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Falls Prevention Assessment

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Preventing falls is a key area of focus for our podiatrists - yet it’s not a topic that is often discussed by others. One reason for this is because preventing falls is often viewed as having nothing more that can be done outside of “being more careful as you get older”. Research has proven, however, that this is far from the truth with over one third of falls being preventable.

Falls are currently Australia’s leading cause of injury deaths, with a falls-related death occurring approximately every 2 hours. Looking at the statistics more closely, 40% of all of Australia’s injury-related deaths are caused by a fall, and falls are the cause of 42% of all of our hospitalised injuries. One in three people aged 65 and over have at least one fall every year that will result in a hospitalisation. That is one Australian being admitted to hospital from a falls-related injury every 5 minutes, and more deaths from falls than from car accidents and transport-related fatalities.

Simply put, falls can have a large and devastating impact on a person and family. This is where our specially-designed falls prevention assessments are key.

What Is A Fall Prevention Assessment?

A falls prevention assessment is a series of tests performed by our podiatrist to gain a clearer picture of your falls risk - and what we can do to manage your risk factors to reduce your likelihood of having a fall. 

Falls Prevention Assessment Process

Your assessment starts by understanding the probability of you having a fall. This includes assessing the range of motion in your joints, your muscle strength and function, your balance, performing a gait analysis and conducting a footwear assessment. We may also perform a lower limb scan on your foot or ankle if a supportive device may be recommended. 

Your podiatrist will discuss all of your results with you, answer any questions, and discuss the best plan and management options to help you prevent a fall both inside and outside of the home. This may include giving you footwear recommendations at your appointment, taking measurements for your ankle foot orthotic (AFO), or giving you your foot and ankle exercise program to get started on at home.

Depending on your falls risk, we will need to repeat this assessment every 3, 6 or 12 months based on your risk. We’ll discuss your progress and any changes we’re noticing, and update your management plan accordingly.

Why Do I Need A Fall Risk Assessment?

Whether you have a history of falls, are starting to feel unsteady on your feet, or want to stay ahead of any issues that arise and prevent a fall from happening in the first place, falls assessments can have immense benefits. Specifically, with over a third of falls in Australia being preventable, this equates to 8 Australians a day whose lives could be saved by preventing their fall. 

If you’re aged over 65 years, you have a higher risk of having a fall than all of the other age brackets combined in Australia, so a falls risk assessment for this age group is highly recommended. And with the help of a podiatrist, research has shown that a person’s fall risk can be reduced by 36%. 

Falls Prevention Strategies We Often Recommend To Patients

Our podiatry team offers a customised approach to falls prevention that is specific to both the unique characteristics of your feet and legs and the results of your assessment, as well as any natural  age-related changes and challenges. Your falls management plan may include:

• Footwear changes or modifications
  

Footwear is well cited as a strong contributor to a person’s falls risk. This is as shoes influence a person’s comfort, balance and gait by altering the feedback provided to the foot and ankle from the ground while modifying the friction available for stability at the point where the shoe meets the floor. In simple terms, your shoes become the ground you walk on and can either carry you safely throughout your day - or throw you off and make daily movement and balance much more tiresome. Studies have also shown that 72% of older adults may be wearing shoes that do not fit both feet correctly, which also has a notable impact on gait and balance.

Your podiatrist will work with you to assess your current range of footwear both outside and inside of the home, as studies have advised that wearing shoes inside the home can help reduce your falls risk compared to walking in bare feet, socks or slippers. Our podiatrists have comprehensive knowledge about a wide range of shoes, including those best suited to older feet that suffer from conditions like bunions, diabetes, claw toes, age-related changes like thin fat pads, and more. We can recommend certain brands and styles, like those with the best traction for a variety of surfaces and conditions, and are also one of few clinics in the area that carry out our own shoe modifications so that you may be able to continue wearing your favourite shoes with some minor adjustments.

• Custom foot orthotics
  

Custom foot orthotics are a large contributor to falls risk reduction because of their entirely customisable nature to achieve a wide variety of goals, and the expertise and care that goes into their prescription from our podiatry team. Orthotics can work in multiple ways: they can best support the feet and adjust the way each foot moves through the gait cycle, which changes how muscles are activated and the feet are loaded with every step. They can promote balance and stability by essentially doubling the proprioceptive feedback to the brain which improves balances. They can also accommodate a wide range of foot shapes and structures and deformities including painful protrusions, corns, calluses, prominent joints and much more, with the goal of making each step less painful and more comfortable and supported. Typically, orthotics will carry out many of these functions to meet each person’s unique needs.

Here at The Feet People, we are well-known for our expertise in our orthotics. Every prescription has years of knowledge and experience behind it, starting with a comprehensive foot assessment with our podiatrists to understand what will best help you to both improve your gait and foot comfort while reducing your risk of falls, and pairing this with a 3D foot scan of your foot to provide the best base for the orthotic that is completely tailored to you - and not some generic foot that doesn’t understand the challenges you face. The use of orthotic insoles has been shown to improve postural stability in studies of older adults.

