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Maturitas 91 (2016) 110–114

Contents lists available at ScienceDirect

Maturitas
journal homepage: www.elsevier.com/locate/maturitas

Review article

Chronic foot pain in older people
Hylton B. Menz
School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Foot pain is a common accompaniment of advancing age, affecting at least one in four older people.
Received 14 June 2016 However, management of foot pain is a largely undervalued aspect of geriatric health care, resulting in
Accepted 21 June 2016 many older people needlessly enduring chronic foot pain and related disability. The aim of this review is
to provide an overview of (i) the prevalence and risk factors for foot pain, (ii) the impact of foot pain on
Keywords: mobility and quality of life, and (iii) the conservative management of foot pain. The available evidence
Foot
indicates that although foot pain is common and disabling in older people, conservative interventions
Pain
such as routine foot care, footwear advice and foot orthoses are effective at reducing foot pain and may
Ageing
also assist in maintaining mobility and independence in this age group.
© 2016 The Author. Published by Elsevier Ireland Ltd. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
3. Epidemiology of foot pain in older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3.1. Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3.2. Risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3.3. Common foot disorders in older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
4. Impact of foot pain in older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5. Management of foot pain in older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.1. Routine foot care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.2. Footwear considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
5.3. Foot orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
6. Summary and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Contributor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

1. Introduction
Indeed, even older people themselves may consider foot pain to be
The human foot plays an essential role in all weightbearing an inevitable consequence of ageing rather than a treatable medical
activities as it provides the only source of contact with the ground. condition [2], resulting in many people needlessly enduring chronic
When walking, the foot contributes to shock absorption, adapts to foot pain and related disability.
uneven surfaces, and facilitates the forward propulsion of the body. The aim of this review paper is to provide an overview of the
In the presence of foot pain, this important biomechanical function epidemiology, impact and conservative management of foot pain
is disrupted, leading to impaired balance, difficulty ambulating and in older people.
ultimately a loss of independence [1]. Despite this, management of
foot pain is a largely undervalued aspect of geriatric health care. 2. Methods

A literature search was conducted in May 2016. The Ovid plat-
E-mail address: h.menz@latrobe.edu.au form was used to explore Medline (1946 to present) and Embase

http://dx.doi.org/10.1016/j.maturitas.2016.06.011
0378-5122/© 2016 The Author. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-
nd/4.0/).

manual dexterity and visual acuity. Many older people also seek surgical intervention tors for foot pain in older people. Two prospective studies also indicate that shown to be associated with impaired balance [36.19] and the influence of women’s footwear. than men [5]. 72% had foot pain three of life. Older 5. Given that local and systemic factors often coexist. neu- and abstract review. bution of metabolic factors associated with excess fat mass [23]. estimating the population prevalence 4. nurses. rheumatoid arthritis [28]. More broadly. as several case definitions have been used which vary according to pain frequency and time There is strong evidence that foot pain has a significant detri- period. a recent systematic review of 31 population- mental impact on mobility and health status in older people. particularly for conditions affecting the forefoot [8. to be more preva- [4] and 20% specifically report foot pain to be the primary cause lent in women than men. this search strategy yielded 194 documents. and to be at least moderately disabling in of their inability to leave their home [35]. although a wide range of health professionals (such mechanical loading of the foot when walking [22] and the contri. Impact of foot pain in older people of foot pain in older people is difficult. with women more likely to report persistent foot pain survey [13. While some studies have reported that older people with foot podiatry treatment can maintain or improve foot health in older problems have a lower level of income [24] others have failed to people [45] and that discharge from podiatry services may result find such an association [17. including female sex [7–9]. Risk factors Australia is highest among those aged 65 years and over [41]. of a podiatrist’s workload. Despite the general consensus that health status is strongly Maintenance of foot hygiene and treatment of toenails and