Age-related differences in foot structure and function

doi:10.1016/j.gaitpost.2006.07.009

Gait & Posture

Volume 26, Issue 1, June 2007, Pages 68-75

https://doi.org/10.1016/j.gaitpost.2006.07.009 Get rights and content

Abstract

The aim of this study was to compare foot characteristics and plantar force and pressure patterns in young and older people. Fifty young (mean age 20.9 ± 2.6 years) and 50 older (mean age 80.2 ± 5.7 years) people without foot problems underwent tests of foot posture, range of motion, strength, sensation and deformity. Plantar force and pressure distribution during gait were evaluated using a floor-mounted resistive sensor mat system. Older participants exhibited flatter/more pronated feet, reduced range of motion of the ankle and 1st metatarsophalangeal joints, a higher prevalence of hallux valgus, toe deformities and toe plantarflexor weakness, and reduced plantar tactile sensitivity. Plantar pressure analysis revealed decreased magnitude of forces and pressures under the heel (−13% to 16%), metatarsophalangeal joints (−11% to 16%) and hallux (−19% to 25%), but greater relative contact time under the heel (+21%), midfoot (+14%) and metatarsophalangeal joints (+5% to 8%) in older participants. Multiple regression analysis revealed that these age-related differences could be largely explained by differences in step length and various foot characteristics, particularly foot posture and the severity of hallux valgus. These findings indicate that ageing is associated with significant changes in foot characteristics which contribute to altered plantar loading patterns during gait.

Introduction

The foot provides the only direct source contact with the supporting surface, and therefore plays an important role in all weightbearing tasks. During gait, the foot contributes to shock absorption, adapts to irregular surfaces and contributes to generating momentum for forward propulsion [1]. Changes to foot structure therefore have the potential to alter the load distribution function of the foot. In particular, changes to the musculoskeletal and neurological characteristics of the foot associated with advancing age, such as foot deformity [2], reduced range of motion [3], [4], reduced strength [5] and diminished plantar tactile sensation [6] could all potentially alter plantar loading patterns. However, neither age-related changes in foot structure nor the mechanisms responsible for altered foot function in older people have been examined in detail.

Only two studies have directly addressed how age may influence the load distribution of the foot. Kernozek and LaMott [7] analysed plantar pressure patterns during gait in 35 young (mean age 22 ± 2.2 years) and 35 older (mean age 78 ± 3.0 years) people using a capacitive platform system. Similar force and pressure characteristics were found in the heel and forefoot for both groups, however, older people exhibited lower peak pressure under the midfoot and a lower force-time integral under the midfoot and hallux. Using an in-shoe pressure assessment of treadmill walking in nine young (mean age 30 ± 5.2 years) and six older (mean age 68.7 ± 4.8 years) people, Hessert et al. [8] reported that older people exhibited significantly less force and pressure under the heel and the medial regions of the foot. Both authors suggested that these changes may be indicative of a less propulsive gait pattern in older people.

The major limitation with these studies, however, is that no foot structure variables were considered. It has previously been shown that foot posture [9], joint range of motion [10] and severity of hallux valgus [11] influence loading patterns under the foot. As these structural factors may also be affected by age, a more detailed understanding of age-related differences in foot function could be obtained by measuring both structure and function in young and older people. Therefore, the aims of this study were to: (i) determine the effect of age on a range of structural foot characteristics; (ii) determine the effect of age on force and pressure distribution under the foot when walking; and (iii) determine the extent to which differences in foot structure can explain age-related differences in force and plantar pressure distribution when walking.

Section snippets

Participants

The study sample comprised 100 participants. Fifty healthy young participants (26 females, 24 males, mean age 20.9, ±S.D. 2.6) were recruited from the student population of La Trobe University. Fifty older people (26 females, 24 males, mean age 80.2, ±S.D. 5.7) were selected from a previously established database obtained as part of a larger study of foot function in older people [12]. The exclusion criteria for this study included current or previous foot pain, previous foot surgery,

Sample characteristics

The older participants were shorter (162.1 ± 8.9 versus 172.1 ± 9.3 cm, t₉₈ = 5.47, p < 0.001) and had a higher body mass index (25.9 ± 3.8 versus 23.1 ± 2.8 kg/m², t₉₈ = −4.26, p < 0.001), however there was no difference in bodyweight between the groups (68.5 ± 13.1 versus 68.8 ± 12.7 kg, t₉₈ = 0.13, p = 0.895).

Age-related differences in foot and ankle characteristics

Descriptive statistics for each of the foot and ankle tests according to age are shown in Table 1. Compared to the young participants, older participants exhibited flatter/more pronated feet, less range of motion

Discussion

The aims of this study were to determine the effect of age on a range of structural foot characteristics, to determine the effect of age on force and pressure distribution under the foot when walking, and to determine whether differences in foot structure can explain age-related differences in plantar force and pressure distribution. The results demonstrate that older people have flatter/more pronated feet, reduced range of motion of the ankle and 1st MPJ, a higher prevalence of hallux valgus,

Conclusion

This study was undertaken to compare foot structure and function in young and older people. The results indicate that older people exhibit flatter feet, reduced range of motion, tactile sensation and strength, and a higher prevalence of foot deformity. Examination of pressure patterns revealed significant reductions in the magnitude of forces and pressures under the heel, lateral forefoot and hallux, but greater relative duration of contact under the heel, midfoot and MPJs in older

Acknowledgement

Dr. Menz is currently NHMRC Australian Clinical Research Fellow (id: 234424).

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Age-related differences in foot structure and function

Abstract

Introduction

Section snippets

Participants

Sample characteristics

Age-related differences in foot and ankle characteristics

Discussion

Conclusion

Acknowledgement

Gait Posture

Gait Posture

Foot Ankle Surg

Gait Posture

Clin Biomech

J Biomech

Foot

Arch Phys Med Rehabil

J Biomech

Complexities of foot architecture as a base of support

J Orthop Sports Phys Ther

Clinical and biomechanical risk factors of patients diagnosed with hallux valgus

J Am Podiatr Med Assoc

Active and passive mobility of lower limb joints in elderly men and women

Am J Phys Med Rehabil

Range of motion of the foot as a function of age

Foot Ankle

Effects of age and gender on toe flexor muscle strength

J Gerontol

Spatial acuity of the body surface over the life span

Somatosens Mot Res

Foot pressure distribution during walking in young and old adults

BMC Geriatrics

Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration

Diabetes Care

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients

J Am Geriatr Soc

Validity of 3 clinical techniques for the measurement of static foot posture in older people

J Orthop Sports Phys Ther