Journal of the American Podiatric Medical Association

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In Appreciation

by Warren S. Joseph

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 550; https://doi.org/10.7547/1030550 - 1 Nov 2013

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n/a Full article

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Are You Ready for ICD-10?

by Matthew G. Garoufalis

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 549; https://doi.org/10.7547/1030549 - 1 Nov 2013

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n/a Full article

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AMERICAN PODIATRIC MEDICAL ASSOCIATION OFFICIAL NOTICE

by Matthew G. Garoufalis and Glenn B. Gastwirth

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 548; https://doi.org/10.7547/1030548 - 1 Nov 2013

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In compliance with Article 9.10.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Medical Association (APMA) will be held at the time and place indicated in this announcement for the purpose [...] Read more.

In compliance with Article 9.10.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Medical Association (APMA) will be held at the time and place indicated in this announcement for the purpose of receiving reports of officers and committees, for the annual election of officers, for action upon regularly offered amendments to the Bylaws and Administrative Procedures, and for such other business as may be presented. Full article

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Effectiveness of Foot and Ankle Exercise Programs on Reducing the Risk of Falling in Older Adults. A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Michael Schwenk, Elise DeHaven Jordan, Bahareh Honarvararaghi, Jane Mohler, David G. Armstrong and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 534-547; https://doi.org/10.7547/1030534 - 1 Nov 2013

Cited by 36 | Viewed by 49

Abstract

Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults. A systematic literature search was performed [...] Read more.

Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults. A systematic literature search was performed in the PubMed database, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Articles were included based on the following criteria: 1) randomized controlled trial, 2) FA exercise program, and 3) use of fall risk–related motor outcomes (strength, balance, flexibility, and functional ability) or use of falls as an outcome. Weighted effect sizes (d) were calculated across studies for estimating the overall effect of FA exercises on the most frequently reported motor outcome parameters. Eight publications met the inclusion criteria. Small to moderate overall effects were found for balance (d = 0.46, P < .001) and ankle flexibility (d = 0.29, P = .006). No significant overall effects were found for ankle plantarflexor strength (d = 0.11, P = .223) and walking performance (d = −0.05, P = .404). Controversial results were reported for other functional measures. Effects varied depending on the type of intervention. Only one study reported improved ankle evertor strength and a significant reduction in falls. Evidence suggests that FA exercise can improve certain fall risk–related motor outcomes and reduce falls. Limited effects on strength and functional ability might be related to insufficient training intensity and lack of adherence. Further studies that include progressive strength and flexibility training are necessary to validate which FA exercise programs are most effective at preventing falls. (J Am Podiatr Med Assoc 103(6): 534–547, 2013) Full article

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Footwear Interventions. A Review of Their Sensorimotor and Mechanical Effects on Balance Performance and Gait in Older Adults

by Anna L. Hatton, Keith Rome, John Dixon, Denis J. Martin and Patrick O. McKeon

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 516-533; https://doi.org/10.7547/1030516 - 1 Nov 2013

Cited by 64 | Viewed by 62

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Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and [...] Read more.

Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation. (J Am Podiatr Med Assoc 103(6): 516–533, 2013) Full article

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Does Footwear Affect Balance? The Views and Experiences of People with Diabetes and Neuropathy Who Have Fallen

by Joanne S. Paton, Anne Roberts, Graham K. Bruce and Jon Marsden

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 508-515; https://doi.org/10.7547/1030508 - 1 Nov 2013

Cited by 19 | Viewed by 76

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Despite falls being a major concern for people living with somatosensory deficit, little is known about the perceived impact of footwear and footwear features on balance. Clinical relevance is increased given that therapeutic footwear is often provided to people with diabetes to reduce [...] Read more.