kera- linked to socio-demographic factors.1. A prospective study independent risk factor for accidental falls [38.505 community-dwelling participants Several studies have demonstrated that foot pain is associated with aged 45 years and over identified eight studies with comparable reduced walking speed [31. However. vascular. delineating a precise 3. of 2718 people aged 50 years and over reported that of those who older people with foot pain report poorer health-related quality reported disabling foot pain at baseline.B. as it likely to reflect differences in how income levels are defined and requires not only adequate joint flexibility. and the the scope of this review. impact disorders resulting in foot pain in older people are keratotic lesions and management). studies [17.1. physiotherapists and pedorthists) may also contribute [44].e. orthopaedic surgeons.16. the UK. dermatological. The association between increased body mass disability in older people is primarily the domain of the podiatry index and foot pain in older people has been attributed to increased profession. primary care consultations for musculoskeletal foot and ankle problems are strongly associated with age. obesity for their foot pain. but also a high level of differences in educational systems between countries. These discrepancies are Difficulty cutting toenails is common in older people. Systemic conditions most commonly associ- ated with foot symptoms in older people include osteoarthritis 3. which may be due to the higher prevalence of hallux valgus 5. as evidenced by lower scores on the Short Form 36 health years later. large-scale epidemiology stud- most relevant manuscripts were selected for citation based on the ies indicate that the most commonly observed and reported foot predetermined subheadings of the review (epidemiology. rheumatologists. The majority of older people with foot quent foot pain of 24% was derived.11].31–34]. However. all of which may decline with . Following title of the foot) and systemic factors (i. Nevertheless. and osteoarthritis [15–17].10.32].37] and is an foot pain is highly persistent in older people. gout [29] and diabetes [30]. and peak in the 65–74 year age group [40]. limited to human studies published as full Foot pain is a complex phenomenon as it may be caused by local journal articles in the English language. leaving a final rological and musculoskeletal conditions that may manifest in the yield of 136 manuscripts for consideration. followed closely by nail disorders (particu- studies is provided. depression [12–14] and comorbidities such as diabetes and toes [43]. Similarly.25. as general practitioners.24] but not others [15. sultations [42].2. After the removal of dupli. Frequent foot pain was found to pain consider it to adversely affect their ambulation on most days most commonly affect the forefoot and the toes. Of these factors. A detailed evaluation of each of these conditions is beyond these manuscripts were then examined for additional titles.21]. Menz / Maturitas 91 (2016) 110–114 111 (1974 to present) by applying the following title keyword search 3.18. Management of foot pain in older people women are significantly more likely to report foot pain than older men.26].25]. factors (i. Similarly. H. A narrative summary of the findings of these (corns and calluses). The reference lists of foot). based studies involving 75.25]. the role of education and totic lesions in older people accounts for a substantial proportion income in the prevalence of foot pain in older people is equivo.3. structural disorders affecting the load-bearing function cates. larly fungal nail infection) and structural deformities such as hallux valgus (‘bunions’) and lesser toe deformities (hammertoes and clawtoes) [7.32] and difficulty performing activities case definitions. 58 documents were removed. podiatry utilisation in 3. with older people accounting for 75% of all publicly-funded podiatry con- Cross-sectional studies have identified several potential risk fac.e. In period [6]. It has long been recognised that foot problems are common in older people [3]. from which a pooled prevalence estimate of fre- of daily living [16.39]. Foot pain has also been two-thirds of cases [4]. Common foot disorders in older people terms: foot OR foot problems OR foot disorders OR foot osteoarthri- tis AND elderly OR older. Clinical audits have shown that regular cal. Similarly. Routine foot care and lesser toe deformities [18. in a subsequent deterioration in foot health and mobility in this tion have been found to be associated with foot problems in some age-group [46]. a study of 4745 women aged 70–75 years Management of foot pain in older people accounts for a reported that foot pain persisted in 51% over a six year follow-up substantial number of consultations to health professionals. female sex and obe- sity appear to have the strongest associations with foot pain. lower levels of educa. The provision of foot health services to manage foot pain and row toe box [20. Prevalence cause of foot pain in older people is difficult and requires a detailed systems examination in clinical practice. which frequently incorporates an elevated heel and nar. Epidemiology of foot pain in older people [27].

