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      Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan

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          Abstract

          Background

          Abnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects’ feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care.

          Methods

          The study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan’s nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student’s t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance.

          Results

          After intervention, abnormalities in the participants’ feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated.

          Conclusion

          In frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals’ social participation increased, and their behavior improved.

          Trial registration

          University hospital Medical Information Network- Clinical Trials (UMIN-CTR) with the number: UMIN000034742. Registration date: 11/01/2018.

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          Most cited references22

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          Guideline for the Prevention of Falls in Older Persons

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            Foot and ankle risk factors for falls in older people: a prospective study.

            Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they 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 falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.
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              The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.

              To determine if short-term exercise reduces falls and fall-related injuries in the elderly. A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years. Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home. Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling. Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements. Time to each fall (fall-related injury) by self-report and/or medical records. Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome. Treatments including exercise for elderly adults reduce the risk of falls.
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                Author and article information

                Contributors
                +81-6-6105-5249 , yamashitatomoko515@gmail.com
                k-yamashita@obd.med.osaka-u.ac.jp
                rinoie@millennia-medical.com
                msato@nr.showa-u.ac.jp
                yamada@obd.med.osaka-u.ac.jp
                sawa-p@surg1.med.osaka-u.ac.jp
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                14 March 2019
                14 March 2019
                2019
                : 19
                : 83
                Affiliations
                [1 ]ISNI 0000 0004 0373 3971, GRID grid.136593.b, Graduate School of Medicine, , Osaka University, ; 1-3 Yamadaoka, Suita, Osaka 565-0871 Japan
                [2 ]Department of Podiatric Surgery, Methodist Hospital of Southern California, 300 W Huntington Drive, Arcadia, California 91007 USA
                [3 ]Takase Clinic, 1-16-6 Shimomaruko, Ota-ku, Tokyo, 146-0092 Japan
                [4 ]ISNI 0000 0000 8864 3422, GRID grid.410714.7, School of Nursing and Rehabilitation Sciences, , Showa University, ; 1865 Tookaichibacho, Midori, Yokohama, Kanagawa 226-8555 Japan
                Author information
                http://orcid.org/0000-0003-4914-0306
                Article
                1097
                10.1186/s12877-019-1097-z
                6419511
                30871498
                63f5bb15-4450-401a-9751-fd1fd394eeed
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 May 2018
                : 27 February 2019
                Funding
                Funded by: JSPS KAKENHI
                Award ID: 26282166
                Award ID: 15K01339
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Geriatric medicine
                frail elderly adult,foot care,foot pressure distribution,lower limbs,muscle strength

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