Elderly – Geriatrics

GERIATRIC PEDAL CONCERNS

Special consideration is required in caring for our elderly ambulators. Their pedal care needs critical assessment regularly; our aging feet may need extra attention to be their safest and most comfortable.

Several factors can be in need for assessment; not only are we concerned with the patient’s physiology, but their general health, choice of shoe gear and fitness are a combined evaluation towards their needs. Following are some guidelines in evaluating and recommendations for your patients.

General health

Our geriatric population often seeks podiatric care when common daily activities become painful or ungainly. Asking your patient about their desired (or expected) daily activity will offer you a glimpse into what they have trouble with:

  • do they wish to walk for excersize or with a pet?
  • do they need to take care of duties in the home?
  • do they need to travel and navigate large parking lots with facility settings (as in going to physicians appointments/grocery stores)?
  • home or furnishing infrastructure impediments?

The challenge will be matching their desires to what is medically possible safely or may add to their becoming a ‘fall risk’:

  •  are there cardiac/vascular/blood pressure limitations?
  •  history of previous falls with/without fractures, as in hip/knee replacements?
  •  history of osteopenia (look for supplements in meds), arthritic changes that are noted and are they on OA/RA/Gout medications?
  •  history of Parkinson’s, myasthenia gravis, multiple sclerosis, chemo fatigue lumbar spinal changes (stenosis/DDD/injury/arthritic damage etc.), conditions that influence neuromuscular efficacy (hepatitis/diabetes/B12 deficiency etc.

 

Now with the patient’s background, a clinical evaluation will offer further information regards their status and current needs: full podiatric systems review:

  1. PVASC (history of revascularizations, DVTs etc.)
  2. SKIN (history of ulcerations,  decreased plantar fat pad, callus),
  3. ORTHO (proximal concerns such as lower extremity prostheses, ankle fusion, arthritic and limited joints, injury, amputations, unequal leg length, deformities especially problematic in shoe fit etc.)
  4. MUSC (CVA, weaknesses, contractures)
  5. NEURO (monofilament and reflex hammer to test, numbness etc.),
  6. NAILS (thickened to point of subungual damage in shoe/pain etc.) to find at least the most common causes of debility or pain in movement.

Once the podiatrist has a sound understanding the persons’ situation, appropriate decisions may be made regards their activity and pedal care.

Preparation for ability and safe ambulation may need to be recommended in unison:

-how fit the person is: physical strength, balance and endurance training/therapy may be in order. Medical community team approach is best when possible.

Now let’s use assistive gear:

-remind all with vision or neuropathic concerns to walk only with assist from a light source, cane or walker and shoes or slippers with non-skid soles.

– should have and know to use sock/shoe donner if reach is an issue in use of more proper gear – discourage ‘slid in’ slippers/shoes as fall risk’

-shoe features: high toe box (extra depth as need) and no width impingement, cushioned tongue of shoe and ankle-heel at counter, sturdy upper construction, many laces/Velcro for better control, protected inner liner, nonskid sole are some features to look for in any brand shoe.

Patients should be aware that they are responsible for daily inspection and maintenance of their feet:

-use of a hand mirror –sometimes even resting on the floor over which their foot can hover to see plantar, will offer assist in inspection

-q-tip applicators can ease webspace post-bathing drying without use of a sawing motion from a washcloth damaging  tender skin

– lotions to foot top, bottom and tufts ( not to webspaces) daily

– use of cushioned liners or padding to assist in friction reduction of bony prominent areas (keeping shoe fit in mind)

As part of the health care team, podiatrists can work to evaluate and offer many modalities of care in creating a fit and safe means for overall well-being for their patients through long term activity and excersice.