In this study. Orthotic therapy plays a major role in the conser- lar scalpel debridement of plantar calluses has been shown to be vative management of foot disorders in older people [77. as regu- bearing activities. dimensions when purchasing shoes [66]. nail disorders and toe deformities. Menz / Maturitas 91 (2016) 110–114 age. This effect may be particularly important timing and magnitude of the forces acting on the foot during weight in the management of the older person with diabetes.112 H. In pain. the risk of falls [74]. in older people who continue to wear this style of regular foot care. shoes that are too tight in the forefoot or too loose in the heel may lead to reduced walking speed and gait instability [70]. a prolonged time to corn recurrence. ment of foot pain is primarily the role of the podiatrist. footwear advice and foot orthoses appear to be footwear. hip and spine and predisposing to musculoskeletal pain. In older people.52]. the construction of custom-moulded insoles derived from plaster The use of corn plasters was associated with a higher propor- casts or 3-dimensional scans of the older person’s feet. but declined to less than 10% by the age of 40 years [73]. as selection of footwear is more strongly influenced by aesthetics ment can be largely attributed to placebo effects [55. heel elevation is associated with hallux valgus and plan. is spent on orthoses each year. such as onychomycosis (fungal nail infection) and oncycryptosis Given the association between suboptimal footwear and foot (ingrown toenails) can be extremely painful and disabling [47].2. effective at reducing foot pain in this age group. In the effective in the prevention of neuropathic ulceration [58]. sufficient mobility to change or remove the the foot is associated with corns on the toes. hallux valgus defor- orthoses when necessary. thereby altering the biomechanics of disabling. suggesting that simply changing footwear may reported immediate reductions in pain following scalpel treat. Foot orthoses debridement of plantar calluses is more effective at improving the mechanical properties of the skin than the application of topical Foot orthoses are devices placed inside the shoe that alter the keratolytic agents [57]. from simple adhesive pads that can be manufactured during a rou- 202 people were randomised to receive either scalpel debridement tine consultation. and the limited availabil- when prescribing orthoses in this age-group.68]. and were followed up for a 12 month period. although the effectiveness of reduction in foot pain and developed fewer keratotic lesions than this approach is uncertain. However. wearing shoes substantially narrower than modative footwear. particularly in older women. obesity. these findings do not preclude the possibility of cumulative bene- fits over a longer time period. educational inter.65]. treatment group suggest that this apparent short-term improve. disabling foot pain were randomly allocated to an intervention ventions to train nursing staff have been shown to be effective at group (who received off-the-shelf. Summary and conclusions The detrimental effect of high heels has been examined in two recent reviews [71. this treatment needs to be the heel [80]. whereas wearing shoes shorter than the foot is the arch contouring provided by the devices. although further . fashion influences ment of plantar calluses [53. two randomised trials found that foot orthoses were effec- Evaluation of footwear is one of the most fundamental compo- tive at reducing symptoms in people with osteoarthritis of the nents of effective management of foot pain in older people. consideration also ity of footwear that caters for the altered shape of the older foot needs to be given to whether the older person has suitable accom- [67.50]. changing footwear could be a simple and effective interven- hospital or residential care settings where podiatry services are tion. compliant elastane upper) or a usual care control group. nursing staff may be required to perform appropriate footwear is effective at reducing foot pain in older this role [48]. Manage- This may be indicative of a life-course trajectory in which the influ. Footwear considerations foot-related disability in older women with osteoporosis [87]. geons may contribute. and is associated with mobility impairment and falls in the knee. with foot orthoses accounting for however a recent randomised trial suggests that corn plasters con- 75% of a hospital’s total appliances budget [79]. 