APMA News - July 2011 - (Page 25)

Stepping Up to Prevent Falls: Part II BY JONATHAN MOORE, DPM EDITOR’S NOTE: In the June issue of APMA News, you read about the impact of falls on America’s elderly and how podiatrists can play a role in assessing the risk of falls among their patients. In this issue, learn more about what you can do for patients you’ve identified as being at high risk for falls. APMA does not endorse any specific ankle-foot orthoses (AFOs) for the prevention of falls. You should carefully evaluate patients with ankle instability to determine the potential benefit of an AFO. Further studies of AFOs and their effect on fall prevention are needed. APMA News invites diverse clinical perspectives from members. O • • • • • • • nce you have conducted an objective assessment of a patient’s risk of falling (see assessment tool in the June 2011 issue of APMA News), you can implement a plan that includes a variety of interventions to mitigate that risk. Some common interventions include: physical activity-based interventions (physical/occupational therapy); assessment of ankle and foot joint weakness and instability; treatment to address instability and improve postural sway for those with loss of sensation/proprioception; assistive devices to improve balance, reduce instability, and improve proprioception (e.g., an AFO designed to improve balance, proper foot wear, and possible treatment for neuropathy); assessment for referrals to ophthalmology or for treatment of vestibular disorders that may be affecting balance; education (a patient checklist of methods to prevent falls); and assessment and treatment of common foot ailments (e.g., corns, calluses) linked to imbalance and fall risk. those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength. Subjects who fell were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological fall risk factors and age.1 Your referral, along with implementation of the right shoe and assistive device, can have an enormous effect on the incidence of falls. A gradual decline in balance abilities and speed of gait occurs with age. These two areas are linked directly with activity level. Weakness in the anterior tibialis muscle, which dorsiflexes the ankle and toes to clear the toes during walking, is common in seniors, which is why many falls every year are attributed to lower extremity weakness, instability, and often poor footwear, which contributes to stumbling and tripping. With age, the tibialis muscle (among others) can get “out of sync” in its timing with other muscles in the leg. As a result, the timing of toe clearance is altered, and the toe may catch on the floor. Treating the fall-risk patient must always include a referral to physical/occupational therapy to facilitate a plan of care that includes strength and balance training. Your referral, along with implementation of the right shoe and assistive device, can have an enormous effect on the incidence of falls. Stepping Up to Prevent Falls continued on page 26 APMA News July/August 2011 Podiatrists routinely recommend all of the interventions above, yet we seldom “package” them for the patient at risk for falling. This article addresses several of these areas in greater depth. Referral for Physical or Occupational Therapy Ankle instability is a key component of fall risk, and ankle range of motion/instability is among the measures in the fall risk-assessment tool in the June issue. Four points are assigned from the presence of significant weakness or loss of range of motion of the ankle joint. In a recent study, researchers compared participants who reported falling to those who did not. Compared to 25

Table of Contents for the Digital Edition of APMA News - July 2011

APMA News - July 2011
President’s Message
Contents
PICA Reflects on its Past, Looks to the Future
APMA Media Event Wrap-Up: Toning Shoes Are All The Rage, Along with Podiatrists' Expert Advice
APMA Member Testifi es Before Congressional Committee on Health IT
Stepping Up to Prevent Falls: Part II
Resident Experts: CPME's Residency Evaluators Share Their Stories
Strategic Planning Retreat Underscores APMA Direction
Reimbursement
Can They Really Do That?
Members Who Know Media
Technofile
Young Voices
Federal Advocacy Forum
Small Business 101
CPME Update
APMAPAC Chair Report
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
Insurance Advisor
New Members
Death Notices
APMAPAC Update
Development Update
Annual Scientific Meeting Sponsors
Committee Nominations
Bylaws Propositions Due
Classified Advertising
Dates to Remember
Advertising Index
Ten Questions

APMA News - July 2011