Underplantar Pressure Technology, Foot Underplantar Pressure Technology, Foot Problems and Footwear PrescriptionProblems and Footwear PrescriptionOlwen Finlay MBE, FCSP, HT, DMSOlwen Finlay MBE, FCSP, HT, DMS

Past President IPTOP, 1999 – 2007.Past President IPTOP, 1999 – 2007.Vice President CSP, 2003 -2007.Vice President CSP, 2003 -2007.

www. Olwen.finlay@btinternet.com www. Olwen.finlay@btinternet.com

Why is footwear not given a higher priority?Why is footwear not given a higher priority? “The Effective health Journal cites footwear as a usual adjunct “The Effective health Journal cites footwear as a usual adjunct

to treatment? to treatment? (Ref 1& 2)(Ref 1& 2)

Is it lack of public awareness about safe footwear?Is it lack of public awareness about safe footwear? Do older people tend to accept foot change as part Do older people tend to accept foot change as part

of the ageing process?of the ageing process? Is advice not sought about foot change until Is advice not sought about foot change until

mobility if affected?mobility if affected? Insufficient training in this specialised field? Insufficient training in this specialised field? Some physiotherapists perceive it as a task for Some physiotherapists perceive it as a task for

others?others?

What would be the objectives of a What would be the objectives of a footwear service? footwear service? (Ref. 3) (Ref. 3)

To identify those in need.To identify those in need. To help keep older people mobile.To help keep older people mobile. To provide well fitting shoes, assisting the wearer to stand, To provide well fitting shoes, assisting the wearer to stand,

balance and move in comfort and safety. balance and move in comfort and safety. To organise a speedy “need responsive” service.To organise a speedy “need responsive” service. Help the elderly cope with a complex market place.Help the elderly cope with a complex market place. To provide sufficient information to reach an informed decision.To provide sufficient information to reach an informed decision. To provide a low cost effective service.To provide a low cost effective service. To provide well fitting shoes. To provide well fitting shoes. To increase environmental safety.To increase environmental safety.

Examples of footwear at admission Examples of footwear at admission (Ref. 4 & 5)(Ref. 4 & 5)

Need for growing recognition Need for growing recognition amongst professionalsamongst professionals

About the role of the ageing foot and the anticipated change.About the role of the ageing foot and the anticipated change. Physiotherapists require to recognise the role of footwear in Physiotherapists require to recognise the role of footwear in

falls. falls. Require convincing that footwear is an effective adjunct to a Require convincing that footwear is an effective adjunct to a

rehabilitation programme.rehabilitation programme. It is important to recognise that an inappropriate product can It is important to recognise that an inappropriate product can

affect test results affect test results To increase knowledge relating to the interplay between To increase knowledge relating to the interplay between

flooring and footwear to ensure what surface is most flooring and footwear to ensure what surface is most advantageous to the older personadvantageous to the older person

N.B. 40% of all fatal accidents take place in the home.N.B. 40% of all fatal accidents take place in the home.

An anticipated age change -An anticipated age change -flattening of the longitudinal arch. flattening of the longitudinal arch.

(Ref.6)(Ref.6)

Wasting of the smaller foot Wasting of the smaller foot muscles may be observed muscles may be observed

Colour & design on floors can affect Colour & design on floors can affect gait may increase falls (Ref.7).gait may increase falls (Ref.7).

This print illustratesThis print illustrates

how toe off is affected how toe off is affected on different carpets. The on different carpets. The soft velvet pile caused a soft velvet pile caused a rocking backwards rocking backwards causing instability and causing instability and was disadvantageous if was disadvantageous if a person had poor a person had poor mobility or balance.mobility or balance.

Feet and footwear Feet and footwear have to cope with have to cope with

enormous stressesenormous stresses

700 tons on each foot in the 700 tons on each foot in the course of a day.course of a day.

200, 000 miles in the course of a 200, 000 miles in the course of a lifetime.lifetime.

Obesity will increase daily load.Obesity will increase daily load.

Physiotherapists are in a unique position Physiotherapists are in a unique position to improve the stability of many older to improve the stability of many older people and influence change people and influence change (Ref.8)(Ref.8)

Knowledge of the internal foot structures.Knowledge of the internal foot structures. Understand gait.Understand gait. Understand the complex interplay between Understand the complex interplay between

walking, footwear and balance. walking, footwear and balance. Can and should influence manufacturers to Can and should influence manufacturers to

respond to needs of older people, as the respond to needs of older people, as the fashion market rarely fulfils their need.fashion market rarely fulfils their need.

Gait Analysis cubicle Gait Analysis cubicle (Ref.9 ).(Ref.9 ).

Underplantar Pressure Technology can help Underplantar Pressure Technology can help define the complex interplay between walking, define the complex interplay between walking, balance and footwear by providing quantative balance and footwear by providing quantative and qualitative data and qualitative data (Ref. 9).(Ref. 9).

