The Ageing Foot: Difference between revisions
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=== Skin === | === Skin === | ||
* flattening of the dermo-epidermal junction, <ref name=":0">Menz HB. [https://www.karger.com/Article/Pdf/368357 Biomechanics of the ageing foot and ankle: a mini-review.] Gerontology. 2015;61(4):381-8.</ref> | |||
* a reduction in the turnover rate of keratinocytes and<ref name=":0" /> | |||
* a reduced density of sweat glands<ref name=":0" /> | |||
* dermis, there is an overall loss of elastin and collagen fibres, with the collagen fibres that remain becoming thicker and stiffer<ref>Smith L. Histopathologic characteristics and ultrastructure of aging skin. Cutis. 1989 May;43(5):414-24. </ref> | |||
* alter the mechanical properties of the plantar skin, leading to increased hardness<ref name=":0" />dryness and loss of elastic recoil, thereby predisposing the older person to xerosis, fissuring and the development of hyperkeratosis (corns and calluses)<ref>Periyasamy R, Anand S, Ammini AC. The effect of aging on the hardness of foot sole skin: a preliminary study. Foot (Edinb). 2012 Jun;22(2):95-9.</ref> | |||
* Hyperkeratosis may result in considerable pain and disability. the stratum corneum and granulosum become hypertrophied, placing pressure on nerves in the papillary dermis. Plantar lesions are more likely to form in older people with hallux valgus or lesser toe deformity, due to elevated and abnormally distributed plantar pressures. Indeed, peak pressures under the metatarsal heads when walking have been shown to be between 9 and 12% higher in older people with calluses at these sites. optimum management of hyperkeratosis in older people requires off-loading strategies to address the underlying mechanical cause. Clinical trials have shown that when used in isolation, scalpel debridement of hyperkeratosis has only a small, short-term effect on pain [<nowiki/>[[/www.karger.com/Article/FullText/368357#ref16|16]]], and that the use of pressure-relieving foot orthoses in conjunction with scalpel debridement has a greater effect than scalpel debridement alone | |||
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=== Soft Tissue === | === Soft Tissue === | ||
deeper plantar soft tissues anchor the skin to the underlying bony architecture of the foot, protect underlying blood vessels and nerves and attenuate the shear forces that are applied when walking. The metatarsal pads,maintain their thickness, but demonstrate greater stiffness, dissipate more energy when compressed and are slower to recover after the load is removed | |||
The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age<ref>Kwan RL, Zheng YP, Cheing GL. The effect of aging on the biomechanical properties of plantar soft tissues. Clin Biomech (Bristol, Avon). 2010 Jul;25(6):601-5.</ref> | |||
the heel pad retains its thickness of 18-20 mm with age, but becomes stiffer and dissipates more energy when compressed . older people with forefoot pain, peak pressure under the lateral metatarsal heads is 10% higher than in individuals without forefoot pain <ref name=":0" /> | |||
stiffness, does not absorb shock, heel and adipose tissue becomes stiffer, plantar fascia with less recoil due to stiffness, less ability to store the energy | stiffness, does not absorb shock, heel and adipose tissue becomes stiffer, plantar fascia with less recoil due to stiffness, less ability to store the energy | ||
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Achilles tendon complaints, range of motion changed (reduction in dorsiflexion), increased risk of falls, less shock absorption | Achilles tendon complaints, range of motion changed (reduction in dorsiflexion), increased risk of falls, less shock absorption | ||
Plantar fascia: The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.<ref>Jha DK, Wongkaewpotong J, Chuckpaiwong B. Effect of Age and BMI on Sonographic Findings of Plantar Fascia. J Foot Ankle Surg. 2022 May 23:S1067-2516(22)00157-0</ref> | |||
=== Physiotherapy Intervention === | === Physiotherapy Intervention === | ||
Revision as of 08:35, 14 September 2022
Original Editor - Ewa Jaraczewska based on the course by Helene Simpson
Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson
Introduction[edit | edit source]
Feet age: impact in elderly. 1 in 5 foot pain
Risk factors[edit | edit source]
diabetes, peripheral neuropathy, neurological disorders (stroke), swelling (circulation, cardiac condition)
Physiological changes[edit | edit source]
Skin[edit | edit source]
- flattening of the dermo-epidermal junction, [1]
- a reduction in the turnover rate of keratinocytes and[1]
- a reduced density of sweat glands[1]
- dermis, there is an overall loss of elastin and collagen fibres, with the collagen fibres that remain becoming thicker and stiffer[2]
- alter the mechanical properties of the plantar skin, leading to increased hardness[1]dryness and loss of elastic recoil, thereby predisposing the older person to xerosis, fissuring and the development of hyperkeratosis (corns and calluses)[3]
- Hyperkeratosis may result in considerable pain and disability. the stratum corneum and granulosum become hypertrophied, placing pressure on nerves in the papillary dermis. Plantar lesions are more likely to form in older people with hallux valgus or lesser toe deformity, due to elevated and abnormally distributed plantar pressures. Indeed, peak pressures under the metatarsal heads when walking have been shown to be between 9 and 12% higher in older people with calluses at these sites. optimum management of hyperkeratosis in older people requires off-loading strategies to address the underlying mechanical cause. Clinical trials have shown that when used in isolation, scalpel debridement of hyperkeratosis has only a small, short-term effect on pain [16], and that the use of pressure-relieving foot orthoses in conjunction with scalpel debridement has a greater effect than scalpel debridement alone
Collagen: thicker, dryer, less recoil, increased compression, callus issue
Unload the metatarsals: customised orthotics to support medial arch, unload metatarsal heads
Soft Tissue[edit | edit source]
deeper plantar soft tissues anchor the skin to the underlying bony architecture of the foot, protect underlying blood vessels and nerves and attenuate the shear forces that are applied when walking. The metatarsal pads,maintain their thickness, but demonstrate greater stiffness, dissipate more energy when compressed and are slower to recover after the load is removed
The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age[4]
the heel pad retains its thickness of 18-20 mm with age, but becomes stiffer and dissipates more energy when compressed . older people with forefoot pain, peak pressure under the lateral metatarsal heads is 10% higher than in individuals without forefoot pain [1]
stiffness, does not absorb shock, heel and adipose tissue becomes stiffer, plantar fascia with less recoil due to stiffness, less ability to store the energy
changes in gait pattern: more pull off vs push off, less propulsion,
Achilles tendon complaints, range of motion changed (reduction in dorsiflexion), increased risk of falls, less shock absorption
Plantar fascia: The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.[5]
Physiotherapy Intervention[edit | edit source]
stretch, mobilisation, stimulate plantar sensors, Hammer toes
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Menz HB. Biomechanics of the ageing foot and ankle: a mini-review. Gerontology. 2015;61(4):381-8.
- ↑ Smith L. Histopathologic characteristics and ultrastructure of aging skin. Cutis. 1989 May;43(5):414-24.
- ↑ Periyasamy R, Anand S, Ammini AC. The effect of aging on the hardness of foot sole skin: a preliminary study. Foot (Edinb). 2012 Jun;22(2):95-9.
- ↑ Kwan RL, Zheng YP, Cheing GL. The effect of aging on the biomechanical properties of plantar soft tissues. Clin Biomech (Bristol, Avon). 2010 Jul;25(6):601-5.
- ↑ Jha DK, Wongkaewpotong J, Chuckpaiwong B. Effect of Age and BMI on Sonographic Findings of Plantar Fascia. J Foot Ankle Surg. 2022 May 23:S1067-2516(22)00157-0
