The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.
Impaired cognition, weakness, and visual-perceptual deficits were the most common problems in this study population. Our study supports the benefits of comprehensive and interdisciplinary rehabilitation for patients with primary as well as metastatic brain tumors.
Fifty feet and ankles in 47 patients (three bilateral) (26 women and 21 men; average age, 44+/-15 years) were treated for chronic foot and ankle pain (duration: minimum, three months; average, 27+/-35 months; range, three to 132 months). Evaluation included detailed history, physical examination, and radiography. Initial treatment consisted of immobilization (full weight-bearing) using a removable walking brace (23.5 hours per day, including in bed at night), with standing and walking limited to activities of daily living. Follow-up evaluation included assessment of pain response and repeat physical examination. There was a history of trauma in 32 (64%) feet and ankles. Braces (pneumatic in 31 [62%] and double-upright in 19 [38%] feet and ankles) immobilized the ankle in neutral position and included a rigid rocker sole. After an average of 13+/-10 weeks (range, three to 50 weeks) of brace use, pain symptoms were improved in 35 (70%), unchanged in 11 (22%), and worse in four (8%) feet and ankles. Physical examination was improved in 43 (86%) feet and ankles, unchanged in six (12%) feet and ankles, and worse in one (2%) foot and ankle. In all 50 feet and ankles, the average number of abnormal physical findings decreased from initial (6+/-3 abnormal physical findings) to follow-up evaluation (3+/-3 abnormal physical findings) (P < 0.001). The average number of diagnoses per foot and ankle decreased from initial (4+/-1 diagnoses per foot and ankle) to follow-up evaluation (2+/-1 diagnoses per foot and ankle) (P < 0.0001). Improvement of pain was independent of duration of pre-existing symptoms, patient age, gender, or type of brace used. In summary, immobilization with a removable walking brace may improve chronic foot and ankle pain and localize the primary source of symptoms.
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