SLR - October 2022 - Joseph Kim, DPM
Reference: Pol, F., Baharlouei, H., Taheri, A., Menz, H. B., & Forghany, S. (2021). Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies. Gait & posture, 89, 14–24. https://doi.org/10.1016/j.gaitpost.2021.06.018
Level of Evidence: I
Reviewed By: Joseph Kim, DPM
Residency Program: Geisinger Community Medical Center
Podiatric Relevance: With a continually aging patient population, it is imperative to understand and recognize the aging-related deterioration and changes in foot and ankle biomechanics in order to provide tailored conservative and surgical treatments for both young and older adults. Although there is a great depth of understanding of normal and abnormal biomechanics, comprehension of gradual biomechanics dysfunction in the aging population is less understood. This study performed a systemic review and meta-analysis to examine the biomechanical gait difference of the foot and ankle between young and older adults.
Methods: This systemic review and meta-analysis included the studies that measured the three-dimensional foot and ankle kinematics, kinetic and plantar pressure of a healthy older adult who is more than sixty-five years old and a healthy younger adult who is from eighteen to sixty-five years old from inception to April 2019. Various electronic databases were reviewed, and studies that contained the participants with neuromuscular disorders were excluded. The quality of studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Results: The qualified studies showed that older adults had significantly less gait velocity compared to young adults when walking at their preferred speed. And the meta-analysis indicated that there were no significant differences in ankle joint dorsiflexion angle at midstance, peak forces in the total plantar surface of the foot, and ankle power absorption observed. Studies showed that older adults had significantly less ankle joint plantar flexion at push-off observed at preferred speed and walking at faster speed.
Conclusions: The author concluded that older adults have reduced ankle joint plantarflexion and ankle joint power generation. As a patient experiences reduced muscle mass with aging, it is normal to undergo loss of plantar flexion in the foot and ankle, which is needed the most during midstance and propulsion. Though most studies included were poor to quality and single segment design rather than multi-segment design and measured only sagittal plane, not considering transverse or frontal deformity, the conservative and surgical management for the older patient can be tailored to assist propulsion and plantar flexion of ankle with less concern for ankle range of motion.