger values for the circumferences of the metatarsal heads and the instep (after normalization with the foot length) than those without pain. The men with pain did not present different measurements from those without pain.

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)

  • K.J. Berkley

    Sex differences in pain

    Behav. Brain Sci.

    (1997)
  • J.M. Bland et al.

    Statistics notes: measurement error

    BMJ

    (1996)
  • S.L. Burns et al.

    Older people and ill fitting shoes

    Postgrad. Med. J.

    (2002)
  • J. Chouquet-Stringer et al.

    Etude statistique sur la mesure des pieds en France

    Med. Chir. Pied

    (1972)
  • J.F. Corso

    The somatosensory system

  • S.S. Dhaliwal

    Prevalence of lower extremity pain and its association with functionality and quality of life in elderly women in Australia

    J. Rheumatol

    (2003)
  • O.E. Finlay

    Foot problems and footwear prescription

  • L.D. Fisher et al.

    Biostatistics: A Methodology for the Health Sciences

    (1993)
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