The ageing process entails a host of physiological changes of the feet, which can gradually induce limitation of mobility and adversely affect the quality of life in older individuals.
Whilst these changes are inevitable, understanding them can make it possible to design treatment programmes that include preventative measures to impede their progress.
Age-related alterations in the plantar skin of the foot lead to an increase in the incidences of conditions such as hyperkeratosis in older patients. This is caused by the progressive levelling of the dermo-epidermal junction and stiffening of the collagen fibres.
There is also diminished mechanical effectiveness of the plantar skin which increases thickness and dryness with an overall loss in skin elasticity; this predisposes older individuals to the development of corns and calluses.
This occurs concurrently with narrowing of the pads of fat cells located on the bottom of the heel; a cumulative effect of weightbearing activities and loss of elasticity over the years, which provides less cushioning against ground forces during heel strike.
Foot and ankle characteristics also undergo age-related changes due to the consistent decline in the range of motion of the lower limb joints. This impairs balance and affects functionality in the lower limbs, increasing the incidences of falls in older patients.
Dr. Martin Spink, of the Musculoskeletal Research Centre in Australia, conducted a study in 2011 to quantify the extent to which foot and ankle strength, range of motion, posture and deformity are important determinants of balance in older people.
By studying these components in a cross section of people over the age of 65 years, he was able to conclude that plantar flexor strength of the hallux and ankle inversion-eversion range of motion can be considered as good measures of balance and functional ability in older individuals.
Another study by Menz et al. involved 176 people from a retirement village undertaking tests for the same characteristics as mentioned above, in order to establish whether foot problems are risk factors for falls.
The authors found that 71 of the participants, with decreased ankle flexibility, plantar tactile sensitivity, toe plantar flexor strength and a severe hallux valgus deformity, reported falling during the follow-up period.
There is a marked deterioration in foot muscle strength that is observed with age.
A method to measure toe flexor muscle strength was developed by Endo et al. to test whether it was affected by gender or age.
At the end of the study, the authors concluded that the observed decrease in toe flexor muscle strength was due to an age-related decrease in the functional base of support, defined as “the maximal volitional anterior and posterior excursion of the ground reaction force, commonly during forward and backward leans.”
There is also a gradual lowering of the medial longitudinal arch of the foot that occurs with the passage of time.
Kohls-Gatzoulis et al. associated this phenomena to the degeneration of the tibialis posterior muscle which plays an important role in supporting the medial longitudinal arch of the foot.
Maintaining fitness levels is a good way of withstanding musculoskeletal changes that take place over the course of time.
M.T. Galloway of Yale University School of Medicine examined age-related functional declines in highly-trained, athletic individuals.
A cumulative total of 30 to 50 minutes of aerobic exercises performed 3 to 5 days a week in conjunction with one set of resistance exercises for specific muscle groups twice a week, was found to be enough to produce significant health benefits.
Customised foot orthotics such as MASS4D® provide protection to the feet from the repeated stresses and trauma of everyday life, which can otherwise hasten the onset of biomechanical abnormalities and postural instabilities that affect the whole body.
By calibrating the orthotic to include the bodyweight, forefoot flexibility and activity levels of the individual, specific musculoskeletal changes that are brought about by the ageing process are taken into consideration in the manufacture of the orthotic, to allow for the optimal distribution of plantar pressure in the feet while building strength in the muscles of the feet.
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