• Treating or managing foot problems
  

Foot problems in older people are shown to be associated with falls.^, Specific risk factors include foot pain, stiffness at the ankle, having a bunion, and reduced toe strength. Additionally, toe deformities and the presence of corns and calluses are common contributors to a person’s falls risk that we see in our clinic because of the way that they can alter a person’s gait and therefore stability.

Podiatrists are the best suited health profession to treat and manage these problems, with all of the mentioned attributes being in our list of expertise and experience. Podiatrists manage painful foot problems from a wide variety of causes, from activity-related injuries to arthritic pain. We help support stiff ankles and minimise their impact on the foot while offering solutions to better accommodate bunions and improve toe strength (see below). We debride and remove corns and calluses, while also making accommodations for toe deformities. Podiatrists are the go-to for foot pain and problems.

• Strength and balance exercises
  

Recently in June 2022, a study was published that unexpectedly showed that a person’s balance between the ages of 51-75 years was a predictor of death or survival over the following twelve years. Specifically, the researchers evaluated a person’s ability to perform a single-legged balance test where each person needed to stand on only one foot on a flat surface with their hands by their sides while looking forwards. They needed to be able to do this for ten seconds to pass, and each participant had three attempts to pass. At the conclusion of the study, even after adjusting for the age and individual health variables of the participants, they found that those who could not complete this test had an 84% higher risk of death over the length of the study (12 years) compared to those who passed the test.

While the study is not unique in its evidence for the importance of balance for falls prevention, and of strength exercises as a way of supporting and improving balance, both of which are heavily cited throughout the literature,^,,,,, it does powerfully reinforce that a fall isn’t a one-off event for many older adults. Suffering from one fall greatly increases your risk for another, and the injuries sustained in your fall may affect your mobility, pain and quality of life - all of which (alongside many other factors) can compound to influence mortality.

Our podiatrists design exercise programs that work to safely and gradually improve strength and balance. Each program is tailored to a person’s level of mobility and function, meaning that you aren’t lumped with unrealistic exercise plans or expectations. Your podiatrist supports you every step along the way and modifies your program as you progress through and see tangible changes and improvements. One study that found a 36% reduction in falls risk was achieved, when participants carried out an exercise program only three times per week, making it very manageable.

• Falls prevention education
  

If you don’t know about it, you can’t take the best steps to manage it or remedy it. That’s why in our falls assessments and treatment sessions with our patients, education is a key component. Numerous studies have shown that tailored education results in increased engagement in falls prevention strategies.^,,

Aside from being able to educate you on the various aspects of falls prevention both in your home and when you’re out and about, with various appointments throughout the year, our team also modifies the information to stay relevant to your existing circumstances, living conditions, and in light of medical conditions or injuries. We also offer take-home information for falls prevention and can guide you to additional trusted sources online.

• Timely referrals
  

Another way that podiatrists play an important role in falls prevention is through the delivery of timely referrals. It is well documented that the best approach to falls prevention involves a multidisciplinary team. During any of your appointments with us, if we detect any changes or concerns that may indicate that you could benefit from the involvement of a health professional that you are not currently working with, such as an occupational therapist, we can refer you promptly. This ensures that new needs and changing aspects of your care are not ‘missed’, and you maintain the best care from a trusted team.

FAQs

Will I need to prepare anything for the assessment?

Please wear a pair of shorts or pants to the assessment, and bring with you (if you’re not wearing already) your regular day shoes and walking shoes - the ones that you spend the most time in on your feet.

Are there any health risks of taking the assessment?

No, your podiatrist monitors you very closely throughout your appointment to ensure your safety. We may also exclude parts of your assessment if we deem it unsafe for your circumstances.

What happens once I get my results?

As we perform the assessment in our clinic together with you, you’ll get your results immediately. Your podiatrist will discuss the results with you and what they mean for your falls risk and your foot health going forwards. You’ll have the opportunity to ask any questions and gain clarity on any concerns. Your podiatrist will then discuss any recommended courses of treatment to help manage your risk of falls, and together, you’ll make a plan forwards.

References
[1]  https://www.aihw.gov.au/reports/injury/falls
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116775/
[3] https://pubmed.ncbi.nlm.nih.gov/19235118/
[4] https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-1448-9
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250347/
[6] https://journals.sagepub.com/doi/pdf/10.1177/0309364615588342
[7] https://www.karger.com/Article/Abstract/475710
[8] https://academic.oup.com/biomedgerontology/article/61/8/866/589349
[9] https://academic.oup.com/ageing/article/48/3/327/5274645
[10] https://bjsm.bmj.com/content/early/2022/06/22/bjsports-2021-105360
[11] https://pubmed.ncbi.nlm.nih.gov/17943831/
[12] https://pubmed.ncbi.nlm.nih.gov/19370674/
[13] https://pubmed.ncbi.nlm.nih.gov/16424286/
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324332/
[15] https://pubmed.ncbi.nlm.nih.gov/20818476/
[16] https://link.springer.com/article/10.1007/BF00643514
[17] https://www.sciencedirect.com/science/article/abs/pii/S0167494317301437
[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161005/
[19] https://global-uploads.webflow.com/5e332a62c703f653182faf47/5e332a62c703f652292fd053_Shuker%20FINAL.pdf