Falls prevention & the role the foot and ankle play 👣🦶💪

A short but concise tidbit at Why the foot and ankle is important for Falls Prevention .

The foot and ankle play a crucial role in maintaining balance and stability and provide a solid foundation for movement. 

Falls are a common cause of injury, especially among older adults, and understanding how to improve foot and ankle ideal function, stability, mobility and strength can greatly reduce the risk of falls.  

The main role of the foot is to help to absorb shock and reduce the impact on other parts of the body during walking or running. 

Majority of of people when they fall go either sideways or forward .Sideways falls are the most likely to result in injury.

Sideways falls have multifaceted reasons for occuring, Biomechanically some of these reasons may include - 

• too much movement to the lateral side of the foot (danger zone) during midstance through to propulsion - inability to transition through to the 1st MPJ for propulsion.
• Inefficent sagittal trunk stabilisation 
• Increased lateral spine flexion 
• COM (centre of mass) being more laterally orientated
• Inability to fire glutes when required
• Increased progression angle

Forward falls are occur predominantly due to tripping, and the inability to dorsiflex efficiently at the ankle during midsance and after toe off through swing phase - weak and inefficient Ant Tib and toe extensors. If you can't transition through to the 1st MPJ, its very difficult to cleanly dorsiflex the ankle.

Other Factors may include:

• Age related issues of the vestibular and visual systems 
• Loss of shock absorption inabiliity to spread the toes pre heel strike continuing through to toe off, and inefficient prontation at heel strike
• Footwear - extra cushioning, extra supportive 
• Use of ill prescribed orthotics and insoles 
• Reduced somatosensory perception - stimulation of the cutaneous receptors on the plantar surface of our feet - For the gait and foot nerds out there - mechanoreceptors such as Merkel discs, Meissner corpuscles, Pacinian corpuscles, and Ruffini endings which respond to pressure 

By the time we turn 40 years of age our visual and vestibular systems start to decline.

By the time we turn 50 years of age, it takes 20% more pressure to stimulate these cutaneous receptors on the plantar aspect of our feet

By the time we turn 80 years of age, it takes 75% more pressure is required to stimulate those same receptors.

Colum D. MacKinnon, Balance, gait and falls in Handbook of Clinical Neurology, 2018

Robbins S, Waked E. Foot Position Awareness: The effect of footwear on instability, excessive impact, and ankle sprain . Critical Reviews in Physical and Rehab Med. 1997, 9:53-74.

By improving foot and ankle ideal function and strength, individuals can enhance their overall balance and stability and reduce the likelihood of falls.

It is also essential to provide increased feedback to CNS (Central Nervous System) of these mechanoreceptors through the application of EVA (Ethyl Vinyl Acetate)  in strategic positions under the foot in footwear to promote increased proprioception , especially on the lateral aspect of the foot.

This just happens to co-incide with majority of the population having difficulty in transitioning from the outside of the foot the the 1st MPJ during midstance to propulsion !!! I see it day in and day out !

Everybody over the age of 40 should be looking at some form of Falls prevention intervention - We need to start incorporating more into our eveyday lives .

It is essential to also include a combination of exercises that focus on balance, strength, and flexibility. 

Unfortunatley there are not enough safe foot, ankle and lower extremity exercises that focus on Falls Prevention, that are safe , easy to do, totally functional,  that are easy to implement into everyday living so therefore improve compliance. 

So Check Out our upcoming Course - Foundation Foot & Ankle Short Course to dive deep into 16 clinically refined exercises to improved the balance, stability, strength and mobility of your clients from the feet up! By simply improving ideal foot function, you may improve all of these things.