PT on the Net Research

Barefoot Baby Boomers: Reducing Falls with Barefoot Science



 

Learning Objectives:

  1. Learn why baby boomers are at such an increased risk of falls
  2. Explore the benefit of barefoot training in general and as it relates to seniors
  3. Review the negative impact orthopedic footwear has on balance, proprioception and fall risk
  4. Explore how to introduce barefoot training into a senior fitness program

According to the CDC, one in three older adults (age 65 and older) fall each year, with an astounding 2.3 million fall-related injuries treated in U.S. emergency rooms in 2010. If these statistics are not alarming enough, they are only going to increase as the U.S. population enters its largest growth within the 65 and older category. In fact, statisticians project that in 2030 one in five American adults will be over age 65. 

Growth of an Aging Population

Blame it on the end of World War II and the baby boom between 1946 and 1964. As the Baby Boom began to taper off, over 76 million babies were born – making up 40% of the U.S. population. So how will this increasing age of our population affect healthcare, fitness and economics? Greatly!  

In 2010 alone the CDC reported fall-related medical costs to be over $30 billion. With numbers like this, health and fitness professionals are going to play a pivotal role in the wellness and reduction of falls in this aging population. 

Why Falls Are So Prevalent

Although falls are multi-factorial and dependent on both intrinsic and extrinsic risk factors, one such area that studies have shown greatly impacts fall risk is footwear and the dampening of proprioceptive input. As a strong advocate for the benefits of barefoot training, I am often told, “this information would be perfect for seniors and fall risk.” And I agree!

Let’s take a look at the evidence of why barefoot science would benefit the Baby Boomers...

Studies have shown that as we age the plantar mechanoceptors of the foot begin to degenerate. Robbins et al. demonstrated that vibratory threshold increases 20% by age 50 and up to 75% by age 80. The greater the threshold, the more stimuli required to create a response. Another study by Robbins et al. demonstrated that plantar receptors actually begin to lose density as we age. His 1993 study demonstrated that Meissner’s Corpuscle (which detects light touch) changes in density from 69 mm2 at age 3 to 8mm2 at age 80!

So we know there is a decline in plantar proprioceptors. But what else may be contributing to falls in seniors? If you guessed “their footwear,” you are correct!

The Negative Impact of Orthopedic Footwear

With the popularity of barefoot running, we are probably all familiar with the downsides of footwear on plantar proprioceptive input.  Numerous studies have shown that footwear alters the foot’s perception of impact forces and foot position sense. 

Again we go to a study by Robbins et al. to see that as footwear sole thickness increases, foot position sense and stability decreases. In fact, his 1998 study found that footwear increased sway velocity by an astounding 300%. What Robbins et al. also demonstrated was that as the firmness of the sole increases, so does the foot position sense and stability.

If you look at orthopedic shoes, most have thick soles and moldable insoles to provide extra cushion and comfort. But are these orthopedic shoes compromising stability for comfort? Unfortunately, yes. 

The Role of Barefoot Training in Fall Reduction

So with this age-related degeneration of plantar proprioceptors, it really is no wonder that there are increased falls seen in the aging population. However, do these Baby Boomers have to fall victim to their aging nervous system? Perhaps not – this is where we look at the benefits of barefoot training and the reduction of falls.

Benefit #1: Neuroplasticity

Through barefoot training and frequent barefoot stimulation, this population will be able to decrease the threshold of their plantar proprioceptors. This concept of stimulation driving nerve growth is referred to as neuroplasticity. 

Studies by Ahlskog et al. have demonstrated that exercise has a neuroprotective effect and that challenging the nervous system with exercise will increase nerve growth factor. 

Benefit #2: Foot to core sequencing

Another benefit of barefoot training is the enhancement of co-activation patterns between the feet and the core. Janda et al. has shown that activation of the intrinsic foot muscles (namely the abductor hallucis) leads to a co-activation of the deep hip rotators and pelvic floor.

By creating a stable base between the foot and lumbopelvic hip complex, seniors will be able to improve the muscular strength needed when walking and doing single-leg maneuvers. 

Benefit #3: Improved efficiency

Efficiency is key to the ease with which we move. With each step we take the foot intrinsics and plantar skin receptors play a role in detecting impact forces and initiating the loading response. The better we are able to load and unload impact forces, the more efficient our body will move and less effort will be expended for activities of daily living. Seniors will begin to feel more confident when movement feels easier to them.  

Programming for Fall Reduction

Some tips as you begin to introduce barefoot training to seniors and a fall reduction program include:

  • Avoid impact exercises

The great thing about barefoot training is that you still gain the plantar stimulation and benefits without high impact forces. Simply standing on one leg, barefoot is still challenging plantar proprioceptors and stimulating skin stretch and foot position sense.

  • Integrate short foot exercises

I strongly believe that the foundation of all barefoot programs is the short foot exercise. The benefits of short foot are vast and include improved foot posture, intrinsic muscle strengthening and co-activation patterns into the deep hip stabilizers - all of which translates to improved stability during ambulation.

  • Integrate balance exercises

A majority of falls occur during locomotion; which means fall reduction programs need to focus on the primarily closed-chain position we are in during ambulation - the single-leg stance. Teaching single-leg foot position sense is critical to the reduction of falls. You can integrate simple balance exercises with head turns, gentle knee flexions (single leg squat teasers) and bowler's squats teasers. 

  • Be creative with plantar receptors

When integrating barefoot stimulation in a fall reduction program, be creative with the types of plantar stimulation you integrate. Remember, plantar receptors are sensitive to skin stretch, vibrations, light touch and texture. All receptors are at risk of degeneration, which means all need to be stimulated and challenged.    

As we continuously explore the benefits of barefoot science it is important to share the vast benefits with the broadest scope of individuals. From children to seniors, all can benefit from plantar stimulation and the co-activation patterns between the foot and hip.  

Are you barefoot strong? 

References:

Ahlskog, J. et al. (2011). Does vigorous exercise have a neuroprotective effect on Parkinson disease? Neurology. 77(3): 288-294.

Janda et al. Sensory motor stimulation. In Liebenson C (ed) Rehabilitation of the Spine. Williams & Wilkins: Baltimore. 319-328

Robbins, et al. (1997). Foot Position Awareness: The Effect of Footwear on Instability, Excessive Impact and Ankle Spraining. Phy Rehab Med, 9(1): 53-74

Robbins, et al. (1995). Proprioception and Stability: Foot Position Awareness as a Function of Age and Footwear. Age and Ageing. 24:67-72.

Robbins, et al. (1993). Protective Sensation of the Plantar Aspect of the Foot. Foot & Ankle. 14(6):347-352