6. rheumatologists and orthopaedic sur- and is replaced with a greater emphasis on comfort and practical. At the 4 Management of painful plantar calluses commonly involves month follow-up period. UK National Health Service. Conservative podiatric interventions such as ity. while found that the use of high heels was common between the ages of the most commonly reported foot disorders by older people are 20–29. The major risk factors for the development of foot However.78]. community-dwelling older people with confidence in managing foot problems [49. However. In this trial. corns and calluses. These 26 and 50% of older people wear shoes that are too short or too nar- studies suggest that foot orthoses may be a useful conservative row [61–63] due to fashion influences [64. A recent trial has shown that scalpel 5. controlled trials involving a ‘sham’ are a significant barrier to adherence. than functional considerations [76]. Although uncontrolled studies have the control group. as several cases of foot ulceration associ- toms. tion of resolved corns. be an effective management strategy.3. and sufficient skin integrity to withstand mity and foot pain. through to more complex techniques involving or corn plasters. Indeed. two uncontrolled studies have suggested that foot orthoses ated with corn plasters have been reported in people with diabetes can reduce foot pain in older people [85. A survey of 2627 women aged 50 years and over mon chronic conditions such as diabetes and osteoarthritis. forefoot [81] and toes [82]) in older people. and very carefully considered in older people with poor skin integrity may also be beneficial for balance [83–85]. is frequently motion of the foot and ankle.72]. and one randomised [60]. Although there is evidence that nursing staff lack people [75]. the intervention group exhibited a greater scalpel debridement by a podiatrist. However. tar calluses [69] and has been shown to impair balance and increase nail disorders resulting from inability to maintain toenail hygiene. general practitioners. associated with lesser toe deformity [69]. depression and com- ishes with age. extra-depth footwear with a improving both foot care knowledge and practices [51. Heel elevation alters the position and Foot pain affects at least one in four older people. Foot orthoses range taining 40% salicylic acid may be more effective [59]. there is some evidence that the use of high heels dimin. not measuring foot treatment for a range of foot disorders in older people. it has been estimated that £38 million Treatment of corns may also require scalpel debridement.54]. More recently. Furthermore.56].86]. Between first metatarsophalangeal joint [88] and midfoot joints [89]. controlled trial found that foot orthoses with a medial arch sup- port and metatarsal pad were effective at reducing foot pain and 5. less Several studies have demonstrated that foot orthoses are effec- pain and reduced corn size over the first 6 months in compari- tive at reducing pressure from painful regions of the foot (including son with scalpel treatment. Nevertheless. although ence and perceived importance of fashion diminishes over time nurses. In relation to symp- or peripheral neuropathy. this age group. female sex. Although often considered to be relatively trivial problems. a recent randomised trial has shown that the use of limited or unavailable. However.B. pain are increasing age.

M. Nursing or chiropody? Nurses’ attitudes to toe nail trimming. E. Assoc. Foot and leg [49] M. Voutilainen. M. Age Ageing 18 (1989) 275–278. J. M. well-being. Baroni. S. J. Mallen. Kwan. in three samples of elderly and very elderly people.G. Influence of obesity and sarcopenic obesity on plantar pressure of Conflict of interest postmenopausal women. The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: cross-sectional findings from the clinical assessment study of the foot. 2004-2008. Menz. 43 Biol.L. Menz. Barr. White. Rebelatto. population prevalence of foot and ankle pain in middle and old age: a [34] L.J. Richardson.W. J.E. R. Arthritis Care Res.S. Keysor. Monteiro. P. Rehabil. Lord.B. T. H. deMelker. 