Background: Although foot pain has been linked to fall risk, contributions of pain severity, foot posture, or foot function are unclear. These factors were examined in a cohort of older adults. Objective: The purpose of this study was to examine the associations of foot pain, severity of foot pain, and measures of foot posture and dynamic foot function with reported falls in a large, well-described cohort of older adults from the Framingham Foot Study. Methods: Foot pain, posture, and function were collected from Framingham Foot Study participants who were queried about falls over the past year (0, 1, and ≥2 falls). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation of falls with foot pain, pain severity, foot posture, and foot function adjusting for covariates. Results: The mean age of the 1,375 participants was 69 years; 57% were female, and 21% reported foot pain (40% mild pain, 47% moderate pain, and 13% severe pain). One-third reported falls in the past year (1 fall: n = 263, ≥2 falls: n = 152). Foot pain was associated with a 62% increased odds of recurrent falls. Those with moderate and severe foot pain showed increased odds of ≥2 falls (OR 1.78, CI 1.06-2.99, and OR 3.25, CI 1.65-7.48, respectively) compared to those with no foot pain. Foot function was not associated with falls. Compared to normal foot posture, those with planus foot posture had 78% higher odds of ≥2 falls. Conclusion: Higher odds of recurrent falls were observed in individuals with foot pain, especially severe foot pain, as well as in individuals with planus foot posture, indicating that both foot pain and foot posture may play a role in increasing the risk of falls among older adults.

Keywords:
Pain, Recurrent falls, Flat feet, Foot pronation, Cohort study
1.
Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-1707.
2.
Ryynanen OP, Kivela SL, Honkanen R, Laippala P, Soini P: Incidence of falling injuries leading to medical treatment in the elderly. Public Health 1991;105:373-386.
3.
Alexander BH, Rivara FP, Wolf ME: The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 1992;82:1020-1023.
4.
Sattin RW: Falls among older persons: a public health perspective. Annu Rev Public Health 1992;13:489-508.
5.
Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI: Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007;36:304-309.
6.
HelpAge International, United Nations Population Fund (UNFPA): Ageing in the Twenty-First Century: A Celebration and a Challenge. New York, London, United Nations Population Fund (UNFPA) and HelpAge International, 2012.
7.
Gill T, Taylor AW, Pengelly A: A population-based survey of factors relating to the prevalence of falls in older people. Gerontology 2005;51:340-345.
8.
Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35(suppl 2):ii37-ii41.
9.
Greenberg L, Davis H: Foot problems in the US. The 1990 National Health Interview Survey. J Am Podiatr Med Assoc 1993;83:475-483.
10.
Hannan MT, Murabito JM, Felson DT, Rivinus M, Kaplan J, Kiel DP: The epidemiology of foot disorders and foot pain in men and women: the Framingham Study. Arthritis Rheum 2003;48:S672.
11.
Hill CL, Gill TK, Menz HB, Taylor AW: Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health Study. J Foot Ankle Res 2008;1:2.
12.
Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB: Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004;159:491-498.
13.
Menz HB, Lord SR: Foot pain impairs balance and functional ability in community-dwelling older people. J Am Podiatr Med Assoc 2001;91:222-229.
14.
Leveille SG, Guralnik JM, Ferrucci L, Hirsch R, Simonsick E, Hochberg MC: Foot pain and disability in older women. Am J Epidemiol 1998;148:657-665.
15.
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR: Gait, balance and plantar pressures in older people with toe deformities. Gait Posture 2011;34:347-351.
16.
Menz HB, Dufour AB, Katz P, Hannan MT: Foot pain and pronated foot type are associated with self-reported mobility limitations in older adults: the Framingham Foot Study. Gerontology 2016;62:289-295.
17.
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR: Foot pain, plantar pressures, and falls in older people: a prospective study. J Am Geriatr Soc 2010;58:1936-1940.
18.
Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E, Hannan MT: Foot pain: is current or past shoewear a factor? Arthritis Rheum 2009;61:1352-1358.
19.
Dawber TR, Meadors GF, Moore FE Jr: Epidemiological approaches to heart disease: the Framingham Study. Am J Public Health Nations Health 1951;41:279-281.
20.
Feinleib M, Kannel WB, Garrison RJ, McNamara PM, Castelli WP: The Framingham Offspring Study. Design and preliminary data. Prev Med 1975;4:518-525.
21.
Riskowski JL, Dufour AB, Hagedorn TJ, Hillstrom HJ, Casey VA, Hannan MT: Associations of foot posture and function to lower extremity pain: results from a population-based foot study. Arthritis Care Res (Hoboken) 2013;65:1804-1812.
22.
Song J, Hillstrom HJ, Secord D, Levitt J: Foot type biomechanics. Comparison of planus and rectus foot types. J Am Podiatr Med Assoc 1996;86:16-23.
23.
Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Mootanah R, Dufour AB, Chow BS, Deland JT 3rd: Foot type biomechanics part 1: structure and function of the asymptomatic foot. Gait Posture 2013;37:445-451.
24.
Menz HB, Morris ME, Lord SR: Foot and ankle risk factors for falls in older people: a prospective study. J Gerontol A Biol Sci Med Sci 2006;61:866-870.
25.
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR: Cross-sectional analysis of foot function, functional ability, and health-related quality of life in older people with disabling foot pain. Arthritis Care Res (Hoboken) 2011;63:1592-1598.
26.
Benvenuti F, Ferrucci L, Guralnik JM, Gangemi S, Baroni A: Foot pain and disability in older persons: an epidemiologic survey. J Am Geriatr Soc 1995;43:479-484.
27.
Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT: Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons. J Am Geriatr Soc 2005;53:1029-1033.
28.
Menz HB, Lord SR: The contribution of foot problems to mobility impairment and falls in community-dwelling older people. J Am Geriatr Soc 2001;49:1651-1656.
29.
Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM: Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc 2002;50:671-678.
30.
Cobb SC, Tis LL, Johnson BF, Higbie EJ: The effect of forefoot varus on postural stability. J Orthop Sports Phys Ther 2004;34:79-85.
31.
Tsai LC, Yu B, Mercer VS, Gross MT: Comparison of different structural foot types for measures of standing postural control. J Orthop Sports Phys Ther 2006;36:942-953.
32.
Tahmasebi R, Karimi MT, Satvati B, Fatoye F: Evaluation of standing stability in individuals with flatfeet. Foot Ankle Spec 2015;8:168-174.
33.
Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB: Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil 2011;92:68-75.
34.
Cornwall MW, McPoil TG: Relationship between static foot posture and foot mobility. J Foot Ankle Res 2011;4:4.
35.
Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT: Association of planus foot posture and pronated foot function with foot pain: the Framingham Foot Study. Arthritis Care Res (Hoboken) 2013;65:1991-1999.
36.
Xu H, Akai M, Kakurai S, Yokota K, Kaneko H: Effect of shoe modifications on center of pressure and in-shoe plantar pressures. Am J Phys Med Rehabil 1999;78:516-524.
37.
Cummings SR, Nevitt MC, Kidd S: Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988;36:613-616.
38.
Campbell AJ, Borrie MJ, Spears GF: Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989;44:M112-M117.
39.
Nevitt MC, Cummings SR, Kidd S, Black D: Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 1989;261:2663-2668.
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2017
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