Footwear does affect gaitFootwear does affect gait Slip-on shoes increases tendency to shuffle.Slip-on shoes increases tendency to shuffle. Plastic /smooth soles produces a small fearful Plastic /smooth soles produces a small fearful

step.step. Thick mid soles increase tendency to fall, due to Thick mid soles increase tendency to fall, due to

edging effect causing instability.edging effect causing instability. Ill fitting shoes slow speed of movement. Ill fitting shoes slow speed of movement. (Walking speeds exceeding 1.07 metres/second is required to cross (Walking speeds exceeding 1.07 metres/second is required to cross

pelican crossings within the allocated time permitted .pelican crossings within the allocated time permitted . In Northern Ireland approximately 230 older In Northern Ireland approximately 230 older

people (0ver 60 years of age) are involved in people (0ver 60 years of age) are involved in accidents on pedestrian road crossings per year.accidents on pedestrian road crossings per year.

Edging Effect which causes Edging Effect which causes imbalance.imbalance.

 

 

 

Gait analysis should be carried out Gait analysis should be carried out

with the therapist behind the patientwith the therapist behind the patient

This patient needed help and advice (Ref. 10)

Balance is a problem for a large Balance is a problem for a large number of older people in Northern number of older people in Northern Ireland.Ireland.

One in three people over 65 years fall each year.One in three people over 65 years fall each year. 1750 hip fractures occur annually.1750 hip fractures occur annually. Total cost is £21,000,000 annually.Total cost is £21,000,000 annually. One in six patients with hip fractures die within One in six patients with hip fractures die within

six months.six months. (As the population ages, the number increases annually with an ever increasing budget). (As the population ages, the number increases annually with an ever increasing budget).

Tapering heels increases instabilityTapering heels increases instability

Soft heel counters provide Soft heel counters provide little supportlittle support

Admission Supplied

Excessive wear and tear can Excessive wear and tear can support or refute medical historysupport or refute medical history

Typical deformities found in the Ulster patient Typical deformities found in the Ulster patient (many are painful and arthritic in origin)(many are painful and arthritic in origin)

Splayed Forefoot and Pronation of the hind footSplayed Forefoot and Pronation of the hind foot

Hallux Valgus of varying degreesHallux Valgus of varying degrees

Hallux Valgus – 97 year old Hallux Valgus – 97 year old femalefemale

Extra depth required at the toe Extra depth required at the toe box is required if Hallux Valgus box is required if Hallux Valgus

is present.is present.

Antalic GaitAntalic Gait

UlcerationUlceration

Pressure PointsPressure Points

This pressure area caused by a shallow shoe box

Home made newspaper insoles were the cause of this pressure area.

Nail problemsNail problems

All nail problems were referred to the Podiatry Department

Nail problemsNail problems

Vascular InsufficiencyVascular Insufficiency

This patient has not sought advice prior to attending the shoe clinic.

This patient was unaware of any skin discolouration.

Some vascular conditions can Some vascular conditions can deteriorate quickly and one must deteriorate quickly and one must recognise when not to supply.recognise when not to supply.

Congenital & Acquired Congenital & Acquired DeformitiesDeformities

Genu ValgumShoe sixe varied by three sizes

SummarySummary Complex interplay between walking, footwear and balance.Complex interplay between walking, footwear and balance. Assessment of the elderly person should include the foot.Assessment of the elderly person should include the foot. Correct fitting shoes are a requisite for daily living and Correct fitting shoes are a requisite for daily living and

should be documented.should be documented. Written advice should be supplied to either patient or carer Written advice should be supplied to either patient or carer

as appropriate or if advice rejected this should be as appropriate or if advice rejected this should be documented.documented.

Feet fit for rehabilitation are an essential part of the care Feet fit for rehabilitation are an essential part of the care programmeprogramme

Supply of a safe product is a cost effective intervention.Supply of a safe product is a cost effective intervention. Need for physiotherapists to increase awareness in this field.Need for physiotherapists to increase awareness in this field. Further research required on interplay between footwear and Further research required on interplay between footwear and

flooring.flooring.

Footwear ReferencesFootwear References 1, Nuffield Health Journal (1996. Preventing falls and subsequent injury in older people. Effective Health Care

2. 4.5 2. National Service Framework for Older People, Department of Health London, 3. Finlay O & Fullerton CJ, (1996). Foot & footwear of Older people I Squires (ed), The role of the

multidisciplinary team. Chapman & Hall, London. (2nd edition). 4. Kwok T, (1994). A survey of inpatients’ footwear. Care of the Elderly J. March, P. 118 5. Finlay O, (1986). Footwear in the elderly care programme (1986). Physiotherapy J Vol 72 No 10: 172 -178 6. Robbins S,. Waked E, McClaran J. (1995). Proprioception and stability; foot stability awareness of age and

footwear. Age & aging 24; 67-72..

7. Finlay O, Beringer TRO. (2007). Effects of floor covering on measurements of gait and plantar pressure.

Physiotherapy J. Vol. 93 No.2 June P.144 -150.

8. Finlay O. (1996) Footwear Problems & Footwear Prescriptions. Chapter 26, P382 - 398 . Physiotherapy with

Older People. Edited by Pickles. Et al, London, Philadelphia Toronto, Sydney & Tokyo 9. Finlay O, (1995). The use of computers to assess problems associated with gait in elderly people. Information

Technology of Nursing 1995 -7 (1): 9-12.10. Olwen Finlay explains. (1996) Health Service J. February 8th