27 (2005) 917–923. C.M. A. Rehabil. M. J.P. Muller. Hochberg. Gerontol.R. J. A. [46] J. [26] J. Menz.L. Arthritis Care Res. Hider. Activities of daily living: changes in functional ability (1966) 1058–1061. A. A. Rheumatol. Gill. Foot 17 (2007) 76–83. A. J.W. J.R. L. Am. Simonsick. Lord. Ferrucci. for functional disability associated with chronic conditions in Canadian older [5] E. Prevalence of foot and ankle conditions in a multiethnic community sample Nurse. of older adults. Foot problems in the US. Foot problems in people with gout in primary care: baseline findings from a prospective cohort study. J. Am.S. Med. H. Butterworth.G. Peat. Am. E. 41 (2010) 93–97.A. [30] E.R. [40] H. A population-based survey of risk factors mobility. Grundy. Bowling. Thomas. Epidemiol. Menz. Thomas. descriptive analysis of the medicare benefits schedule database. in older people. C.L.F. Med. elderly women in Australia. Croft.M. S. Podiatr. A population-based survey of risk factors mobility. J.F. S. J.L. 156–163. Nurs. M.R. [42] H. J. 10 (1995) 241–244. Menz. 148 (1998) [47] A. Foot and leg enhanced primary care program. 27 (2005) 917–923. Roddy. Geriatr. study. Foot pain impairs balance and functional ability in intervention on nurses’ knowledge of foot care and on the foot health of older community-dwelling older people. C.R. J. and Disability Index. J. Lord. Rheumatology 45 (2006) 863–867. A. Med. E. Suhonen. M. C. Pasco. [3] M. Menz. Griffith. Wu. L. 60A (2005) 1546–1552. Foot pain and disability in older women. Devine. Menz. D.R. Prevalence of foot complaints in the elderly. Footwear characteristics and foot problems in older practice of nurses. Gangemi. Leung. 49 (2001) 1651–1656. Menz. Prof. Footcare for very elderly people: a community survey. [37] H.B. S. M. Munro. Am. Foot pain in Foot Ankle Res. E. J. Podiatr. (1995) 479–484. Mickle.B. Assoc. Prince. Who treats feet? J. Dick. Foot Ankle Int.L. Menz.K. Foot problems of the aged and infirm. J. J. Steele. K. Foot health in older people problems are important determinants of functional status in community and the nurses’ role in foot health care–a review of literature. D.M. Podiatr. The 107–114. H. Nontraumatic foot complaints people: a prospective study. B. Med. K. Browning. Morris. [51] M. Geriatr. 13 (2004) 470–473. J. 101 (2011) 159–166. Lee.R. Nurs. Harle. J. J. Nontraumatic foot complaints [48] H. J.W.B. Ann. Epidemiol. Sci. W. Link between foot pain Wheeler. G. S. Foot and ankle characteristics associated [7] F. I. J. Raina. Gabriel. Podiatr. R. pain: anthropometric variables and footwear among older people. Muller. E. Geriatr. and health-related quality of life in older and older. Ferrucci. D. Foot Ankle Res. Biomechanics of the ageing foot and ankle: a mini-review. Morris. H. Jones. Moreira. S. Am.T. 25 (2004) 866–874. Roddy. J. Kendig. Mulley. [45] L. S. H. Sci.B. E. Leung. Gorter.R. Med. J. Lord. Chan. S. Am. Suhonen. Scand. J. Urquhart. Menz. H. 66 (2011) 474–480. S. Hannan.I. Am. S.G.K. [39] K.A. Guralnik. Geriatr. Hale. Lord. J. Kuyvenhoven.A. 33 (2012) 446–453. cil of Australia Senior Research Fellow (ID: 1020925).J. Am. 8 (2015) 31. Menz. problems are important determinants of functional status in community [43] H. McKinlay. J. Am. Menz. Menz. people with disabling foot pain. Geriatr. Predictors of podiatry utilisation in [11] K. Wluka. T. 88 (1998) 242–248. Guralnik. 1 (2008) 10. community-dwelling older people: an evaluation of the Manchester Foot Pain [44] C. Appl. J. Stolt. . Leino-Kilpi. 30 (2003) 2689–2693. Gilheany. Soc. H. B. Maturitas 68 (2011) impairment and falls in older people. Thomas. 74 (2015) HBM is the sole author of this review. R. discharge from NHS podiatry services.R. Munro. Utilisation of podiatry services in Australia under the medicare [12] E. Thirlaway. Kendig. Burnside.A. Davis. Cross-sectional analysis [2] B. J. Characteristics of primary care [10] S. J. Hirsch. K. Blagojevic-Bucknall.B. 68 (2016) the NHS. H. [25] J. [41] H. A.J. Sci. Podiatr. Benvenuti. Clin. Menz. S. Leveille.R. Contributor G. Awale. Obese older adults suffer foot pain and foot-related Australia: the north west adelaide health study. Res. [24] L. P. Gerontol. Foot pain and disability in older women. Foot Ankle Res. Paiva de Castro. 