On 29 Apr, 2023, Seniors Today hosted the Health Live Weekly Health Live Webinar with Dr
Abhishek Kini, an orthopaedic surgeon who spoke on and answered questions about Foot and Ankle Care for Seniors.
Dr. Abhishek Kini is Consultant – Foot and Ankle Reconstruction & Sports Medicine, and Orthopaedic Surgeon at the Sir H N Reliance Foundation Hospital and Research Centre, Mumbai.
Dr Kini completed his MBBS from Krishna Institute of Medical Sciences, MUHS in 2007 and
postgraduate training for DNB in Orthopaedics and Traumatology at Tejasvini Hospital and SSIOT, Mangalore. He further trained at the Chelsea and Westminster Hospital, Cormwell Hospital and Hampshire Clinic, UK as a Fellow in Foot and Ankle reconstruction. He underwent specialised training as a Fellow in High Osteotomy. He trained at the Marien-hospital, Dusseldorf, Germany and as a Fellow in Foot and Ankle Arthroscopy at the Academic Medical Centre, University of Amsterdam, Netherlands.
Dr Kini holds memberships of Indian Orthopaedic Association, Indian Foot and Ankle society, Bombay Orthopaedic Society, AO Trauma India and AO Spine India. He is a faculty for Indian Foot and ankle society (IIFAS) and undertakes educational activities around the country. He has authored 13 indexed publications and delivered more than 30 presentations at orthopaedic conferences.
Fall, in the urban lifestyle is an important predictor of morbidity, says Dr Abhishek. Mortality, due to cardiac arrest or any other medical condition is when we know that the patient is already heavy abode. But morbidity, when the patient is bed bound for days, weeks or months is something that is inner hands and it is also the arena where we can make a change. Which is why fall prevention is extremely important.
To keep your feet and ankle well protected, it is important that you choose the right footwear.
There is no such thing as an ideal footwear. It all depends on your foot type, activity, demand.
The main function of the footwear is-
– Protection from our external environment
– Additional stability to our feet and helping in the balance of the body
– Helps in overcoming certain foot disabilities, such as foot from, polio, flat foot. We can modify
their footwear to accommodate their feet.
– Helps in achieving our goals- for those who are adventurous, like to walk/ hike/ run a marathon.
Such individuals can get customised shoes which can help them in achieving their goal and help them in walking/ running better.
The pros and cons to the different footwear are discussed below, to help you make an informed
choice.
• Slippers:
Easiest to wear and buy
They are dangerous because they not have/ provide any support
They do not provide any protection to the upper part of the foot/ dorsum
Prone to ankle injuries, toe injuries, toe curling
Dr Kini does not recommend them
• Flip flop slippers:
They are comfortable but can bring agony to your feet
They do not provide a lit of stability or protection
They are better than slippers, but they too do not provide any arch support for us, heel pain, twisting injuries are common.
• Sandals/ Platforms/ Wedges:
They are slightly better than the above mentioned options
They are comfortable and functional
They provide better stability and protection with the strap that comes around it
They too do not have arch support, it can be added to the footwear by adding an in-sole to it Wedges with their limited support can cause twisting injuries to the ladies
• Leather shoes/ Oxford shoes:
They are the most commonly worn formal footwear
They are comfortable depending on the fit
They provide a lot more support and protection
They also do not come with an arch support. Adding it to the shoes, can sometimes make the shoes at little stuffy and can cause foot pain, heel pain, foot cramping, mid foot ache.
• Sports shoes/ Sneakers:
Comfortable to wear
They give a good mix of form and function
Provide good protection
They can be easily customised with arch support
• High heels/ Stilettos:
These are fashion wear and not comfort wear
They are aesthetic but they do not give protection to the feet, stability or comfort
They can cause shoes bites, bunions, toes curling inwards, twisting of ankle, posture concerns
As the protection increases, the comfort decreases. The most comfortable shoes are not always the most protective.
Nowadays, we also have customised footwear. They are not aesthetic but are functional. These can be extremely helpful in people with polio, nerve weaknesses, high arched foot, flat foot, people prone to ankle injuries, diabetic foot, etc.
Heel pain is very commonly seen in our population. It is also commonly misdiagnosed as plater spurs.
Heel pain can be of 2 types:
1. Infra calcaneal- below the heel
Plantar fasciitis is the most common cause for infra calcaneum type of heel pain. This is caused
due to irritation of the plantar heel spurs.
They are common early during the morning, following initiation of movement especially after a
period of rest. It is associated with calf pain and calf tightness.
More than 50% of patients above the age of 50 years have heel spurs. These heel spurs are not
pathological. They originate at the muscle and not at the fascia.
Physiotherapy is the easiest way to treat it. This involves a lot of stretching.
In rare cases you might require a night splint
Use a soft cushioned footwear
Rarely, you might require ink. Corticosteroid
Surgery- if indicated
Other causes include- heel fat pad atrophy, seen in the elderly
Calcaneum stress fracture following a fall, exertion
Nerve impingement
Rheumatoid arthritis
2. Retro calcaneal- behind the heel
Bony deformity/ bump behind the heel
Commonly seen in the elderly who have had long standing jobs in their earlier years
Treatment includes physiotherapy, stretching
Wearing soft sole, open counter shoes with heel rings
Surgery- when indicated
Flat foot is very commonly seen in our population due to the flexibility/ laxity of the ligament that’s
seen in our population.
It is commonly maltreated
Adult acquired flat foot-
The arch height is variable in different people just like our height
Low arch height is not always pathological
Any flat foot- abnormal loss of arch, with pain is pathological. Pain causes the pathology
This causes deformity in the hind foot and the forefoot.
The hind foot moves outwards and the front of the foot moves/ turns inward.
If the deformity happens in 3- dimension, you need to identify treat and correct each and every
component of the deformity.
The patients usually present with pain on the inner side of the foot, this where the tendon of
fibularis posterior comes and attaches, thus causing degeneration, stretching and pain. The
arthritis and the impingement of the outer side of the foot causes the deformity.
When you are asking for an X-ray of the foot, you need to ask for a standing X ray to get a better
idea about the deformity of the foot.
The deformity has grades:
1. Grade 1: does not require any intervention. All that is needed is arch support and
physiotherapy
2. Grade 2: this is the stage where we can make a difference with the help of a reconstructive
surgery where the arch of the foot is normalised. Each and every component of the deformity is
corrected.
3. Grade 3: the deformity is fixed in addition to arthritis. These patients require corrective fusion
4. Grade 4: ankle arthritis is also present. An ankle replacement surgery is also done, to preserve
the moment and function of the ankle and foot.
