Preventing Falls in The Elderly – The Role of Podiatry



A major source of injury in the elderly is falling.  It is estimated that nearly 40,000 falls each day occur in the US alone with over 14 million US adults aged 65 and older experience a fall each year.  Statistics gathered in 2010 show that such falls cost the US healthcare system over 30 billion dollars with 20,000 of falls that year resulting in death.

The reasons for falls include:
  1. Muscle weakness.
  2. Blood pressure that drops too much with standing, called postural hypotension.
  3. Balance problems caused by inner ear disease or vertigo.
  4. Cardiac issues.
  5. Peripheral neuropathy, in which the peripheral nerves have decreased ability to allow one to determine position of body parts.  Proprioception is the ability of the body to sense the position and movements of body parts.
  6. Orthopedic conditions such as hip, knee, foot and ankle disorders that create instability of such joints.
  7. Diseases of the cerebellum, that part of the brain responsible for gait and muscle coordination.
  8. Combinations of the above.

Podiatrists, trained in biomechanics of the lower extremity, are essentially doctors of gait. Gait disorders that lead to falls can be readily identified and helped.

One of the most significant modalities employed by podiatrists in the last few years is the Moore Balance Brace, a prescription custom ankle foot orthotic.  The concept we are addressing is known as postural sway and controlling postural sway to prevent falls.  “Postural  sway” refers to movement, mainly horizontal movement around the center of gravity.  

The process of maintaining balance requires input from multiple sensory systems including:
  • The vestibular system – relating to equilibrium and directional input with respect to head position.
  • Visual system – allows coordination relative to positions of objects about the body.
  • Somatosensory system – pressure, vibration and joint position via input from skin and joints.
Use of braces to control postural sway works at the level of the somatosensory system.  The ability to sense position and motion generally requires feedback from foot pressure but the goal of bracing to expand or enlarge the feedback system so more information is being provided to the brain to control postural sway.  The Moore Balance brace and similar products constitute a custom molded boot that surrounds the foot and ankle and is placed in the shoe.  It functions to:
  1. Provide more contact area to the foot, ankle and leg during gait thereby increasing the body’s ability to control postural sway.
  2. Add stability to weak ankles further stabilizing gait.
  3. Provide a custom molded foot plate designed to offset orthopedic deformities, weakness and instability within the foot.


Ankle foot orthotics such as the Moore Balance Brace are not beneficial to everyone but a thorough podiatric exam can help determine if one is a candidate for such treatment.

For more information on Fall Prevention in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!
Kavounoudias A, Roll R, Roll JP. The plantar sole is the „dynamometric map? for human balance control. Neuroreport. 1998;9(14)3247-3252.
Thornett CE, Langner MC, Billington GD. Portable modular transducer system for the measurement of stabilizing forces in TLS-HKA orthoses. J Biomed Eng 1986;8:224-8.
 Baier M, Hopf T. Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability. Arch Phys Med Rehabil 1998;79:939- 44.
Kuo AD, Zajac FE. Human standing posture: multi-joint movement strategies based on biomechanical constraints. Prog Brain Res 1993;97:349-58.
 Vuillerme N, Demetz S. Do ankle foot orthoses modify postural control during bipedal quiet standing following a localized fatigue of the ankle muscles? Int J Sports Med 2007; 243-246
Chastan N, Debono B, Maltete D, Weber J. Discordance between measured postural instability and absence of clinical symptoms in Parkinson's disease patients in the early stages of the disease. Mov Disord 2008;23:366-72.  
Spink MJ, Henz HB, Fotoohabadi MR, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomized controlled trial. BMJ2011;342:d3411 doi:10.1136/bmj.d3411  
Ramstrand N, Ramstrand S. AAOP State-of-the-science evidence report: the effect of ankle-foot orthoses on balance — a systematic review. SSC Proceedings 10: P4-P23, Oct 2010.

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