83–87.E. Epidemiol. Hannan. Mickle. Plumb.R. HBM has no conflict of interest to declare. Soc. J. Geriatr.J. Assoc. Effect of an educational [19] H. Am. J. Med. Leveille.B. Plummer.G.Y. Gerontology 51 (2005) 346–351. and falls in older people: a prospective study. Routasalo.R. Assoc. K.E. 657–665.R. Tiedemann. Gerontology 61 (2015) 381–388. Population attributable risk systematic review. J. I. [32] K.B. W. Onset and persistence of disabling foot pain in adults. Foot Ankle This article has undergone peer review.M. Steele. Am. C. Roddy. Foot and ankle risk factors for falls in older [8] K.C. [14] A. 148 (1998) Rheumatology 49 (2010) 1391–1398. Link. Helfand. Crincoli. Cicuttini. Assoc. Menz. Roddy. 2 (2009) 7. S. F. Ergon.B. Mann. A Biol. K.T. Clinical audit of core podiatry treatment in and the prevalence of depressive symptoms. Barnes. 43 [1] H.P. M. R. Marshall. and M866–M870. J.M. Lord. Brennan.M. Silman. [52] M. S. Foot pain and with impaired balance and functional ability in older people. Kuyvenhoven. Physician 39 (1989) 101–110. [38] H. Peat. Fat mass is associated with foot pain in men: the geelong osteoporosis study. Podiatr. Barr. Howell. J. The contribution of foot problems to mobility in women aged 70 years and over: a prospective study. L.J. Am. M. Riccitelli.B. L. S. Simonsick.E.P.R. Morris. S. Nail and hyperkeratotic problems in the elderly foot.F. Menz. Assoc. Albert. J.Y. Foot pain and disability in older persons: an epidemiologic survey. B.J.J. C. Hochberg. 1997–2006. Integrating foot care into the everyday clinical [20] H. Menz. Greenberg. M. Guralnik. Sousa.J. Ferrucci.E. 83 (1993) 475–483. Provenance and peer review [29] E. P. Barr. Soc.L. [13] H. [21] A. 14 [33] A. (1995) 479–484. Med. Med. Menz / Maturitas 91 (2016) 110–114 113 controlled trials are required to adequately evaluate their effective. Jordan.R. Lai. The relationship between foot ness.M. 25 (2010) 461–467.S. S.E. [22] M. Beecroft. H.L.B.L. Med. Garrow. Foot and ankle surgery in Australia: a dwelling older people. 24 (2010) 194–201.A. Sci.J.R.T. 58 Survey: a population survey assessing prevalence and associations. Chen. G. Br. Mickle.M. Steele. Thomas. A disability in older persons: an epidemiologic survey. Fam. Gerontol. P. [28] J. Macfarlane. M. G. Morris.B. Neves e Castro. 222–229. M. 90 (2000) 397–402. J. S. S. 43 (2016) 138–143. Love. R. M. J. Predictors and persistence of foot problems [36] H. [50] C.B. consultations for musculoskeletal foot and ankle problems in the UK. J.M. M.J. Am. Clin. Guralnik. R. Med. Modelling deterioration of foot health in older people following [15] S. P. Am.L. A. Chandratre. E. Rheumatol. Foot-care awareness.T. J. [17] E. Dufour. Roddy. P.L. Myers. Farndon. Dunn. Menz. Taylor. Littlewood. H. 159 (2004) 491–498. Browning. Menz.J. 657–665. 63 (2011) 1592–1598. Am. [16] K. Soc. 1 (2008) 8.M. Disabil. Foot Ankle Res. A review of rheumatoid arthritis affecting the foot and ankle. de Melker. Rathod. Hill. Aranha. R. Sci. [23] P. S. Katz. C. R. Podiatr. Lord. [6] H.M.B. Assoc. Hirsch. Stathokostas. Zhu. Geriatr. Stolt. Med.C. Steele. S. H. Age Ageing 39 (2010) 738–745.B. people. Foot pain plantar [9] A.M. W. K. Lord. Am.M. H. Man. Gangemi. Munro. M. Pain 110 (2010) 1936–1940. Disabil. Prevalence of lower extremity pain and its association with functionality and quality of life in HBM is currently a National Health and Medical Research Coun. Aurichio. Rheum.G. M.B. Gorter. H. A. 24 (2008) 551–567. 871–876. 91 (2001) residents.A. J.B. 61A (2006) in older people.L. Lord. Pain 152 (2011) 2870–2880. E. Caring dwelling older people. Biol. 77 (1987) 308–311.J. Biomech. A survey of persons aged 65 years of foot function functional ability. and Wong. The 1990 national health Funding interview survey. Campbell.B. Landorf. M. The effects of a foot and toenail care protocol for older adults. Am. Sci. Menz. L. Dhaliwal. Brown. K. J. Benvenuti. T.J. T.D. J. The Cheshire Foot Pain and Disability pressures. Gait Posture 42 (2015) 442–447. [18] J. R. H.B. Rome. References [31] F.M. M.B. (2004) 378–384. Landorf. Med. Podiatr.L. E. Sci.R. M. 2 (2009) 30. 85 (1995) 293–294. Assoc.B. community-dwelling older adults over a 3-year period: a prospective cohort [35] E. H. Soc.B. well-being. J. H.M.B. Black. Age Ageing 26 (1997) [4] M. Baroni.B.J. 90 (2000) 397–402. Zhang. Dis. Felson. Diabetic foot management in the elderly. Leino-Kilpi. [27] E.E. Walters. Ferrucci.J. Jaakkola.B. A. functional limitation.

