Lower-limb factors associated with balance and falls in older adults: a systematic review and clinical synthesis.

Review written by Dr Mariana Wingood info

Key Points

  • The following factors should be considered when assessing foot and ankle-related risk factors for falls - range of motion, orthoses, strength, footwear, pain, plantar skin, soft-tissue changes, and sensory-loss.
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One in four older adults have foot pain (1), and up to 87% of older adults have foot deformities (2). Both of these types of impairments are associated with decreased ability to complete activities of daily living, difficulty ambulating and maintaining balance, and decreased health-related quality of life (1,2). Part of this is due to age-related changes, including decreased range of motion, decreased ankle and intrinsic foot muscle strength, increased pronation, pes planus, increased prevalence of foot deformities, integumentary changes, and plantar soft tissue thinning (3).

The authors of this paper thought that it was important to identify these impairments early and address them prior to the individual being identified as having a heightened risk for falling. Thus, the authors’ primary aim was to examine the evidence and describe the influence of lower leg, foot, ankle, and footwear related factors on balance, gait, and fall risk among community-dwelling older adults. The authors’ secondary aim was to synthesize the gathered data and develop pathways to visually inform clinical links between lower limb factors and fall risk.

One in four older adults have foot pain, and up to 87% of older adults have foot deformities.
This review paper reminds clinicians about the importance of including foot and ankle assessments during a multi-factorial fall risk assessment.


Design: Systematic review Databases: PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Inclusion Criteria: Studies needed to include community-dwelling adults over the age of 55 and the studies had to discuss age-related changes in the foot

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