Foot problems as a risk factor for falls in community-dwelling older people: A systematic review and meta-analysis
Introduction
Falls in older people are a major public health problem and are responsible for substantial morbidity and mortality in this age-group [1]. The aetiology of falls is multifactorial, and over 150 risk factors for falls have been identified. These risk factors include medical conditions (such as Parkinson’s disease, stroke and dementia), medications (such as psychotropics and antidepressants) and sensorimotor impairments (such as muscle weakness, slow reaction time and poor balance) [2]. Detailed screening of these factors can assist in identifying older people at elevated risk of falling and inform the selection of interventions targeted at these deficits [3].
Foot problems, which affect between 20 and 45% of older people [4], may also contribute to falls in this population. The foot provides the only direct source of contact with the ground when performing weight-bearing activities, and therefore plays an important role in stabilising the body when negotiating uneven or compliant surfaces [5]. With advancing age, the foot exhibits increased soft tissue stiffness, reduced strength and range of motion, and a more pronated (flat) posture [6], and is more susceptible to the development of structural disorders such as hallux valgus and lesser toe deformity [7]. These changes may impair balance, functional ability and gait patterns, thereby increasing falls risk [8].
To date, there have been no systematic reviews to consolidate and critique the available research literature exploring the association between foot problems and falls. Therefore, the aim of this study was to conduct a systematic review and meta-analysis to determine the extent to which foot problems (including both foot pain and structural foot disorders) are associated with falls in community-dwelling older people.
Section snippets
Methods
This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) [9] and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) [10] guidelines, and was prospectively registered on the PROSPERO database (CRD42018099127).
Search results
The electronic search yielded 216 papers. After the removal of duplicates, 146 publications were examined by title and abstract, and nine were considered for full text review [[16], [17], [18], [19], [20], [21], [22], [23], [24]]. An additional six publications were identified through searching the reference lists of included publications [[25], [26], [27], [28], [29], [30]], resulting in a total yield of 15 eligible publications. See Fig. 1.
Of these 15 eligible publications, seven reported
Discussion
The objective of this systematic review was to determine whether foot problems increase the risk of falling in community-dwelling older people. We found 15 eligible studies, of which six were cross-sectional and nine were prospective. Of these, we were able to conduct a complete quantitative synthesis of 12 studies. Older people who fell were more likely to have foot pain, hallux valgus, lesser toe deformity, plantar fasciitis, reduced ankle dorsiflexion range of motion, reduced toe
Conclusions
This systematic review and meta-analysis of 15 studies suggests that foot problems, particularly foot pain, hallux valgus and lesser toe deformity, are associated with falls in older people. To further strengthen the evidence base for this association, future studies need to ensure that foot problem risk factors are more clearly defined and assessed using reliable and valid techniques, and that appropriate adjustment for confounders is undertaken.
Contributors
Hylton B. Menz conceived the idea for the manuscript, developed the search strategy, reviewed the included papers, conducted the data extraction and drafted the manuscript.
Maria Auhl reviewed the included papers, conducted the data extraction and quality assessment, and assisted with drafting the manuscript.
Martin J. Spink conducted the quality assessment and assisted with drafting the manuscript.
All authors read and approved the final manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
No specific funding was received for the preparation of this review.
Provenance and peer review
This article has undergone peer review.
Acknowledgement
HBM is currently a National Health and Medical Research Council of Australia Senior Research Fellow (ID: 1135995).
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