Foot and ankle characteristics associated with fear of falling and mobility in community-dwelling older people: a cross-sectional study.

BACKGROUND: Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community-dwelling older people. METHOD: One hundred and eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility. RESULTS: Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure-time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure-time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%. CONCLUSION: Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review.

BACKGROUND: Gait problems are an important symptom in Parkinson's disease (PD), a progressive neurodegenerative disease. Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention that can modulate cortical excitability of the gait-related regions. Despite an increasing number of gait-related tDCS studies in PD, the efficacy of this technique for improving gait has not been systematically investigated yet. Here, we aimed to systematically explore the effects of tDCS on gait in PD, based on available experimental studies. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Scopus, and PEDro databases were searched for randomized clinical trials assessing the effect of tDCS on gait in patients with PD. RESULTS: Eighteen studies were included in this systematic review. Overall, tDCS targeting the motor cortex and supplementary motor area bilaterally seems to be promising for gait rehabilitation in PD. Studies of tDCS targeting the dorosolateral prefrontal cortex or cerebellum showed more heterogeneous results. More studies are needed to systematically compare the efficacy of different tDCS protocols, including protocols applying tDCS alone and/or in combination with conventional gait rehabilitation treatment in PD. CONCLUSIONS: tDCS is a promising intervention approach to improving gait in PD. Anodal tDCS over the motor areas has shown a positive effect on gait, but stimulation of other areas is less promising. However, the heterogeneities of methods and results have made it difficult to draw firm conclusions. Therefore, systematic explorations of tDCS protocols are required to optimize the efficacy.

Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies.

BACKGROUND: The foot and ankle complex undergoes significant structural and functional changes with advancing age. RESEARCH QUESTION: The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults. METHODS: Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS: A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: -5.15; 95 %CI: -6.47 to -3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: -0.62; 95 %CI: -0.82 to -0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible. SIGNIFICANCE: Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.

Structural and functional foot and ankle characteristics associated with falls in older people.

BACKGROUND: Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors. RESEARCH QUESTION: what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults? METHOD: One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ±â€¯5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls. RESULTS: Seventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15-0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors. SIGNIFICANCE: We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.