Despite falls being a major concern for people living with somatosensory deficit, little is known about the perceived impact of footwear and footwear features on balance. Clinical relevance is increased given that therapeutic footwear is often provided to people with diabetes to reduce foot ulcer risk. This qualitative study aims to explore the experiences and views of people with diabetes and neuropathy who have recently fallen to understand whether footwear type is perceived to affect balance or contribute to falling. Sixteen individuals (13 men and three women aged 44–83 years) were purposively sampled from a larger population of potential participants. Audio-recorded, in-depth, semistructured interviews were conducted in participant homes or at a place preferable to them. Once transcribed verbatim, the data were themed, charted, and interpreted using a framework approach. Although most participants did not believe that the footwear in which they fell contributed to their fall, most revealed how footwear choice influenced their balance confidence to undertake daily tasks. Most found their therapeutic footwear “difficult” to walk in, “heavy, or “slippery bottomed.” Design recommendations for enhanced balance included a close fit with tight fastening, lightweight, substantial tread, and a firm, molded sole/insole. Complying with these recommendations, the hiking sandal was believed to be the most stable and safe shoe and was frequently worn as a walking aid to reduce fear of falling and boost confidence. People with diabetic neuropathy have disease-specific needs and concerns relating to how footwear affects balance. Engaging with patients to address those needs and concerns is likely to improve the feasibility and acceptability of therapeutic footwear to reduce foot ulcer risk and boost balance confidence. (J Am Podiatr Med Assoc 103(6): 508–515, 2013) Full article

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Balance Rehabilitation. Promoting the Role of Virtual Reality in Patients with Diabetic Peripheral Neuropathy

by Gurtej S. Grewal, Rashad Sayeed, Michael Schwenk, Manish Bharara, Robert Menzies, Talal K. Talal, David G. Armstrong and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 498-507; https://doi.org/10.7547/1030498 - 1 Nov 2013

Cited by 46 | Viewed by 55

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Individuals with diabetic peripheral neuropathy frequently experience concomitant impaired proprioception and postural instability. Conventional exercise training has been demonstrated to be effective in improving balance but does not incorporate visual feedback targeting joint perception, which is an integral mechanism that helps compensate for [...] Read more.

Individuals with diabetic peripheral neuropathy frequently experience concomitant impaired proprioception and postural instability. Conventional exercise training has been demonstrated to be effective in improving balance but does not incorporate visual feedback targeting joint perception, which is an integral mechanism that helps compensate for impaired proprioception in diabetic peripheral neuropathy. This prospective cohort study recruited 29 participants (mean ± SD: age, 57 ± 10 years; body mass index [calculated as weight in kilograms divided by height in meters squared], 26.9 ± 3.1). Participants satisfying the inclusion criteria performed predefined ankle exercises through reaching tasks, with visual feedback from the ankle joint projected on a screen. Ankle motion in the mediolateral and anteroposterior directions was captured using wearable sensors attached to the participant’s shank. Improvements in postural stability were quantified by measuring center of mass sway area and the reciprocal compensatory index before and after training using validated body-worn sensor technology. Findings revealed a significant reduction in center of mass sway after training (mean, 22%; P = .02). A higher postural stability deficit (high body sway) at baseline was associated with higher training gains in postural balance (reduction in center of mass sway) (r = −0.52, P < .05). In addition, significant improvement was observed in postural coordination between the ankle and hip joints (mean, 10.4%; P = .04). The present research implemented a novel balance rehabilitation strategy based on virtual reality technology. The method included wearable sensors and an interactive user interface for real-time visual feedback based on ankle joint motion, similar to a video gaming environment, for compensating impaired joint proprioception. These findings support that visual feedback generated from the ankle joint coupled with motor learning may be effective in improving postural stability in patients with diabetic peripheral neuropathy. (J Am Podiatr Med Assoc 103(6): 498–507, 2013) Full article

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Hallux Valgus Surgery May Produce Early Improvements in Balance Control. Results of a Cross-Sectional Pilot Study

by Saba Sadra, Adam Fleischer, Erin Klein, Gurtej S. Grewal, Jessica Knight, Lowell Scott Weil, Lowell Weil and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 489-497; https://doi.org/10.7547/1030489 - 1 Nov 2013

Cited by 23 | Viewed by 60

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Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Using a cross-sectional study design, gait and [...] Read more.

Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted. (J Am Podiatr Med Assoc 103(6): 489–497, 2013) Full article

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Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

by Carolyn Kelly, Adam Fleischer, Sai Yalla, Gurtej S. Grewal, Rachel Albright, Dana Berns, Ryan Crews and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 480-488; https://doi.org/10.7547/1030480 - 1 Nov 2013

Cited by 52 | Viewed by 63

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Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling. A voluntary group of older [...] Read more.

Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling. A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe. Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A_1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A_1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling. Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy. (J Am Podiatr Med Assoc 103(6): 480–488, 2013) Full article

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Effects of Nonslip Socks on the Gait Patterns of Older People When Walking on a Slippery Surface

by Anna L. Hatton, Daina L. Sturnieks, Stephen R. Lord, Joanne C.M. Lo, Hylton B. Menz and Jasmine C. Menant

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 471-479; https://doi.org/10.7547/1030471 - 1 Nov 2013

Cited by 14 | Viewed by 54

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Slips are a common cause of falls, and nonslip socks have been marketed to prevent slips in older people. However, few studies have investigated the biomechanical and clinical effects of walking in nonslip socks. This study aimed to examine gait parameters in older [...] Read more.

Slips are a common cause of falls, and nonslip socks have been marketed to prevent slips in older people. However, few studies have investigated the biomechanical and clinical effects of walking in nonslip socks. This study aimed to examine gait parameters in older people walking on a slippery surface wearing nonslip socks compared with standard sock and barefoot conditions. Fifteen older people completed five trials of the fast-paced Timed Up and Go test while barefoot and while wearing standard socks and nonslip socks. Kinematic data (step length, heel horizontal velocity at heel strike, and foot-floor angle at heel strike) and clinical data (total Timed Up and Go test time, total number of steps, number of steps in turn, and observed slips, trips, or falls) were collected. Performance on the Timed Up and Go test did not differ between the barefoot and nonslip sock conditions; however, participants walked more slowly and took shorter steps when wearing standard socks. Participants rated nonslip socks to feel less slippery than barefoot and standard socks. Compared with wearing standard socks, wearing nonslip socks improves gait performance and may be beneficial in reducing the risk of slipping in older people. (J Am Podiatr Med Assoc 103(6): 471–479, 2013) Full article

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“Good for Older Ladies, Not Me”

by Annette Davis, Anna Murphy and Terry P. Haines

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 465-470; https://doi.org/10.7547/1030465 - 1 Nov 2013

Cited by 23 | Viewed by 55

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Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors [...] Read more.

Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls. A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm. The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear. This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education. (J Am Podiatr Med Assoc 103(6): 465–470, 2013) Full article

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Older People’s Perceptions of a Multifaceted Podiatric Medical Intervention to Prevent Falls

by Hylton B. Menz, Martin J. Spink, Karl B. Landorf, Keith D. Hill and Stephen R. Lord

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 457-464; https://doi.org/10.7547/1030457 - 1 Nov 2013

Cited by 10 | Viewed by 48

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Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of [...] Read more.

Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial. Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants’ perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided. Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be “about right.” Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided. The multifaceted podiatric medical intervention used in this trial was generally perceived to be beneficial and demonstrated high levels of satisfaction among participants. Further research is now required to evaluate the feasibility of implementing the intervention in a range of clinical practice settings. (J Am Podiatr Med Assoc 103(6): 457–464, 2013) Full article

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The Role of Podiatry in the Prevention of Falls in Older People. A JAPMA Special Issue

by Bijan Najafi, Eling D. de Bruin, Neil D. Reeves, David G. Armstrong and Hylton B. Menz

J. Am. Podiatr. Med. Assoc. 2013, 103(6), 452-456; https://doi.org/10.7547/1030452 - 1 Nov 2013

Cited by 21 | Viewed by 51

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Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these [...] Read more.

Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventing falls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventing falls. (J Am Podiatr Med Assoc 103(6): 452–456, 2013) Full article

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J. Am. Podiatr. Med. Assoc., Volume 103, Issue 6 (11 2013) – 13 articles , Pages 452-570

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