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3 evidence-based strategies for foot health

The Bottom Line

  • People living with diabetes should check, clean, and moisturize their feet daily; and frequently consult with a doctor or specialist to prevent foot-related problems.
  • Intrinsic foot muscle strengthening exercises may improve toe strength, balance, and mobility, and reduce the risk of falls in older adults who were independent, generally healthy, and living in the community.
  • Podiatry care, in combination with multiple strategies, may reduce falls in older adults living in the community.

Our feet help move us forward in life, literally. But to put our ‘best foot forward,’ we need to make the health of our feet a priority. Ask yourself these two critical questions: 1) how often do I check the health of my feet, and 2) do I address the concerns I identify? In a perfect world, our answers would be frequently and yes. However, the reality is likely different. From wounds to infections to deformities and more, the list of problems our feet can ‘run’ into stretches far beyond that pesky coffee table that our toes always seem to find. So, moving forward, let’s put our feet first. Here are a few research-based strategies that can improve the health of our feet and reduce complications related to poor foot care practices and certain diseases. Click on the links below to learn more.


1. Routine at home checks

Diabetes increases the risk of developing open wounds or sores on the feet, also known as foot ulcers (1-3). These ulcers can be caused by nerve damage that prevents people with diabetes from realizing they have injured their feet, poor circulation, dry skin that leads to cracked heels, and muscle deformities that further impact damaged skin and tissue (1). When not appropriately treated, these ulcers can become infected, potentially resulting in amputation or death (4;5). Luckily, most amputations can be avoided by implementing some simple practices into one’s daily routine (1;6). First, knowing the signs and symptoms that indicate something may be wrong is essential; these include loss of sensation in the feet, numbness, and tingling (7-9). This increased awareness must be supplemented with daily foot checks, where folks are also cleaning and moisturizing their feet. Special attention needs to be paid to cuts and open wounds, discoloration, thick toenails, blisters, dryness, and cracks. People with diabetes should also avoid walking barefoot and instead opt for properly fitting shoes (1;10). Lastly, even those without diabetes should lookout for the issues mentioned and promptly address them.


2. Intrinsic foot muscle strengthening

The state of our feet is not always top of mind when we think about falls. But research shows that it should be a major consideration. Take, for example, the strength of our intrinsic foot muscles or, more plainly put, the small muscles in our feet that help with small movements and stability and provide information used to drive large movements. Given what they do, it is safe to say that these muscles are important. Unfortunately, intrinsic foot muscles tend to be smaller and weaker in older adults, which can impact balance and tackling day-to-day activities. Research shows that foot and ankle strengthening programs may improve toe strength, balance, and specific aspects of functional mobility in adults 65 years of age and older who are independent, generally healthy, and living in the community (11). Additional benefits include potentially decreasing the risk of falls, a leading cause of death from unintentional injury worldwide (11;12).


3. Visits with a doctor or foot specialist

While investing personal time and effort to improve and maintain the health of our feet is a vital part of the equation, seeking professional care is the other part. For example, podiatrists work to diagnose and treat issues related to our lower limbs. Research shows that multicomponent care—which involves podiatrist care including advice, information, exercises, footwear, and orthotics—and multifaceted care—which involves risk assessments done by a team of professionals from different specialties and referral to a podiatrist—may decrease falls in older adults (13).


If we turn back to the topic of diabetes, we see that experts recommend that folks get their feet regularly screened by a doctor or foot specialist. This is supported by research that shows that foot problems can be significantly reduced by talking to your doctor about proper foot care, getting foot assessments, and attending follow-up visits (9).     


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References

  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Clinical practice guidelines: Foot care. Can J Diabetes. 2013; 37:S145-149. doi: 10.1016/j.jcjd.2013.01.040.
  2. Hopkins R, Burke N, Harlock J, et al. Economic burden of illness associated with diabetic foot ulcers in Canada. BMC Health Serv Res. 2015; 15-30. doi: 10.1186/s12913-015-0687-5. 
  3. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003; 361:1545-1551. doi: 10.1016/S0140-6736(03)13169-8.
  4. Faglia E, Favales F, Morabito A. New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993 – A 6.5 year follow-up. Diabetes Care. 2001; 24:78-483. doi: 10.2337/diacare.24.1.78.
  5. Iversen MM, Tell GS, Hanestad BR, et al. History of foot ulcer increases mortality among individuals with diabetes: Ten year follow-up of the Nord-Trondelag Health Study, Norway. Diabetes Care. 2009; 23:2193-2199. doi: 10.2337/dc09-0651. 
  6. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention Diabetes Care. 1990;13:513-521. doi: 10.2337/diacare.13.5.513.
  7. Sharma S, Kerry C, Atkins H, et al. The Ipswich Touch Test: A simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration. Diabet Med. 2014; 31:1100-1103. doi: 10.1111/dme.12450.
  8. Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care. 2004; 27:2642-2647. doi: 10.2337/diacare.27.11.2642.
  9. Ahmad Sharoni SK, Minhat HS, Mohd Zulkefli NA, et al. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: A systematic review. Int J Older People Nurs. 2016; 11(3):214-239. doi: 10.1111/opn.12112. 
  10. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293:217-228. doi: 10.1001/jama.293.2.217.
  11. World Health Organization. Falls. [Internet] 2021. [cited March 2022]. Available from  https://www.who.int/news-room/fact-sheets/detail/falls
  12. Futrell EE, Roberts D, Toole E. The effects of intrinsic foot muscle strengthening on functional mobility in older adults: A systematic review. J Am Geriatr Soc. 2021; 70:531-540. doi: 10.1111/jgs.17541.   
  13. Wylie G, Torrens C, Campbell P, et al. Podiatry interventions to prevent falls in older people: A systematic review and meta-analysis. Age Ageing. 2019; 48(3):327-336. doi: 10.1093/ageing/afy189.

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