Supplementary Material for: Foot problems in older adults presenting to a Falls and Balance Clinic

Introduction: Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aims to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk.
Methods: Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems and footwear were assessed in clinic.
Results: One-hundred and two patients were included; median age 79.3 [73-84.3] years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p<0.001).
Conclusion: The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

引言：肌肉骨骼疾病、周围神经病、外周动脉疾病及皮肤病症等足部问题在老年人群中十分常见，且与跌倒风险升高密切相关。已有研究证实，多组分足病干预可降低跌倒发生率。本研究旨在识别跌倒与平衡门诊中需要足病诊疗介入的老年患者，描述其接受的足部医疗照护模式，探讨足部问题与身体功能间的横断面关联，并最终阐明足病诊疗介入在跌倒风险多学科管理中的作用。

方法：本研究为队列研究，纳入前往跌倒与平衡门诊接受老年综合评估的患者。研究收集受试者的人口学资料，并在门诊评估其功能独立性、活动能力、足部问题及鞋履适配情况。

结果：共纳入102例受试者，年龄中位数为79.3岁（四分位间距73~84.3岁），女性占比68.6%，93.1%的受试者独立居住，62.7%使用助行器具。80.4%的病例接受了足病转诊，其中肌肉无力为最常见的检出问题（占比90.2%）；74.8%的受试者存在鞋履适配不当的情况。多数受试者接受了鞋履适配教育，半数受试者获得了足踝肌力强化训练处方。拇趾及其他足趾无力与更低的简易体能状况量表（Short Physical Performance Battery, SPPB）评分显著相关（p<0.001）。

结论：跌倒与平衡门诊的多数老年受试者需要足病诊疗介入，足部无力及鞋履适配不当是最常见的转诊原因。拇趾及其他足趾无力的受试者平衡与活动能力更差，而这一情况与更高的跌倒风险密切相关。本研究结果凸显了在老年人群跌倒风险的多学科管理中，纳入足病评估与干预措施的必要性。