Preventing Falls in the Elderly and Podiatry – It’s a Natural Fit

Preventing Falls in the Elderly and Podiatry


London Bridge is falling down. And so are a great many senior Americans.

Automatically and without a thought, we take our natural human abilities to stand and walk for granted. But the capacity to remain safely upright, whether at rest or in motion, is the product of an intricate and fascinating system of neuromuscular control.

The natural processes of aging tend to compromise that control system. The geriatric process inevitably diminishes the ability of older adults to safely stand and walk. Tripping the light fantastic begins to result in tripping, period.

The more we age, the more we fall. The Centers for Disease Control and Prevention (CDC) report that each and every year, 36 million Americans aged 65 or older suffer significant falls. Falls are the leading cause of serious injury, like broken bones, concussions, and hip fractures in older people. 

Those falls result in about 3 million emergency department visits annually. And they directly cause over 32,000 deaths. Death rates for older people who fall in America increased by 30% between 2007 and 2016.

Falls are not just serious health hazards for the elderly. Falls are also costly. In the year 2015, for example, the total medical costs consequent to falls was more than $50 billion. 

And falls also impose a mental toll. Even if they are not serious in and of themselves, falls often lead to an understandable fear of falling again. This can seriously constrict the free independence of an older person’s physical activity and quality of life.

Podiatric intervention helps prevent falls in older adults 

The evidence is conclusive. Podiatry has a leading role in fall prevention for older Americans. Healthy feet are stable feet.

Elderly foot care is a standard component of most podiatry practices. Podiatrists regularly remedy conditions that commonly afflict older patients, such as ingrown toenails, calluses, blisters, dry skin, fungal infections, poor circulation, and diabetic neuropathy. 

But not all podiatrists have incorporated fall prevention strategies among the elderly as an integral element of their practice. Fortunately, recent research has accelerated the adoption of programs that address fall prevention.

How can podiatry take the lead in preventing falls among elderly patients?

Some factors that increase the risk of falling, such as obesity, medical conditions, and the side effects of medications like antidepressants and over-the-counter sleep aids, may be beyond the realm of podiatry.

But other leading risk factors that increase falls among elderly patients fall (sorry) squarely within the scope of podiatric practice.

As one example of the link between elderly falls and podiatry, foot pain is an independent and statistically significant factor that increases the risk of falling. And the reduction of foot pain is, of course, a primary mission of podiatry.

The reduction of ankle flexibility and foot muscle strength that inevitably accompanies aging leads directly to an increased risk of falls. And the restoration of ankle flexibility and foot strength is another primary mission of podiatry.

Foot conditions such as hallux valgus (bunions), hammertoes, deformities of the lesser toes, plantar fasciitis, and foot sores all play a significant role in causing the elderly to fall. 

Foot disorders like loosened ligaments, diminished fat pads, and diminished blood flow can also contribute to a fall. And effective treatment, resulting in a cure for these foot issues, is yet another primary mission of podiatry.

Appropriate footwear is another link between fall prevention and podiatry

Indoor footwear issues are strongly connected to the risk of falling among elderly people. One study shows that walking barefoot indoors, or simply wearing cotton socks, result in an 11-fold increase in the risk of falling, in comparison with seniors who wear shoes while indoors.

Other studies have shown that wearing slippers indoors, rather than substantial shoes, also leads to an increased risk of falling.

And not all shoes are protective against falls. Some shoe characteristics that are associated with an increased risk of falling are:

    • Shoes without firm attachment to the foot, i.e., without laces, straps, or buckles
    • Shoes with a heel height greater than 2 inches like high heels
    • Shoes with a narrow heel
    • Shoes with a reduced floor contact area
    • Shoes with a smooth or slick sole

What is a podiatric fall risk assessment?

A systematic review, published in the journal Age and Aging, shows that multifaceted podiatric interventions produce a significant reduction in the rate of falls among the elderly. 

The researchers examined nine studies, involving over 6,500 participants. The results of this study, together with corresponding information from the CDC, show that podiatrists decrease the fall risks for older patients by:

    1. Assessing the fall risk potential of every patient over the age of 65, with the goal of helping each elderly patient understand her or his own unique risks of falling.
    2. Taking a history of previous falls.
    3. Evaluation of the patient’s foot health, including gait, strength, and balance.
    4. Discussion of medications that may increase the risk of falling
    5. Learning about home safety and walkways as well as potential hazards in the patient’s home (throw rugs, slippery shower floors, etc.)
    6. Measuring each elderly patient’s orthostatic blood pressure, both standing and lying down (for some people, standing up suddenly can cause dizziness and a consequent fall).
    7. Diagnosis and treatment of podiatric conditions that might contribute to falling.
    8. Education on footwear, including shoe fit, non-slip traction, insoles, heel height, and sole contact area. Provision of orthotics and/or referral to appropriate footwear.
    9. Introducing elderly patients to a foot and ankle exercise program designed to enhance balance and reduce falls. 
    10. Education of each patient on his or her modifiable risk factors and corresponding fall prevention strategies.
    11. Discussing assistive devices, such as nightlights, grab bars in the shower, and use of a cane or walker.
    12. When appropriate, working with caregivers to develop a prevention program. 
    13. Checking visual acuity, with referral to ophthalmologist/optometrist when indicated.

Why choose University Foot and Ankle Institute for elderly foot care?

If you’re at high-risk for falling, we’re here to help. Our nationally recognized foot and ankle doctors offer the most advanced foot care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.

For more information or to schedule a consultation in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.

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