Full length articleBiomechanical approach in facilitating long-distance walking of elderly people using footwear modifications
Introduction
Improving health and preventing disease in the elderly population are among the top priorities in health-care policy of many governments. Evidence suggests that regular physical activity can reduce fall-related injuries [1], cognitive declination [2] and mortality rates [3] among older adults. Long-distance walking is a safe and convenient way of exercise for older people [4], which can easily be integrated into their daily routine [1]. Walking for over an hour per day was found to be able to reduce the risk of mortality [3] and disability [5] of the elders. However, walking ability clearly declines with advancing age [6]. A meta-analysis of 42 studies indicated that adults aged over 65 walked only an average of about 3000 steps per day [7], less than a total 30 min of walking per day.
Muscle weakening and fatigue could be the major reasons for the difficulty faced by the healthy elders walking long distances. Over the age of 60, muscle strength decreases by an average of 3% per year [8]. In addition, older people have even greater relative force loss than young adults and slower return to resting levels, after the muscles become fatigued [9]. Plantarflexors were found to be more susceptible to fatigue than other lower-limb muscles [10]. Fatigued plantarflexors could lower the abilities of shock absorption and motion generation [10], which potentially affect the ability of long-distance walking.
Discomfort and pain at the plantar surface of the foot could also account for the lack of walking among elderly people. The pain may not occur at the beginning of the day, but it may be perceived after some walking [11]. This could be explained by the hysteresis of the soft tissue at the plantar foot reducing its stiffness upon repeated loading [12]. A previous study suggested that after a long-distance walk the gait of the young adults changed to reduce loading at the forefoot which could be a response of avoiding pain and discomfort [13]. There is a lack of studies investigating the changes in level of pain at the lower-limb upon long-distance walking of older people. However, it was documented that older people have lower shock absorption ability of the soft tissue at the plantar foot [14], potentially bringing them more susceptible to foot pain upon repeated loading at the feet.
Modifying the forces applied to the lower limbs might address the biomechanical problems. Traditionally, orthopedic insoles are used to treat patients with foot pain. Silicone insoles were found effective in relieving foot pain in patients [15], inducing a significant reduction in peak plantar pressure [16] and soft tissue strain [17]. In addition, a wedge lifting the heel has been used to reduce the stretching of plantarflexors during lomoction, reducing further strain and fatigue [18]. Advantages of heel lifting in amputee population included a reduction in power generation of plantarflexors and a facilitation to walk longer distances [19]. Footwear modification has been used with success to treat a variety of foot problems [[15], [16], [17], [18]]. However, little attempt has been made to use such approach to facilitate long-distance walking of older people.
This study examined whether modification of shoe inserts, with the use of a full-length silicone insole and a heel lift, could facilitate long distance walking of the elderly. Gait tests measuring spatial–temporal, kinetic and kinematic parameters as well as evaluation of perceived level of physical exertion, fatigue and pain were conducted in the same group of older adults who walk for one hour with and without the shoe inserts modifications. It was hypothesized that such footwear modifications reduced pain and fatigue, producing noticeable improvements in perceived exertion and gait patterns of older people walking long distances.
Section snippets
Subjects
A convenience sample of 15 elderly subjects (age > 65 years) participated in this study. Subjects should be aged over 65, living in a community-based setting, and capable of ambulation without any walking aids. They should not have a history of fall in the past year, cardiovascular or pulmonary diseases, diabetes, cancer, uncontrolled hypertension. They should not have any lower-limb pain or deformities that affect walking, as assessed by a certified orthotist following standard procedures
Results
All fifteen healthy elderly subjects (11 males and 4 females, aged 71.6 ± 6.1 years, height 162.8 ± 7.4 cm, and weight 63.3 ± 6.0 Kg) completed two walking sessions of: 1) wearing the original insoles of the standardized shoes, and 2) wearing the prescribed insoles and the standardized shoes on both feet.
No significant differences were found in scores on Borg’s (assessing perceived level of physical exertion) and Visual Analogue Scale scales (assessing perceived level of pain and fatigue) at
Discussion
Heel lifts and silicone insoles are commonly used to relieve plantar foot pain and reduce the strain on plantarflexors, respectively [16]. This study applied a combination of both aiming at facilitating long-distance walk of elderly people. Upon using the heel lifts and silicone insoles, improvements in perceived level of fatigue and pain were observed. Such improvements could explain the significant differences in changes in gait patterns upon walking long distances of the same group of
Conclusions
Heel lifts and silicone insoles are generally used to relieve plantar pain and reduce strain of plantar flexors in patients. This study showed they could significantly improve subjective perception of physical exertion, pain and fatigue of elderly people, who did not have obvious lower-limb problems, performing long-distance walking. Objective gait anaylsis showed that without using the prescribed insoles, long-distance walking produced significant reductions in stance time, vertical ground
Funding source
This work was supported by The Health and Medical Research Fund of Hong Kong SAR [grant number: HMRF11122231].
Conflicts of interest
None.
Acknowledgments
The authors would like to thank all the subjects who participated in the study.
References (30)
- et al.
Walking one hour or more per day prevented mortality among older persons: results from ilSIRENTE study
Preventive Med.
(2008) - et al.
Dynamic loading on the human musculoskeletal system—effect of fatigue
Clin. Biomech.
(1998) - et al.
Standing and very slow walking: foot pain-pressure threshold, subjective pain experience and work activity
Appl. Ergon.
(2001) - et al.
A novel ultrasound indentation system for measuring biomechanical properties of in vivo soft tissue
Ultrasound Med. Biol.
(2003) - et al.
Effects of aging on the plantar soft tissue properties under the metatarsal heads at different impact velocities
Ultrasound Med. Biol.
(2005) - et al.
A pilot study to assess the effectiveness of orthotic insoles on the reduction of plantar soft tissue strain
Clin. Biomech.
(2013) - et al.
Walking speed influences on gait cycle variability
Gait Posture
(2007) - et al.
A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise
Chest J.
(1999) - et al.
Joint-specific power production and fatigue during maximal cycling
J. Biomech.
(2009) - et al.
Walking–the first steps in cardiovascular disease prevention
Curr. Opin. Cardiol.
(2010)
A prospective study of physical activity and cognitive decline in elderly women: women who walk
Arch. Intern. Med.
Habitual walking and its correlation to better physical function: implications for prevention of physical disability in older persons
J. Gerontol. Ser. A
Physical activity Is associated with incident disability in community‐based older persons
J. Am. Geriatrics Soc.
11 the etiology and reversibility of muscle dysfunction in the aged
J. Gerontol.
Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis
Phys Ther.
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These two authors contributed equally to this work.