As the “baby boomer” generation moves into retirement age, falls among older people are becoming an increasingly important public health issue. One in three people older than 65 living independently in the community will fall in any given year, while in aged-care facilities this rate increases to one in two. Falls are now the leading cause of injury-related hospitalization among older people and account for nearly half of all injury-related deaths in this age group.[
1]
Arthur Helfand’s remarkably prescient article provides an excellent general overview of risk factors for falls and puts forth several plausible suggestions regarding the link between foot problems, footwear, and balance impairment. What is significant about this essay is that it was published in 1966, a time when comparatively little was known about age-related balance problems and falls. Sheldon’s classic article on postural sway in older people[
2] was published in 1963, but it was not until the late 1970s that detailed studies of risk factors for falls were undertaken. Indeed, the search term
accidental falls was not added to the MEDLINE database until 1987. Research literature on falls has since undergone exponential growth, with approximately 300 articles published on the topic each year since 2000.[
1]
Helfand’s review article takes a broad view of falls and discusses both intrinsic (or physiologic) and extrinsic (or environmental) risk factors. Most importantly, it recognizes that the foot is a “keystone in support and balance,” and thus that “common foot conditions, such as heloma, tyloma, hallux valgus, rigidus, and any other condition which modifies support and/or balance, can contribute to a fall” (p. 327). These ideas, and many others proposed in the article, have since been supported by empirical studies, and there is now strong evidence that foot problems have a detrimental effect on balance and are an independent risk factor for falls.[
3] Recent falls-prevention guidelines published by various organizations recommend that older people at risk of falling be assessed by a podiatric physician, and a number of publicly funded falls-prevention clinics have employed podiatric physicians as part of the multidisciplinary team.
This article, and indeed the entire catalog of Helfand’s impressive body of work, is a superb example of a podiatric physician taking a broad view of the literature, and it highlights the increasingly important contribution of podiatric medicine to geriatric health care. The messages in this work are as relevant in 2007 as they were more than 40 years ago.
Hylton B. Menz, PhD, BPod(Hons) Musculoskeletal Research Centre, La Trobe University, Bundoora, Victoria, Australia