Podiatr. Pieber. Evaluation of the impact of chiropodist care in the secondary prevention of [78] C. M. H. P. J.J. Vernon.R. trial. P. V. G.J. S. Sci. off-the-shelf: extra-depth footwear in reducing foot pain in older people: a [56] H.B. Gray. [65] M. Arch support use for improving 41 (2012) 290–294. Whitney.-D. Rathod. Haines. Sci. Rheumatol. Woodburn. Foot Ankle Res.J. Edmonds. Menz.J. I. A. Menz / Maturitas 91 (2016) 110–114 [53] A. D. N. Effect of scalpel debridement on the pain [73] H. Res. 42 (2012) 649–657. (2012) 9. Foot. Protection or pleasure: female footwear. diabetes mellitus − a data basis for shoe design. Barnish. Chou. Haas.Y. Menz.M. W.J. Vernon. Church. Croft. Levinger. Bradburn. 21 (2008) 153–158. The effect of foot orthoses on balance: foot [68] K. Hashmi. Peat. Shimamura. Am. Nixon. Arthritis Care Res.J. [61] B. Helliwell. G. Foot deformities.E. Barros Bertolo. Marques Neto.C. Sci. M. H. Med. Ther.R. H.R.M. Med. Lo. J. Roddy. I. Netherlands. Z. 35 Electromyogr. Allen. Davis. Spink. J. Gait Posture 32 (2010) 274–278. Foot Ankle Res. Hsi. Yamaguchi. Frescos.S. Clin. A. Redmond. Podiatr.J. Effectiveness of scalpel debridement for painful plantar calluses in older [75] H. M. Menz. 6 (1989) 818–819. T. Optimizing footwear [55] K. Aging 9 (2014) 351–356. J. M. P.R. Dev. 6 (2013) 40.B. B. The effects of shoe fit on gait in 68 (2016) 581–589.S. A Biol. P. Janchai. Trials 17 (2016) 251. J.E. J. [63] A.M. Komatsu. Murphy. J. Thomas.114 H. Comparison of the veterans wear appropriately sized shoes? The Veteran Affairs shoe size pressure-relieving properties of various types of forefoot pads in older people selection study. Redmond.E. Steele. [84] T. Comparison of shoe-length fit between people with and without [83] M. Concannon. Siebenhofer. Davys. W. Med. S. 89 treatment responses and plantar pressure parameters of metatarsal pad (1999) 506–514. Mercer. A. Appl. 20 (2003) 511–526. Mulford. Johnson. [66] B. Munro. Women and their shoes: attitudes influences and behaviour. Kang. L.R. Menz. Lord.-H. M. Lord. C. Ando. M. Groothoff. P. R. McInnes. 5 adults. Diabetes Care 26 (2003) 1691–1695. 4 (1994) 79–82. Farndon. W. Gait Posture 22 (2005) 302–307. Foot dimensions of elderly people with and without Disord. Branthwaite. Ristevski. Sanger. Med. A. Haley. J. A. (2016) 987–996. Kao. A. Gross. M. for older people at risk of falls. Auhl. Nester. Podiatr. Fox. S.G. 70 (2015) Debridement of plantar callosities in rheumatoid arthritis: a randomized 511–517. Emery. High-heeled shoes and musculoskeletal injuries: a Roddy. Nivens.J. Lam.R.T. different toe props on plantar pressure and patient comfort. A. Good for older ladies: not me: how elderly [57] F.S.B. [71] M. Med. Effectiveness of a heel cup [64] P. M. Gerontology 48 (2002) [87] C. S. Podiatr. Conaghan. Chantelau. N. Podiatr. Keenan. J. The effect of three elderly. S. Grainger.J. associated with plantar hyperkeratosis.W. J.R. F.J. Gede. Menz.R. M. J. for plantar callus: a three-armed randomised. J. M. Foot. Makiura. Rakovac. I. D. M. Menant. scalpel debridement of corns: a randomised controlled trial. Foster. [89] J. Munteanu. A. Plank. pain: balance and function in older adults. M. Assoc. Bonanno. J. de Paiva Magalhaes. Surg.B. Bellini Coimbra. H. Assoc. Kurosaka. Joyce. Trials 14 (2013) 243. Auhl. J. Potter. comparative trial using [77] K. Landorf. M. Payrie. Roddy. Farndon.J. Footwear characteristics and foot problems in older [88] H. Sommer. N. Chen. F.J. Household-shoe wearing and purchasing habits – a [86] J. B. Menz. D. Br.G. 7 (2006) 95. with an arch support insole on the standing balance of the elderly. Chockalingam. M. Kruizinga. Res.R. Balanowski. Clin. T. Rheumatology 52 (2013) 515–522. Flynn. Gerontol. Munro. P. [58] J. M. community-dwelling older adults. J.D. Winson.J. Seferin. The effectiveness of salicylic acid plasters compared with ‘usual’ [79] H.B. Menz.P. C. Biol. J. Lin. Effectiveness of foot orthoses versus rocker-sole footwear for first [70] T. L. Brown. Das.F. Chaiwanichsiri. R. metatarsophalangeal joint osteoarthritis: randomized trial. 103 (2013) 465–470. BMJ Open 6 (2016) e010053. E. J. biomechanical and pathomechanical changes biophysical outcome measures. Steele.H.R. Lee. The evaluation of three treatments women choose their shoes. Doi.W. [76] A. D. Bonanno.-C.M. Chen. J. Taggart. Tsai. M. A. associated with aging including orthotic considerations. Assoc. 24 (2014) 258–263. S. treatment of symptomatic midfoot osteoarthritis using clinical and [72] N.A. 3 (2000) 111–115. [67] E. K. The effects of high heeled shoes on female gait: a review.L. Steele. Foot orthoses: an audit of expenditure and efficacy. de Morais Barbosa.B. 241–244. people. Hirata. Med. Gerontology 51 (2005) 346–351. Foot Ankle Res. Do US [81] P. E. Footwear Sci. Munteanu. Munro. Foot shape of older pain and disability in elderly women with osteoporosis: a randomized clinical people: implications for shoe design. J. M. R. Potter.E. Clin. [54] K. (2011) 385–389. S.E. Walters. M. Davitt. Elzinga. L. Sports Phys. Goeken.M.P. P. Effectiveness of people: a randomized trial. S.J. Med.R.B. [74] J. S. [62] D. Turner. Kinesiol. 5 (2012) 22.B.B. Rheumatology 44 (2005) 207–210. H. Wendell. Effects of foot orthoses on balance in older diabetic peripheral neuropathy: a case-control study.B. A. Rabinovich.J. K. 2 (2010) 131–139. M. Part II. Interv. T. Mickle.C. Vernon. Hashmi. H. Corn cures can damage your various shoe inserts in older people with plantar heel pain. J. 7 (2014) 18. Marshall. A. 45 (2008) 1167–1181. C.-L. S. Barnish. 13 (2003) 39–45. R.B. patients supplied with foot orthoses from orthopaedic workshops in The [59] L. Menz. Correlations between subjective survey of people aged 65 years and older. Armstrong.K. Chapman. E. Work [85] D.M.R. . biomechanical outcomes: a randomised feasibility study. T. Foot 18 (2008) 186–191. Vazquez. Diabet. Assoc. Am. Dixon. Gait Posture 33 feet: an important lesson for diabetic patients. [80] D. Halstead. balance and reducing pain in older adults. 96 (2006) 290–292.G. W.B. L. J. Med. Asai. S.B. [69] H. Morrow. H. associations with foot pain and hallux valgus.J. BMC Musculoskelet. with forefoot pain. 89 (1999) Epidemiology of shoe wearing patterns over time in older women: 515–519. Landorf. Gorzer. Effect of painful keratoses debridement on foot (Epub ahead of print). Am. Watkins. Morris. Menz. Tan. Orthop. Rehabil. E. Nash. W. Landorf.C. D. C. Helliwell.A. H. Gerontol. Cronin.J. Sci. Foot orthoses in the narrative systematic review. treatment in metatarsalgia patients: a prospective study. N. Wright. J. Podiatr. Tantisiriwat. S. Wilkins. J. Proper shoe sizes for Thai [82] S. C. Boonstra.C. Novak. J. Characteristics of foot ulcerations in diabetic subjects. Foot Ankle Res. A. Pressure-relieving properties of [60] A. controlled trial. J.R. A. randomized controlled trial. Nurs. E. A. J. Am. Van der Linden. J. Chen. Naemi.